What medications should migraine sufferers consider?
Those who only have mild or infrequent attacks might need
only OTC analgesics. Those who experience moderate, severe
or frequent attacks during the month as well as those whose headaches
don't respond well to medicines should try to figure out their triggers
and avoid them by modifying their lifestyle. Some of these
lifestyle modifications could include:
- Going to bed and getting up the same time every
- Getting daily exercise, even if you're schedule
is packed. This will improve the quality of your sleep and
reduce the severity and frequency of migraine headaches.
- Never skip meals and don't go on prolonged fasts.
- Learn some relaxation techniques to help you
- Limit the amount of caffeine you consume to no
more than two caffeine beverages per day.
- Avoid flashing or bright lights, and wear sunglasses
outside on a bright day.
- Learn to keep a migraine diary. This just
means that you start noticing what foods are bringing on headaches,
and jot them down. Review this diary with a doctor and ask
him to help you develop a diary that avoids as many trigger foods
In addition to lifestyle modifications and analgesics,
there are other medications to consider (with the help of your doctor). For instance, prophylactic medications are taken each day
to reduce the duration and frequency of migraine attacks. These
should be taken before the headache, not after it's begun.Several
categories of prophylactic medications include beta blockers, tricyclic
antidepressants, calcium-channel blockers, anticonvulsants and antiserotonin
agents. The medicines with the longest proven history of use
are amitriptyline (brand name Elavil), which is an antidepressant
and propranolol (brand name: Inderal), which is a beta blocker. When discussing these medications with your doctor, make sure
you understand the side effects of each, as well as drug interactions,
and co-existing conditions like heart disease, diabetes and high
While we're on the subject of beta blockers, let's discuss exactly
what these are. Put simply, they're a drug class which block
effects of beta-adrenergic substances --for instance, adrenaline
(or epinephrine).By blocking these effects, a beta blocker
can relieve the stress on a person's heart by slowing the heart
rate.These drugs have also been used for treating high blood
pressure, some types of tremors, angina, stage fright, and a too-fast
heart beat / palpitations. Beta blockers were discovered years
ago to be effective in preventing migraine attacks.However, it's
not known exactly why they work. The specific beta blockers
used to prevent migraines include atenolol, propranolol, metoprolol,
nadolol, and timolol.
Another migraine medication are tricyclic antidepressants
(or TCAs). These prevent migraine attacks by altering the
brain's neurotransmitters, serotonin and norepinephrine, which the
brain uses to communicate with each other. The TCAs used to
prevent migraine attacks include nortriptyline amitriptyline, doxepin,
imipramine, and protriptyline. There are a few side effects
though, including blurred vision, a fast heart rate, difficulty
urinating, constipation, dry mouth, low blood pressure as the person
is standing, and weight loss or gain.
Antiserotonin medications have also been used to
prevent migraines.They work by constricting the person's blood
vessels, thus reducing inflammation in these vessels. However,
these medicines aren't used as widely any more because of potentially
dangerous side effects, including scarring of the tissue which surrounds
the ureters which carry urine to the bladder. This has the
potential of leading to kidney failure.
One other medication type used to prevent migraine
attacks are known as calcium channel blockers (or CCBs).These drugs
block entry of calcium into the heart's muscle cells and into the
arteries. By blocking the calcium, CCBs reduce the heart muscle's
contraction, thus decreasing the heart rate and lowering blood pressure. This is why it's often used for treating high blood pressure--but
they appear to also block serotonin, which helps prevent migraine
attacks.Your doctor will be happy to discuss the pros and cons
of each of these treatment options with you, to develop a strategy
suited for you.