Migraines affect nearly 30 million Americans each year. Costs associated with lost work and productivity exceed $16 billion, according to American Family Physician. Effective migraine treatment depends on a comprehensive strategy, including the use of over-the-counter (OTC) medication and/or prescription medication for the relief of symptoms.
Non-prescription medications
OTC medications, such as ibuprofen (Advil), acetaminophen (Tylenol) and naproxen sodium (Aleve), can be effective if they are taken early in the course of the headache and at appropriate therapeutic doses. The treatment of migraine headaches often requires the maximum recommended dose listed on the OTC product label, according to The New England Journal of Medicine. Excedrin, a combination of acetaminophen, aspirin, and caffeine, can be effective for some patients. Caffeine use can provoke headaches in some patients while preventing and/or enhancing treatment of migraines for other patients.
Triptan Medication
Collectively known as triptans, the arrival of this new type of migraine medication in the 1990s revolutionized the treatment of migraine headaches. These drugs act directly on blood vessels in the brain and are remarkably effective. There are seven triptans in routine clinical use. Some of the more commonly presecribed triptans are rizatriptan (Maxalt), sumatriptan (Imitrex) and zolmitriptan (Zomig). The majority of the triptans are in tablet or capsule form, but nasal sprays and injectable forms also exist. Patients are encouraged to try one triptan for two or three separate migraines before abandoning that medication for another.
Other Treatments
Although some migraine headaches respond to low doses of caffeine, such as that found in Excedrin, large or chronic caffeine use generally worsens migraines. Sleep may also alleviate or improve a migraine headache, and physicians often take advantage of the sedative properties of medications such as diphenhydramine (Benadryl) or the anti-nausea drugs metoclopramide (Reglan), prochlorperazine (Compazine) or promethazine (Phenergan).
Stronger (usually narcotic) medication is often prescribed for severe migraines that are unresponsive to other medications. Meperidine (Demerol), butorphanol (Stadol), and ketorolac (Toradol) are usually administered in the emergency room by injection or IV. Chronic use of narcotic medications can lead to the formation of chronic, daily headaches and should be avoided.
Steroid therapy, intra-nasal lidocaine, acupuncture, cervical manipulation and scalp botulinum (Botox) injections have also shown some promise as potential migraine treatments, according to the American Academy of Ophthalmology.
