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Migrane


Most migraines sufferers can manage mild-to-moderate attacks at home with the following strategies:

Using a cold compress to the area of pain

Resting with pillows comfortably supporting the head or neck

Resting in a dark, quiet room with no strong smells

Withdrawing from stressful surroundings

Sleeping

Drinking a moderate amount of caffeine

Trying certain over-the-counter headache medications

  • Non-steroidal anti-inflammatory drugs (NSAIDS): These include medications like aspirin, ibuprofen (Motrin, Advil), naproxen (Naprosyn, Aleve), and ketoprofen (Orudis).  Stomach ulcers and bleeding are serious potential side effects.  This type of medication should not be taken by anyone with a history of stomach bleeding.
  • Acetaminophen (Tylenol): Acetaminophen may be safely taken with NSAIDs for an additive effect.  Taking acetaminophen by itself is usually safe, even with a history of stomach ulcers or bleeding.  Acetaminophen should not be taken if the migraine sufferer has liver problems or has 3 or more alcohol drinks a day.
  • Combination medications: Some over-the-counter pain relievers have been approved for use with migraine.  These include Excedrin Migraine, which contains acetaminophen and aspirin combined with caffeine.  A similar effect can be achieved by taking 2 aspirin or acetaminophen tablets with a cup of black coffee.

Medical Treatment

Despite medical advances, migraines can be difficult to treat.  About half of migraine suffers stop seeking medical care for their headaches because they are dissatisfied with therapy.

Migraines can be treated with 2 approaches: abortive and preventive.

  • Abortive: The goal of abortive therapy is to prevent a migraine attack or to stop it once it starts.  The prescribed medications stop a headache during its prodrome stage (during the aura) or once it has begun and may be taken as needed.  Some can be administered as a self-injection into the thigh; others, as a wafer that melts on the tongue.  These forms of medication are especially useful for people who have nausea and vomiting during a migraine, and they work quickly.

    Abortive treatment medications include the triptans, a group of drugs that specifically target the brain chemical serotonin.  They are all very similar in their action and chemical structure.  The triptans are used only to treat headache pain and do not relieve other forms of pain.
    • Sumatriptan (Imitrex)
    • Zolmitriptan (Zomig)
    • Eletriptan (Relpax)
    • Naratriptan (Amerge, Naramig)
    • Rizatriptan (Maxalt)
    • Frovatriptan (Frova)
    • Almotriptan (Axert)

The following drugs also affect serotonin, but they affect other brain chemicals also.  Occasionally, one of these drugs works when a triptan does not. 

    • Ergotamine tartrate (Cafergot)
    • Dihydroergotamine (D.H.E.  45 Injection, Migranal Nasal Spray)
    • Acetaminophen-isometheptene-dichloralphenazone (Midrin)

The following drugs are mainly used for nausea, but they sometimes have an abortive or preventive effect on headaches:

    • Prochlorperazine (Compazine)
    • Promethazine (Phenergan)

The next drugs are weak narcotic drugs.  They are not specific for migraine, but they can help relieve almost any kind of pain.  Since they are habit forming, they are less desirable than the specific headache drugs listed above.  These drugs should be used primarily as a "backup" for the occasions when a specific drug does not work.

    • Butalbital compound (Fioricet, Fiorinal)
    • Acetaminophen and codeine (Tylenol With codeine)
  • Preventive: This type of treatment is considered if a migraine sufferer has more than 1 migraine per week.  The goal is to lessen the frequency and severity of the migraine attacks.  Medication to prevent a migraine can be taken daily.  Preventive treatment medications include the following:
    • Medications used to treat high blood pressure - beta-blockers (propranolol [Inderal]), calcium-channel blockers (verapamil [Covera])
    • Antidepressants - Amitriptyline (Elavil), nortriptyline (Pamelor)
    • Antiseizure medications - Gabapentin (Neurontin), valproic acid (Depakote), topiramate (Topamax)
    • Some antihistamines and anti-allergy drugs, including diphenhydramine (Benadryl) and cyproheptadine (Periactin)

Many foods may trigger migraines and avoiding your food triggers may greatly lessen how often you suffer with a migraine.  Chocolate is the most common trigger for migraines.  Suddenly decreasing the amount of caffeine in your diet can also bring on a migraines.  Alcohol, cheeses, citrus fruit, and hot dogs may all trigger migraines in a person sensitive to them.

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