Treating Migraine Pain

If you can’t prevent a headache you can still do damage control

Migraine sufferers, especially those with more than two episodes per month, know the importance of medication to halt and ease their pain. Neurologists approach migraine treatment in two ways: prevent the attack, or relieve pain after the headache has begun. Here is an overview of the options available.

Before It Starts
Preventive medications are taken regularly to stave off chronic headaches. The Food and Drug Administration (FDA) has approved four drugs for migraine prevention: blood pressure medications propranolol and timolol (both known as beta blockers), and anti-seizure medications topiramate and divalproex sodium. These are also called prophylactic medications.

Taken daily, topiramate, the most commonly prescribed formula, is believed to work by calming the nerve cells that trigger the pain response in the brain.

Control the Damage
Abortive treatments called triptans (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan) are most effective if taken early on, when symptoms such as auras first appear. “A lot of patients will know a migraine is coming,” says neurologist Traci Purath, M.D., medical director of Comprehensive Headache Care at Wheaton Franciscan Medical Group in Racine, WI. “Maybe they’re sensitive to light or some patients start yawning 24 hours beforehand. What we want the patients to do is once they get that signal or start feeling that pain, reach for their rescue medication.”

Triptans work by increasing the amount of serotonin in the brain, which stops brain vessels from swelling. They are available in many forms, including self-injectable, nasal spray or a rapidly dissolving tablet. The goal is to deliver relief as quickly as possible. There are certain contraindications for taking these medications so consult your physician before starting triptans.

NEXT: Come back from the pain

 

Come Back from Pain
Sometimes no matter how hard you try, you can’t stop a migraine from progressing. That’s where rescue drugs come in. In some cases, an over-the-counter pain reliever intended for migraines is enough to treat the pain. But Dr. Purath cautions that overusing these medications can actually make headaches worse over time. “You get into a situation we call a rebound headache, where the headaches actually get worse,” says Dr. Purath. Rebound headaches are also called medication overuse headaches. If you continue to use painkillers, especially as a preventive measure, your body adjusts to the dosage and may require more to combat pain. If you forget or abruptly stop taking the drugs, you may end up with an even worse headache. Detoxifying from the medication is the only way to reverse the process.

Prescription-strength analgesics such as butorphanol are available, but physicians caution against their regular use because they can be habit-forming. And as with over-the-counter pain medications, using prescription painkillers too often can result in rebound headaches that actually make the pain of migraine worse over time.

Going Off-Label
Several medications prescribed for migraine relief are not painkillers at all, and are not specifically approved for the treatment of migraines. These “off-label” remedies are medications that are FDA-approved for one ailment, but prescribed to treat a condition other than what’s indicated on the label. One such drug is gabapentin, an anti-seizure medication that also reduces the frequency of migraine for some sufferers. Exactly how gabapentin works to prevent migraine is a question doctors have yet to answer, but research is ongoing. Antidepressants such as amitriptyline also provide relief by affecting certain neurotransmitters in the brain. Beta blockers (in addition to propranolol and timolol) and calcium channel blockers, used to treat heart disease, are also prescribed to migraine patients. These medications may work by affecting certain nerve impulses associated with migraine pain.

Targeted Treatment
The pharmacological advances in migraine treatment over the last 20 years have been life-changing for people with migraines. But physicians say that properly diagnosing migraine sufferers, who spent years thinking they had sinus or tension headaches, is the greatest advancement in migraine treatment. Only with correct diagnosis can a patient get the relief they need.

“Triptan therapy has certainly changed the face of how we rescue people from migraine,” Dr. Purath says. “There are medications coming down the line that we hope can maybe help stop migraines before they even get to the part of being painful. But none of these medications will do anything for anybody if patients don’t realize that there’s something more to this headache; it’s not just something you can take over-the-counter medication for and that is difficult.” So if you suffer from migraine pain, do more than just grab for that bottle of ibuprofen. Talk to your doctor about medications that specifically target and ease your kind of pain.