migranekit

At one time, aspirin was almost the only available treatment for headaches. Now there are drugs specifically designed to treat migraines. Several drugs commonly used to treat other conditions also may help relieve migraines in some people. All of these medications fall into two classes:

Pain-relieving medications. These stop pain once it has started.
Preventive medications. These reduce or prevent a migraine headache.

Choosing a preventive strategy or a pain-relieving strategy depends on the frequency and severity of your headaches, the degree of disability your headaches cause and other medical conditions you may have. You may be a candidate for preventive therapy if you have two or more debilitating attacks a month, if you use pain-relieving medications more than twice a week, if pain-relieving medications aren't helping or if you have uncommon migraines.

Some medications aren't recommended if you're pregnant or breast-feeding. Some aren't used for children. Your doctor can help find the right medication for you.

Pain-relieving medications

For best results, take pain-relieving drugs as soon as you experience signs or symptoms of a migraine headache. It may help if you rest or sleep in a dark room after taking them:

Nonsteroidal anti-inflammatory drugs (NSAIDs). These medications, such as ibuprofen (Advil, Motrin, others) or aspirin, may help relieve mild migraines. Drugs marketed specifically for migraine, such as the combination of acetaminophen, aspirin and caffeine (Excedrin Migraine), also may ease moderate migraines, but aren't effective alone for severe migraines. If over-the-counter medications don't help, your doctor may suggest a stronger, prescription-only version of the same drug. If taken too often or for long periods of time, NSAIDs can lead to ulcers, gastrointestinal bleeding and rebound headaches.

Triptans. Sumatriptan (Imitrex) was the first drug specifically developed to treat migraines. It mimics the action of serotonin by binding to serotonin receptors and causing blood vessels to constrict. Sumatriptan is available in oral, nasal and injection form. Injected sumatriptan works faster than any other migraine-specific medication — in as little as 15 minutes — and is effective in most cases. But injections may be inconvenient and painful.

Since the introduction of sumatriptan, a number of similar drugs have become available, including rizatriptan (Maxalt), naratriptan (Amerge), zolmitriptan (Zomig), almotriptan (Axert), frovatriptan (Frova) and eletriptan (Relpax). These newer agents provide pain relief within two hours for most people, have fewer side effects and cause fewer recurring headaches. Side effects of triptans include nausea, dizziness, and muscle weakness and, rarely, stroke and heart attack.

Ergots. Drugs such as ergotamine (Ergomar) and dihydroergotamine (D.H.E. 45) and dihydroergotamine nasal spray (Migranal) help relieve pain. These drugs may have more side effects than do triptans.

Medications for nausea. Metoclopramide (Reglan) is useful for relieving the nausea and vomiting associated with migraines, not the migraine pain itself. It also improves gastric emptying, which leads to better absorption and more rapid action of many oral drugs. It's most effective when taken early in the course of your migraine or even during the aura before your headache begins. The drugs prochlorperazine (Compazine), chlorpromazine (Thorazine), promethazine (Phenergan) and hydroxyzine (Vistaril) also may relieve nausea, but don't affect gastric emptying.

Preventive medications

Preventive medications can reduce the frequency, severity and length of migraines and may increase the effectiveness of pain-relieving medicines used during migraine attacks. In most cases, preventive medications don't eliminate headaches completely, and some can have serious side effects. For best results, take these medications as your doctor recommends:

Cardiovascular drugs. Beta blockers — which are commonly used to treat high blood pressure and coronary artery disease — can reduce the frequency and severity of migraines. These drugs are considered among first-line treatment agents. Calcium channel blockers, another class of cardiovascular drugs, especially verapamil (Calan, Isoptin), also may be helpful. In addition, the antihypertensive medications lisinopril (Prinivil, Zestril) and candesartan (Atacand) are useful migraine prevention medications. Researchers don't understand exactly why all of these cardiovascular drugs prevent migraines. Side effects can include dizziness, drowsiness or lightheadedness.
Antidepressants. Certain antidepressants are good at helping prevent all types of headaches, including migraines. Most effective are tricyclic antidepressants, such as amitriptyline, nortriptyline (Pamelor) and protriptyline (Vivactil). These medications are considered among first-line treatment agents and may reduce migraines by affecting the level of serotonin and other brain chemicals. Newer antidepressants, however, generally aren't as effective for migraine prevention. You don't have to have depression to benefit from these drugs.
Nonsteroidal anti-inflammatory drugs (NSAIDs). Regularly taking over-the-counter NSAIDs such as ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve) may reduce the frequency of migraines. If these medications don't help, your doctor may suggest a stronger, prescription-only version of the same drug. However, NSAIDs may increase your risk of cardiovascular events, such as heart attack and stroke. In addition, long-term use of these medications can lead to ulcers and other gastrointestinal problems, such as stomach bleeding. Talk to your doctor before taking these medications regularly — even the nonprescription varieties.
Anti-seizure drugs. Although the reason is unclear, some anti-seizure drugs, such as divalproex sodium (Depakote), valproic acid (Depakene) and topiramate (Topamax), which are used to treat epilepsy and bipolar disease, seem to prevent migraines. Gabapentin (Neurontin), another anti-seizure medication, is considered a second-line treatment agent. Taken in high doses, however, these anti-seizure drugs, depending on which one you take, may cause side effects such as nausea and vomiting, diarrhea, cramps, hair loss and dizziness.
Cyproheptadine. This antihistamine specifically affects serotonin activity. Doctors sometimes give it to children as a preventive measure.
Botulinum toxin type A (Botox). Some people receiving Botox injections for their facial wrinkles have noted improvement of their headaches. However, it's unclear what effect Botox actually has on headaches. It may cause changes in your nervous system that modify your tendency to develop migraines. Additional research is necessary.