Migraine Medicine: What a patient should know

Migraine Medications Introduction

Migraines can be incredibly debilitating, affecting millions of people worldwide. If you’re one of the many who suffer from these throbbing headaches, you’re not alone. Migraine headaches are one of the most common headaches, which start from one side of the head or the eye and then spread all over. They may be accompanied by nausea, vomiting, neurological symptoms like tingling, paraesthesia, numbness, weakness, and other gastrointestinal symptoms. Migraine medications depends upon the correct diagnosis of patient-specific factors such as age, comorbidities, frequency of headaches, association of aura symptoms, and occupation. In this blog, we’ll explore different migraine medications in simple language so you can make informed decisions about your treatment options.

Types of Migraine Medication

Medications are divided into two categories: 

acute and abortive medication and preventive or prophylactic medications. Both play a specific and considerable role in stopping and preventing migraine headaches.

Acute Migraine Medication

These are taken when you already have a migraine attack to relieve the pain and associated symptoms.

•  Over-the-counter (OTC) Pain Relievers

These belong to the category of NSAIDs, which are painkillers and include drugs like ibuprofen, aspirin, or naproxen. These drugs can help alleviate mild to moderate migraine pain. However, they may not work for everyone and should be used cautiously to avoid overuse. If taken for more than ten days in a month, they may result in what is known as medication overuse headaches.

• Triptans

These drugs work on serotonin receptors in the brain nerves and abort the pain transmission pathways. They work by narrowing blood vessels in the brain and reducing pain signals. Commonly used triptans are sumatriptan, rizatriptan, and eletriptan. Triptans can be very effective but should be used under a doctor’s guidance. These medicines are usually avoided in patients with cardiovascular risk factors and should be taken only under supervision. Other administration forms, like subcutaneous injections and intranasal sprays, are also available for patients with intense nausea and headaches who cannot accept oral medication.

Preventive Migraine Medication

This class of medication is used for patients with frequent headaches and helps prevent the onset of headaches. These are taken daily and are divided into the following categories:

• Tricyclic compounds and neurotransmitter modulators

Drugs like amitriptyline or venlafaxine can help prevent migraines. They work by altering the brain’s chemical balance. These drugs are helpful in many patients who may have underlying anxiety, psychiatric disorders, or depression.

•  Beta-Blockers

Medications like propranolol are often used to manage migraines. They help relax blood vessels and reduce the frequency of attacks. These drugs have been well-studied and considered safe for most patients. Caution is exercised for patients with asthma, breathing problems, thyroid diseases, and depression.

•  Topiramate or valproate

Drugs like topiramate or valproate may be prescribed for migraine prevention. They affect the brain’s electrical activity and can be effective for some individuals. These drugs may cause cognitive slowing and weight gain (especially valproate). Caution is exercised for pregnant patients.

•  CGRP Inhibitors

These newer medications, such as erenumab and fremanezumab, target a protein involved in migraine development. They are often used when other preventive options fail.

Rescue Migraine Medication

In severe cases, the following drugs may be used. However, these may not be available in all countries, and their use may also be restricted due to abuse potential. It is best to discuss with your Neurologist about rescue medicines mentioned below.

•  Ergotamines

These are older medications that can be effective but have more side effects and are used less frequently today.

• Steroids:

In some cases, short-term use of steroids like prednisone and dexamethasone may be recommended to break a severe migraine cycle. Steroids have also been shown to prevent migraine relapse; however, their use remains limited due to multiple side effects.

Choosing the Right Migraine Medication

When choosing the migraine medication, it is essential to confirm the diagnosis. Elaborate history with recognition of migraine triggers is significant. Your doctor may recommend preventive Migraine medication if you have frequent and severe migraines. For occasional migraines, acute medications may be sufficient.

Medical History

Your overall health, other medical conditions, and current medications can influence which migraine medication is safest and most effective for you. Patients with diabetes, high blood pressure, hypothyroidism, and mental and psychiatric patients should discuss their conditions with the Neurologist. Pregnancy and lactation also determine the choice of drugs. 

As migraine medicines need to be used over an extended period, it is essential to discuss the side effects of these drugs. All drugs may not be suitable for you. Patients engaged in day jobs have different drug preferences than those who have night jobs. A detailed discussion with your Neurologist will help.

Cost and Accessibility

Insurance coverage and medication costs can vary. Check with your insurance provider and discuss affordable options with your doctor.

Patient Preferences

Your preferences and comfort with the chosen medication also matter. Some people prefer pills, while others may prefer injections or nasal sprays.

Conclusion

Migraines can be incredibly disruptive, but you don’t have to suffer in silence. With various migraine medication available, there are options to help you manage and prevent migraine attacks. Work closely with your Neurologist to find the proper medication or combination of treatments that best suit your needs. 

Remember, managing migraines is a journey, and what works for one person may not work for another. Stay patient and keep an open line of communication with your healthcare team to ensure you receive the best possible care for your migraine condition.