Migraine Headache Prescription drugs

A 2006 review article by S. Modi and D. Lowder offers some general guidelines on when a physician should consider prescribing drugs for migraine prevention:

Following appropriate management of acute migraine, patients should be evaluated for initiation of preventive therapy. Factors that should prompt consideration of preventive therapy include the occurrence of two or more migraines per month with disability lasting three or more days per month; failure of, contraindication for, or adverse events from acute treatments; use of abortive medication more than twice per week; and uncommon migraine conditions (e.g., hemiplegic migraine, migraine with prolonged aura, migrainous infarction). Patient preference and cost also should be considered.

...Therapy should be initiated with medications that have the highest levels of effectiveness and the lowest potential for adverse reactions; these should be started at low dosages and titrated slowly. A full therapeutic trial may take two to six months. After successful therapy (e.g., reduction of migraine frequency by approximately 50 percent or more) has been maintained for six to 12 months, discontinuation of preventive therapy can be considered.

Preventive medication has to be taken on a daily basis, usually for a few weeks, before the effectiveness can be determined. Supervision by a neurologist is advisable. A large number of medications with varying modes of action can be used. Selection of a suitable medication for any particular patient is a matter of trial and error, since the effectiveness of individual medications varies widely from one patient to the next. Often preventive medications do not have to be taken indefinitely. Sometimes as little as six months of preventive therapy is enough to "break the headache cycle" and then they can be discontinued.

The most effective prescription medications include several drug classes:

• beta blockers such as propranolol and atenolol. A meta-analysis by the Cochrane Collaboration of nine randomized controlled trials or crossover studies, which together included 668 patients, found that propranolol had an "overall relative risk of response to treatment (here called the 'responder ratio')" was 1.94.
• anticonvulsants such as valproic acid and topiramate. A meta-analysis by the Cochrane Collaboration of ten randomized controlled trials or crossover studies, which together included 1341 patients, found anticonvulsants had an "2.4 times more likely to experience a 50% or greater reduction in frequency with anticonvulsants than with placebo" and a number needed to treat of 3.8. However, concerns have been raised about the marketing of gabapentin.
• antidepressants include tricyclic antidepressants (TCAs) such as amitriptyline and the newer selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine. A meta-analysis by the Cochrane Collaboration found selective serotonin reuptake inhibitors are no more effective than placebo. Another meta-analysis found benefit from SSRIs among patients with migraine or tension headache; however, the effect of SSRIs on only migraines was not separately reported. A randomized controlled trial found that amitriptyline was better than placebo and similar to propranolol.

Other drugs:

• Sansert was withdrawn from the US market by Novartis, but is available in Canadian pharmacies. Although highly effective, it has rare but serious side effects, including retroperitoneal fibrosis.
• Namenda, memantine HCI tablets, which is used in the treatment of Alzheimer's Disease, is beginning to be used off label for the treatment of migraines. It has not yet been approved by the FDA for the treatment of migraines.
• ASA or Asprin can be taken daily in low doses such as 80 to 81 mg, the blood thinners in ASA has been shown to help some migrainures, especially those who have an aura.

Migraine headaches are one of the most common problems seen in doctors’ offices and emergency departments. Of the two types of migraines, common migraine accounts for about 80% of migraines. However, the classic migraines are usually the severer of the two. Yet another type of migraine headaches is Status Migrainosus, where the migraine does not go away by itself.

The body chemical serotonin is believed to be the primary cause of migraine headaches. Serotonin plays many roles in the body, and it affects the blood vessels. High levels of serotonin shrink blood vessels, while a fall in levels swells them. Although considerable research has already been done on migraines, the exact cause of migraines remains a mystery. Some experts believe that migraine headaches could be because of an expansion of blood vessels that results in the release of certain chemicals in the body.

Migraine headaches are not limited to adults alone. Children can also have stresses leading to headaches. Experts are of the opinion that migraine headaches that are associated with nausea and vomiting often begin in childhood, and the frequency increases as children pass through puberty. Usually, girls are the ones who are affected the most during their adolescent years. The pain during a migraine headache can be intense and can prevent people, particularly women, from living their daily life. However, the intensity of the headache varies from person to person.

Certain foods items and lifestyle factors, like stress, trigger migraine headaches. Therefore, it is advisable that individuals with migraine problems should try to limit or completely avoid certain foods and stressful lifestyles. For avoiding stress, you can seek the advice of your doctor on starting a program on relaxation skills. You can start eating a healthy diet and use prescribed medicines, although there were instances where excessive dependence on medicines were observed to cause a condition called ‘rebound headaches.’ It is advisable for children to start learning relaxation exercises, such as deep breathing, early on so that they are able to cope with migraines as they grow up. Children should not be given over-the-counter painkillers like aspirin since it increase their risk of Reye’s Syndrome, a problem in children that causes fever, nausea and severe vomiting, amongst other health problems.

It is advisable that migraine patients keep a record of the frequency of migraine headache. Such a record enables doctors to diagnose the frequency and intensity of migraines and suggest remedial steps for the future. While migraines are difficult to handle, the fact remains that the disease can be controlled through a disciplined approach.