Migraine Treatment
We’re In a New Era of True & Specific Migraine Treatment
The past 26 years have been a long-awaited and welcome period for migraine treatment. In this regard, if you’re having migraines and you’re younger than about age 35, you’re lucky. You’re living during the age of modern migraine medications. Our understanding of migraines has greatly increased. Way back in 1993 the first “triptan”, sumatriptan (Imitrex®), became available in the U.S. Before that the migraine medications didn’t work very well and had some miserable side effects. Things like meperidine (Demerol®), propoxyphene (Darvon®), and others. In comparison, Imitrex® felt like a miracle drug to migraine sufferers. Since then we have many more triptans, and they’ve been on the market so long that inexpensive generic versions of many are available. Patients with migraines and doctors who treat them now have good and effective tools.
Migraine Treatment – The Triptans – Sumatriptan Was First
As we mentioned above, sumatriptan (Imitrex®) came out in 1993. This started a revolution in helping people with migraines. The other triptans are:
- rizatriptan (Maxalt®)
- almotriptan (Axert®)
- naratriptan (Amerge®) – slower onset, lasts longer in your body
- zolmitriptan (Zomig®)
- eletriptan (Relpax®)
- frovatriptan (Frova®) – slower onset, lasts longer in your body
- eletriptan (Relpax®)
Though all of these medications are triptans, they’re not all the same. Some work better for some people and others in the list work better for others. In fact, it’s often true that for any one person, one triptan works better than another. It’s a very individual matching of medicine and person. When a triptan works as it is supposed to, it will stop the headache, the nausea, and the general awful feeling of migraine syndrome. When it works a person can go from miserably ill to perky and well in a few hours.
We Need More and Better Meds for Migraine Treatment
Even with the medications we have now and all the ways we have of getting the medication into the person, like by mouth, nasal spray, injection, and skin patch, there are still people with migraines who are not helped. More needs to be done. New medications have become available, like the CGRP blockers (see more on these below), and more are being found.
A Reader Asks:
When I broke my arm at work, falling off a fork lift, the doctor gave me Vicodin for the pain. It worked great. My wife has painful migraines and some of the drugs they give her take hours to work. Why don’t they just give her Vicodin for the pain?
There are several good reasons why narcotic drugs like Vicodin®, Percocet®, and Demerol® don’t work for migraines. As we mention above, these were the drugs used in the “bad old days” before we had specific migraine medicines. We mention this a bit more below. The opioid-based (narcotic) drugs are of surprisingly little use for migraine. It’s far better to use CGRP blockers to keep from getting migraines at all, and then a triptan or a different CGRP blocker if a migraine comes despite the prevention. And, of course, narcotic drugs can be addictive, and with better treatments that have zero addiction potential, why take a chance on developing a drug problem.
It is Surprising How Little Plain Pain Medications Help Treat Migraine
Usually when someone has a pain you would first think about taking a pain medication. So it’s surprising that usual, regular medications for pain don’t help migraine pain much at all. Medications like ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin help somewhat on occasion. Many people with migraines like to take one of these with their triptan. One very popular combination is taking a naproxen with a triptan. (For years there was a medical rumor that naproxen had an effect on brain chemistry that helped the triptans, but this likely was a medical myth and not true. Naproxen is still quite a good medication, though.)
Not Even Opioid Narcotics Help Much
Narcotic pain killers are of surprisingly little use. Migraine is much more than headache pain. The nausea, vomiting, and general awful feeling are a big part of the problem in migraine attacks. Motrin, Aleve, and narcotics can cause stomach upset and nausea in some people, which makes them even less useful in migraine.
We All Want Fast-Acting Migraine Treatment
How quickly can one expect one or another form of a triptan to take your migraine away?
The tablets you take by mouth need about one to two hours to work completely. The two hour wait is more common. The fastest acting formulation is the shot, the injection under the skin, such as with sumatriptan injectable. The injection can work as fast as twenty minutes. Twenty minutes and, wow, headache, nausea, and yucky feeling are gone.
The nasal sprays are almost as fast as the injections, starting to work in as little as twenty or thirty minutes. Many people don’t like needles and find the nasal spray a much more to their liking. Also, it’s easier to use a nasal spray in places where you are around other people. There are some people, however, that don’t seem to mind giving themselves the injection and say that the nasal spray leaves a bad taste in their mouth
The skin patch is slower, taking about as long to start working as the tablet you take by mouth, that is, one to two hours.
You can get sumatriptan as a type of “injection” that does not use a needle. But in truth, it is “needle-free” but it is not pain-free. It does hurt. If you are really afraid of the needles themselves and the pain of an injection is not the problem, this needle-free Sumavel DosePro® might be a good choice for you.
We Can Block Migraines from Ever Starting
The “triptans” and the older medications were made to treat a migraine that you have now. That’s great, but now there’s a way to go one step better. Stop the damned migraine attacks before they even start.
CGRP Blockers Prevent Migraines
CGRP blockers are a whole new type of migraine medication. The first of this medicine family was FDA-approved in May, 2018. The CGRP blockers have to be given by injection. One of them is erenumab (Aimovig®). Erenumab is given by injection just a once-a-month, and then, no more migraines. That’s the plan, but, in fact, a person actually might have just a few mild migraines. Nothing’s perfect. As with any new medication, the CGRP blockers are expensive. If you’re a paid subscriber to the site you can see the specific page on these blockers.
Beta Blockers
The “beta blockers” have been around for a long time. They’re used to treat high blood pressure. And, in addition, people have been using beta blockers for migraine prevention for many years. For some individuals who get frequent severe migraines, beta blockers can lessen the severity and frequency of attacks. Among the beta blockers the three that are often used for migraine prevention are propranolol (Inderal®), metoprolol (Lopressor®), and timolol (Betimol®). They don’t help everyone, however, and some people say the beta blockers make them feel slow and tired, and that they’re useless to prevent migraines.
Other High Blood Pressure Medications Used to Prevent Migraines
There are other classes of medication that, while made to treat high blood pressure, might work to prevent migraines. They are the “calcium channel blockers” like verapamil (Calan®) and the “ACE-inhibitors” like lisinopril (Zestril®). That is, some migraine sufferers find calcium channel blockers or ACE inhibitors helpful to prevent migraines. As with the beta blockers, it’s not a guarantee.
Migraines Prevented by Medications for Depression
And, No, This Does Not Mean You’re Depressed
Most people who get migraines are not depressed (except maybe bummed that they get migraines). That said, it could be that as many as three out of ten people with migraines also have a medical depression. But depressed or not, there are medications for depression that are useful for preventing migraine headaches. Two examples are amitriptyline (Elavil®) and nortriptyline (Pamelor®), and there are others. It might seem odd that a medication for one problem would work for another. But it’s not that unusual. Brains are complicated organs and there is overlap among what goes wrong in the many ways a brain works. (See our FREE page on Your Mind & Your Brain for more on how complicated the brain/body connection is.)
There Are People with Migraines and Depression
Yes, there are people with migraines who also have depression. If a person has both it’s important for the depression to get separate and specific treatment. If the depression is not recognized and treated the migraines will likely be much worse and stay worse. After the depression is successfully treated it will be easier to treat the migraines. The migraines will respond better to migraine medications.
Medications Usually Used to Treat Seizures Can Help Prevent Migraines
Here’s another example of medications made to do one thing that later are found to help in other ways. There are two medications used to treat epilepsy, valproate (Depakote®) and topiramate (Topamax®), have been found to be helpful in preventing migraines. As with the medications for hypertension and for depression, we don’t know exactly how these medicines for epilepsy work to prevent migraine, but they do work, at least for some people.
Other Things You Can Do to Prevent Migraines
Don’t Trigger the Triggers
Often migraines are set off by foods, weather, or situations. For example, some individuals who get migraines realize that the things going on around them, things they do or foods they eat, or other changes around them, can trigger a migraine attack. If you haven’t noticed this yourself, you might try keeping a “headache diary” for awhile.
The Headache Diary
A headache diary is a daily record, or even several-times-a-day record, of foods eaten, the weather that day, social situations, and stressful events along with whether or not you had a migraine that day, and was it a bad headache or a mild one. Maybe you can discover what triggers your headaches. Bad weather predicted in the next few days, or changes from good weather to bad or vice versa, can trigger migraines. Hot dogs and other meats containing nitrites can trigger them. And other things like skipping meals, too much or too little coffee or tea, hard exercise, beer or wine, too much sleep, or being overly tired.
Stay Healthy
We’re not just saying this to keep you healthy, it’s really true. Some people eventually realize that when they are run down and tired they get more migraines. When life is going better, when they feel good and are full of energy, they get fewer headaches. So, do your best to take really good care of yourself in every way that you can. Put yourself first in getting what you need. Get enough sleep at night but don’t oversleep. Try to avoid stress, or, if you’re already stressed, try to lower the intensity. Rest and relax when you feel a headache might be coming on. Or, for that matter, rest and relax every chance you get. But, as we all know, there are times when life’s stress is unavoidable. For these tense times it might help to learn and practice some muscle relaxation exercises like yoga or meditation.
Alternate Medication Treatments
We can’t recommend these treatments because there’s too little good, hard information to do so. They’re not part of “Evidence-based Medicine”. But some people swear by them. And, if they help and don’t cause a problem, one of these “alternative medication” ideas might be on a list for you to think about. For example, Cognitive-Behavioral Therapy, biofeedback, message therapy, some vitamins or herbs (be careful in this area), and/or even acupuncture.
To Sum It Up Migraine Treatment
Help is available for both preventing migraines and treating a migraine you already have. It might, and probably will, take time and patience on your part to find all your best answers, but something will work to treat your painful attacks and to lessen the likelihood of future attacks.
Helpful links:
Clinical Trials.gov – recruiting and not yet recruiting studies of migraine in the U.S.
The Mayo Clinic on Migraine
American Migraine Foundation on Commonly Used Acute Migraine Treatments
FDA on Approving Aimovig (erenumab)
NIH Medline Plus magazine on migraine