Characterized by throbbing head pain associated with nausea, vomiting, and sensitivity to light and/or sound, migraine headaches affect nearly 30 million Americans and account for more than $13 billion in lost wages and impaired work performance, according to American Family Physician. Effective management of migraine headaches depends on a good patient-physician relationship, with ongoing investigation of possible migraine triggers and a comprehensive strategy to both treat and prevent migraines. Several types of medications are indicated in the treatment of acute migraine headache.
Over-the-Counter (OTC) Medication
Many mild to moderate migraines, if identified early, can be successfully treated with OTC medications such as acetaminophen (Tylenol), ibuprofen (Motrin), or naproxen sodium (Aleve). Excedrin, a combination of acetaminophen, aspirin, and caffeine, has also been effective in aborting a migraine attack, according to articles in American Family Physician, The New England Journal of Medicine, and The Archives of Internal Medicine.
The keys to successful OTC management include the prompt recognition of an impending migraine and the use of adequate drug dosages by the patient. Although these medications do provide relief for many patients, they are not specific migraine treatments and may not be effective for every patient and every migraine.
Triptan Medication
Collectively known as triptans, this novel class of drugs has revolutionized the treatment of migraine headaches. These medications stimulate serotonin receptors in the brain and constrict blood vessels; however, the exact mechanism of action is not entirely clear according to Dr. Peter Goadsby et al. in "Migraines--Current Understanding and Treatment," published in The New England Journal of Medicine. These medications are prescribed as tablets and capsules, although nasal sprays and injectable forms also exist. There are seven triptans in routine clinical use: almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig). Generally, patients are encouraged to try one triptan for two or three separate migraines before abandoning that medication for another.
Other Treatments
Some migraine headaches may respond to an older prescription drug (Midrin), which is a tablet combination of three drugs, including acetominophen. Therapies geared toward treating the accompanying nausea and vomiting induced by migraines can also help alleviate headache pain. Metoclopramide (Reglan), prochlorperazine (Compazine), diphenhydramine (Benadryl) and promethazine (Phenergan) are often prescribed for this purpose. Less severe migraines can also respond favorably to low doses of caffeine and/or sleep.
Stronger (usually narcotic) medication can be prescribed for the treatment of severe, unrelenting migraines. These include meperidine (Demerol), butorphanol (Stadol) and ketorolac (Toradol). Chronic use of narcotic medications (including Vicodin, Percocet, and Tylenol #3 with codeine) can lead to the formation of chronic, daily headaches and should be avoided.
According to the American Family Physician article, "Management of the Acute MIgraine Headache," steroid therapy, intranasal lidocaine, acupuncture, and cervical manipulation have shown some promise as potential nonpharmacologic treatments.
References
- American Family Physician: Management of the Acute Migraine Headache
- American Family Physician: Medications for Migraine Prophylaxis
- New England Journal of Medicine: Migraines--Current Understanding and Treatment
- Archives of Internal Medicine: Efficacy and Safety of Acetominophen in the Treatment of Migraine
