Migraine treatment
Treatment for migraine can be aimed at either preventing the migraine from developing ('preventative treatment') or at stopping a migraine that has already started ('abortive treatment').
Preventative treatment
The four principal classes of medications that are effective for migraine prevention are:
• Antiepileptics (medications often used to control seizures)
• Antidepressants (medications often used to treat depression) and
• Antihypertensives (medications often used to treat high blood pressure)
• Muscle-relaxing injections (medications often used cosmetically to treat wrinkles)
Antiepileptics are generally well tolerated, however, they can cause weight gain, hair loss, and polycystic ovary disease; therefore may not be ideal for young female patients who have a tendency to gain weight.
Antidepressants may be used in people who cannot tolerate the side effects of the antiepileptic medications.
Antihypertensives may be useful in treating migraine in patients who are generally young, fit and prone to anxiety. They may not be the ideal choice for elderly patients or patients with depression, thyroid problems, or diabetes.
Muscle-relaxing injections may be beneficial in patients with intractable, chronic migraine that has failed to respond to at least 3 conventional preventive medications. The injections are administered to the scalp and temple. This treatment has been shown to reduce the frequency and severity of migraine attacks for 2-3 months after the injections are given.
Abortive treatment
Many medications can be used to treat migraine once it has started. The choice for an individual patient depends on the severity of the attacks, associated symptoms such as nausea and vomiting, comorbid problems, and the patient's response to previous treatments. Acute treatment is most effective when given within 15 minutes of pain onset and when pain is mild.
Pain relief used in moderate migraine includes paracetamol and non-steroidal anti-inflammatory drugs. For more severe pain, 5-hydroxytryptamine-1 (5-HT1) agonists (triptans) and/or strong opioid analgesics are used, either alone or in combination with dopamine antagonists (e.g. prochlorperazine). The use of these medications to abort migraine must be carefully managed, and must be limited to 2-3 days a week to prevent development of a rebound headache phenomenon.
Get frequent migraines? Act now!
If you or a member of your family suffer from frequent migraines then we may be able to help. Simply contact us to book an appointment for assessment and treatment at one of our clinics (or if you have any questions).
