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Prescription Migraine Treatments

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Updated April 20, 2009

When a migraine hits, there are a number of options when it comes to treatment. Typically, most migraine sufferers will try an over-the-counter medication first, but often they will end up needing some sort of prescription migraine treatment as well. Many of the abortive treatments available for headaches will treat not only migraines, but other headache types as well. However, there are a number of specific prescription migraine treatments as well. As with all treatments for migraines, be sure to discuss questions and concerns you may have with your health care provider.

Non-steroidal Anti-inflammatory Drugs (NSAIDs)

Many NSAIDs are available without a prescription, but there are some that can be prescribed by your health care provider. NSAIDs fall into two categories: COX-1 and COX-2 inhibitors. Each block the activities of chemicals involved in inflammation and have similar side effect profiles. Examples of the COX-1 inhibitors include diclofenac (Voltaren), meloxicam (Mobic), and nabumetone (Relafen). An example of a COX-2 inhibitor is celecoxib (Celebrex). Common side effects of NSAIDs include gastrointestinal problems such as nausea, vomiting, and stomach pain. NSAIDs can also cause stomach ulcers and gastrointestinal bleeding.

Narcotic Pain Medications

Narcotics can be used for a wide variety of painful conditions, and in some circumstances they may be necessary to treat a migraine when it hits. Because addiction to pain medications is common, caution should be used when using them for a long period of time. Your health care practitioner will likely discuss his or her concerns about narcotics before issuing a prescription for the first time. Narcotics combined with other pain medications, such as acetaminophen, are used frequently. Examples of these combinations include Darvocet, Vicodin, and Percocet. Nausea and/or vomiting, dizziness, drowsiness, and constipation are all common side effects of narcotic pain medications.

Ergots

Ergotamine and its derivatives (such as dihydroergotamine, or DHE) have historically been used in treating headaches, although they have fallen out of favor in recent years. Medication overuse headaches (MOH) occur frequently after treatment with ergots. Other problems associated with the ergots are increasing headache frequency, overdose, and problems with prophylactic, or preventative, migraine medications. If your health care provider recommends ergots as a treatment for your headaches, be sure to use them as needed, avoiding chronic use.

5-HT Receptor Agonists (“Triptans”)

Triptans are a group of medications that are widely used and effective in treating migraine headaches. They are usually reserved for moderate to severe migraines, or mild to moderate migraines that cannot be treated effectively with NSAIDs or other analgesic medications. There are generally few side effects, but triptans should be avoided in patients with ischemic vascular conditions (such as cardiac disease or stroke), uncontrolled hypertension, and other significant cardiovascular disease. Examples of the triptans include sumatriptan (Imitrex), naratriptan (Amerge), rizatriptan (Maxalt), and zolmitriptan (Zomig).

Barbiturate Combinations

Combination products containing barbiturates, caffeine, and acetaminophen (e.g., Fioricet) have long been used in treating headaches. In addition to the analgesic properties of acetaminophen, the barbiturate component can cause sedation, increasing the effect of the medication. There are some of these combinations that add a narcotic such as codeine for an even greater pain-relieving effect. Barbiturate combinations are also notorious for causing MOH, especially after chronic use, so stopping their use suddenly is ill-advised. Side effects include drowsiness, dizziness, nausea and vomiting, and stomach pain.

Sources:

Auckerman, G, et al. Management of the acute migraine headache. Am Fam Physician. 2002 Dec 1;66(11):2123-30.

DeMaagd, George. Migraine headaches: the pharmacist and the role of OTC medications. Pharmacy Times. March 2007.

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