Migraine: Treatment options you can opt for

Migraine is always stressful. If you are in pain, you tend to get stressed. Once you get stressed, it can lead to more pain. It’s a brutal cycle. Nothing to worry about! The treatment options exist. You may choose from the available treatment options and ease your life.

Medicines for the Treatment of Migraine

Four types of medicines commonly treat migraine attacks:

• Ordinary painkillers, like paracetamol.
• Anti-inflammatory painkillers, like aspirin, ibuprofen
• Anti-sickness medicines, like domperidone, prochlorperazine
• Triptans, like almotriptan, naratriptan, sumatriptan, zolmitriptan

Painkillers

Aspirin and paracetamol both work well for migraine episodes. Take the dosage as early as possible after symptoms appear. Taking painkillers early often reduces the severity of the headache or stops it completely. Unfortunately, many people do not take a painkiller until they have a terrible headache. It is often too late for the drug to function effectively.

Strictly speaking, aspirin is an anti-inflammatory painkiller. Aspirin may not treat many painful conditions. However, it often works very well for migraines and is worth a try. A review of research confirms the working of aspirin. It states that aspirin either takes away migraine pain or lessens pain, within two hours, in more than half of the people taking it.

Take the maximum dosage of the painkiller. For an adult, 900 mg aspirin (usually three 300 mg tablets) or 1000 mg of paracetamol (usually two 500 mg tablets) are recommended. Repeat the dosage after four hours if necessary. Soluble tablets are best; they are more quickly absorbed than solid tablets.

Do not use codeine and drugs containing codeine, like co-codamol, for migraines. Codeine may make feeling sick (nausea) and being sick (vomiting) worse, making migraines worst. If you use these drugs frequently, they are more likely than paracetamol or aspirin to cause a medication-overuse headache (also called 'medication-induced headache').

Anti-inflammatory painkillers

Anti-inflammatory painkillers, like aspirin, probably work better than paracetamol to ease migraine. You can buy ibuprofen or aspirin at pharmacies or obtain them by prescription. Other types, such as naproxen, diclofenac, or tolfenamic acid, require a prescription. Also, what you must know about anti-inflammatories is:

• It is best to take the maximum recommended dose as early as the headache begins rather than taking smaller doses.
• Take an anti-inflammatory medicine with milk or some food. This lessens the risk of stomach upset, which is common with these drugs. However, it is not feasible if you are feeling sick (nausea) or are actually sick (vomit).
• A brand of ibuprofen dissolves and disperses in the mouth and is swallowed with saliva. Therefore, it may be easier to take it than other tablet forms in case you feel sick.
• A brand of diclofenac comes as a suppository. Therefore, it may be helpful if you usually vomit during a migraine episode.
• People with high blood pressure, asthma, kidney failure, or heart failure may not be able to take anti-inflammatory painkillers.

Dealing with Vomiting and Nausea

Migraine attacks may often cause you a feeling of sickness (nausea) or cause you actually to be sick (vomit). Nausea makes it harder for the body to absorb migraine medicines into the body. Therefore, if one takes painkillers, they may remain in the stomach and not work well. You may even vomit the medicine. Tips that may help are:

• Use soluble (dissolvable) painkillers. These are absorbed more quickly in your stomach and are likely to work better.
• A brand of diclofenac comes as a suppository. It may be helpful if you usually vomit during migraine.
• You may take an anti-sickness medicine in addition to painkillers. For example, a doctor may prescribe domperidone, prochlorperazine or metoclopramide.
• Anti-sickness drugs work best if you take them immediately after the symptoms appear.
• Domperidone, an anti-sickness medicine, is available as a suppository. It is good if you feel very sick or vomit during a migraine attack.

Combination of Medicine

Some brands of migraine medicines contain both a painkiller and an anti-sickness drug, for example, ParaMax-R and MigraMax-R. They may be convenient. However, the dose of each part may not suit everyone, or it may be strong enough. People may prefer to take painkillers and anti-sickness medicines separately to control each dosage and know what they are taking.

Triptans Medicine

A triptan is an alternative drug if painkillers or anti-inflammatory painkillers do not work effectively. Triptans are a group of medicine to ease the symptoms of a migraine attack or cluster headache. They include Sumatriptan, Zolmitriptan, Rizatriptan, Naratriptan, Frovatriptan, Eletriptan, and Almotriptan, and come in different brand names. Triptans are also known as 5-HT1 agonists. They are available as migraine tablets, injections, and nasal spray preparations. You require a prescription for most of the Triptans. However, you can buy Sumatriptan without a prescription from pharmacies.

How does a Triptan work?

A Triptans is not a painkiller. It works by duplicating the action of a brain chemical called 5-hydroxytryptamine (5-HT). 5-HT is also known as serotonin. 5-HT instructs cells by attaching to specific sites (receptors) outside them. One of the effects of 5-HT is to cause widened (dilated) blood vessels to narrow (constrict). So do not take a triptan too early in a migraine attack. They may also lower the release of other brain chemicals during a migraine attack.

How to take Triptans?

Always take the first dose when the migraine is just beginning to develop, but not before this stage. Do not take a Triptan in the aura stage if you have an aura. Also, do not take it to prevent one from coming on. Studies show that Triptan does not work well if you take it too early. Triptans tablets are designed to work rapidly within an hour or so. Injected triptans usually work within 10-15 minutes. After you have taken the first dose:

• If the Triptan worked to relieve your migraine, but then the headache returned later, you can repeat the dose after 2-4 hours. Each Triptan has a maximum daily dosage that you should not exceed. This will be written on the patient information leaflet.
• If the Triptan did not work, a second dose is unlikely to work, so do not take the next dosage. The exception is Zolmitriptan (2.5 mg), where you can try the next dosage after two hours despite the ineffectiveness of the first dose.

Your doctor may prescribe a larger dosage if a low dose does not work well. Also, some triptans work for some persons while not for others. So, if one Triptan does not work, the same one at a higher dosage or a different one may work well. Sometimes, people may have to try three or more different triptans before finding one that works best for them. However, do not make a judgment after just using a particular triptan once.

What If Pain Returns After Taking Triptans?

Most people with migraine can usually find a triptan that works well for most migraine attacks and where side effects do not occur or are not too bad. The downside of triptans is that the headache returns within the next 48 hours of taking a triptan in one in every four cases. If the same thing happens to you, the options for you are:

• You can take a repeat dosage if the pain returns (if the first dose worked). You can repeat the dose within 2-4 hours (depending on the type). However, first, ensure you do not exceed the maximum recommended dosage over 24 hours. For example, the maximum dosage of Sumatriptan per day must not exceed 300 mg in tablets or 40 mg as a nasal spray. 
• The doctor may consider prescribing Naratriptan or Eletriptan. Return of the headache is less prevalent after treatment with these two triptans.
• People may take a short course of an anti-inflammatory painkiller such as diclofenac or tolfenamic acid 24-48 hours after the headache. This may prevent the return of the pain and lower the requirement for a repeat dose of the Triptan.

Can I buy Triptans, or are these just prescription only?

You can buy Sumatriptan without a prescription from pharmacies, although only after an assessment by the pharmacist. Take Triptans only to treat migraine or cluster headaches previously diagnosed by your doctor. There are many causes of headache besides migraine and cluster headache, and you need a diagnosis. Apart from Sumatriptan, all other Triptans are only available on prescription.

Conclusion

Medicines to treat migraine attacks (episodes) include painkillers, anti-inflammatory painkillers, anti-sickness drugs, and triptans.

Aspirin and paracetamol both work well for many migraine attacks. Anti-inflammatory painkillers, like aspirin, probably work better than paracetamol to ease migraine. Other types, such as naproxen, diclofenac, or tolfenamic acid, need a prescription. Migraine episodes may cause you a feeling of sickness (nausea).

A triptan is an alternative drug if painkillers or anti-inflammatory painkillers do not help much. Triptans are a group (class) of medicines to ease the symptoms of a migraine attack or cluster headache.