Medical Treatment

Drug treatment for migraine headaches can relieve the pain and symptoms of a migraine attack and prevent further migraine attacks.

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

Abortive: The goal of abortive therapy is to stop it once it starts. The prescribed medications stop a migraine when you one coming or once it has begun and may be taken as needed. Abortive medications can be administered by self-injection, by mouth, or by nasal spray. These forms of medication are especially useful for people who have nausea or vomiting related to their migraine, and they work quickly.

Abortive drugs include the triptans, which specifically target serotonin. They are all very similar in their action and chemical structure. The triptans are used only to treat headache and do not relieve pain from back problems, arthritis, menstruation, or other conditions. People with certain medical conditions should not take these medications.

The following drugs are also used for treatment.

• Acetaminophen -isometheptene-dichloralphenazone (Midrin)
• Dihydroergotamine (D.H.E. 45 Injection, Migranal Nasal Spray)
• Ergotamine tartrate (Cafergot)
• Over- the-counter medications such as Advil Migraine (containing ibuprofen), Excedrin Migraine (containing aspirin, acetaminophen, caffeine), and Motrin Migraine Pain (containing ibuprofen)

The following drugs are mainly used for nausea related to migraine headaches in addition to migraine treatment:

• Metoclopramide (Reglan)
• Prochlorperazine (Compazine)
  Promethazine (Phenergan)

Some drugs are used for headache pain but are not specific for migraines. These include analgesics, narcotics, and barbiturates. Since they can be habit forming, they are less desirable than specific headache drugs listed above. These drugs should be used primarily as a “backup” for the occasions when a specific drug does not work.

Preventive: This type of treatment is considered if migraines occur frequently, typically more than one migraine per week, or if migraine symptoms are severe. 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], timolol), calcium channel blockers (verapamil [Covera])
• Antidepressants : amitriptyline (Elavil), nortriptyline (Pamelor)
• Antiseizure medications: gabapentin (Neurontin), topiramate (Topamax), valproic acid (Depakote)

Some nontraditional supplement treatments for migraine prevention include butterbur, coenzyme Q10, and feverfew. Evidence has been inconclusive and studies have produced mixed findings.