Stopping Migraine Headaches: The ABCs of Treatment
More than 90% of people with migraines experience some disability related to their headaches. If you're one of them, you know how high a price you pay: missing school, work, and enjoyable activities, not to mention enduring hours or days of incapacitating pain.
Fortunately, there are effective ways to abort a migraine. The first step—if you haven't already done so—is to have your migraines diagnosed by a doctor. Less than 60% of people have. Some effective abortive treatments are available only by prescription, so you may be enduring needless pain by not seeing a doctor.
Start keeping a headache journal. Make sure to identify the activities you miss because of migraines. Doctors are more likely to prescribe specific and effective treatments if they're aware that your headaches prevent you from continuing your typical activities.
Effective strategies for treating migraines vary from person to person. You might need to try a variety of techniques before you find the ones that work best for you. Many people treat migraines in a ‘step-wise' manner, beginning with non-medicinal strategies and progressing to medications if their pain isn't relieved.
(The Information below about over-the-counter and prescription medications comes from clinical guidelines developed by the US Headache Consortium, a collaboration between several medical organizations.)
Lying down in a quiet, dark room can reduce pain, since migraines are often accompanied by intense sensitivity to light and noise. Relaxation techniques, such as listening to meditation tapes and deep breathing, can help you fall asleep, which can interrupt the migraine cycle. Some people find that cold packs applied to the head, face, or neck help, too .
Feverfew, or bachelor's button, has become increasingly popular as a treatment for migraine. Most people suggest that it's best used on a regular basis to prevent migraines, as opposed to being a reliable abortive treatment.
Over-the-counter pain medications
NSAIDs, which stands for non-steroidal anti-inflammatory drugs, includes aspirin, ibuprofen, and naproxen. All are effective in treating migraine headaches. Effervescent aspirin is a particularly effective form for controlling pain in migraines. Some people also find that consuming caffeine—in chocolate, coffee, or cola—reduces the intensity of their headache.
Combination over-the-counter medications that contain acetaminophen (known as paracetamol outside the US), aspirin, and caffeine are also effective at aborting migraines. Some evidence suggests that this combination of drugs is more effective than a prescription triptan-type medication at aborting the pain of migraine.
NSAIDs have significant side effects, including stomach upset and potential kidney damage. Frequent use of can also result in ‘rebound' headaches. Guidelines suggest that the use of NSAIDs shouldn't be used for headache pain more than twice a week.
This class of medications binds to serotonin receptors in the blood vessels of the brain, causing them to constrict and limiting the release of inflammatory substances. Triptan medications that the US Headache Consortium recommends for first-line migraine treatment include:
naratriptan (Amerge®, Naramig®)
zolmitriptan (Zomig®), and
Newer triptans are also available, including eletriptan (Relpax®), almotriptan (Axert®, Almogran®), and frovatriptan (Frova®, Migard®). Studies evaluating their effectiveness are still in the works; as this data becomes available, these medications can be expected to join the other triptans on the Headache Consortium's ‘A' list.
Triptans are available in the US by prescription only and are substantially more expensive than either over-the-counter medications or ergot drugs. Frequent use of triptans can also cause rebound headaches, and side effects can include flushing of the face, tingling, dizziness, or a sudden feeling of warmth
Ergotamine-containing drugs, such as Cafergot®, have a long history of use in treating migraines. Ergotamine also binds to serotonin receptor sites in the blood vessels, causing constriction. Some experts suggest that ergot drugs should be given as a rectal suppository, because absorption is better.
Ergotamine-containing drugs are available by prescription only. Frequent use can cause rebound headaches, and side effects can include upset stomach or vomiting.