Migraines

DISCLAIMER: This is a summary of information about migraine medication. This information should not replace medical advice and you should always seek the advice of a doctor for any health care concerns. Do not delay seeking your physician’s advice or ignore advice they’ve given you because of this information. 

Overview

A migraine causes a severe throbbing pain or pulsing sensation, usually on one side of the head. Migraines are usually accompanied by vomiting, extreme sensitivity to light and sound, and nausea. Migraine attacks may last from hours to days, and the pain can be so intense that it interferes with your day to day activities.

Sometimes, you will have a warning symptom before experiencing a migraine known as an aura. An aura can include visual disturbances like blind spots or flashes of light, or other disturbances such as tingling in the arm, leg, one side of the face, or difficult speaking. 

There are migraine medications that can help to prevent some migraines or make them less painful. The right medications, combined with lifestyle changes and self-help remedies could help. 

Symptoms

Migraines often begin in childhood, adolescence, or early adulthood. They can progress through 4 stages: prodrome, aura, attack, and post-drome. Not everyone who experiences migraines has all 4 stages. 

Prodrome

A day or two before a migraine you may notice subtle changes that warn of an upcoming migraine, these include: 

  • Mood changes, from euphoria to depression
  • Increased urination and thirst
  • Constipation
  • Frequent yawning
  • Neck stiffness

Aura

For some people, auras may occur before or during migraines. Auras are reversible symptoms of your nervous system. They are usually visual but can include other kind of disturbances. Generally each symptom will begin gradually, build up over several minutes, and last for 20-60 minutes. 

Examples of migraine aura include: 

  • Vision loss
  • Difficulty speaking
  • Uncontrollable jerking or other motions
  • Visual phenomena like seeing bright spots, various shapes, or flashes of light. 
  • Numbness or weakness in the face or on one side of the body
  • Pins and needles sensations in a leg or arm
  • Hearing music or noises

Attack

A migraine will usually last for around 4-72 hours if untreated. The frequency of migraine occurrences varies from person to person. Migraines might occur seldomly or strike several times a month. 

During a migraine you will likely experience: 

  • Pain that pulses or throbs
  • Pain usually on one side of the head, but sometimes both
  • Nausea and vomiting
  • Sensitivity to sound, light, touch, or smell

Post-drome

After a migraine attack you may feel confused, washed out, and drained for up to a day. Some people have reported feeling elated. Sudden head movements can bring the pain back briefly.

Causes

Though migraine causes are not understood fully, environmental factors and genetics appear to play a role. 

Changes in the brainstem and the way it interacts with the trigeminal nerve could be involved. So might inbalances in brain chemicals including serotonin which helps to regulate pain the the nervous system. 

Researchers are currently studying the role serotonin plays in migraines. Other neurotransmitters also play a role in the pain of the migraine. 

Migraine triggers

There are many migraine triggers including: 

  • Hormonal changes in women. Fluctuations in estrogen seem to trigger headaches in women. This can happen due to menstruation, menopause, or pregnancy.
    Hormonal medications, such as hormone replacement therapy and oral contraceptives can worsen migraines. Some women find their migraines occur less often when taking these medications. 
  • Drinks. These include wine, other alcohols, and too much caffeine. 
  • Stress. Stress of any kind can cause migraines. 
  • Sensory stimuli. Bright lights as well as sun glare can induce migraines, as can loud sounds. Strong smells – including second hand smoke, perfume, and paint thinner among others can trigger migraines in some people. 
  • Sleep changes. Missing sleep, jet lag, or getting too much sleep can trigger migraines. 
  • Physical factors. Intense physical exertion might bring on migraines.
  • Weather changes. A change of barometric pressure or weather can provoke a migraine. 
  • Medications. Vasodilators and oral contraceptives can cause migraines or aggravate them. 
  • Foods. Salty processed foods and aged cheeses can trigger migraines. Skipping meals or fasting can also trigger migraines. 
  • Food additives. These include the preservative monosodium glutamate (MSG) and aspartame. 

Diagnosis

If you have migraines or a family history of migraines, a neurologist will likely diagnose migraines based on your symptoms, a neurological and physical examination, and medical history. 

If your condition becomes severe suddenly, or is unusual or complex, tests to rule out other causes for the pain may include: 

  • MRI. An MRI scan uses radio waves and a powerful magnetic field to produce detailed images of the brain and blood vessels. MRI scans can help doctors to diagnose strokes, tumors, infections, bleeding in the brain, and other nervous system and brain conditions. 
  • CT scan. A CT scan uses a series of X-rays to create detailed cross-sectional images of the brain. This helps doctors to diagnose tumors, brain damage, infections, bleeding in the brain, and other possible medical complications that could cause headaches. 

Treatment

Migraine treatment is aimed at preventing future attacks and stopping symptoms. 

Many migraine medications are available to treat migraines. Medications used for combatting migraines fall into two broad categories: 

  • Preventative medications. These migraine medications are taken on a regular basis, often daily, to reduce the frequency and severity of migraines. 
  • Pain-relieving medications. Also known as abortive or acute treatment, these migraine medications are taken during migraine attacks and are designed to stop symptoms. 

The treatment your doctor goes with will depend on the severity and frequency of your migraines, whether you experience vomiting and nausea with your headaches, how severe and disabling they are, and other medical conditions you have. 

Medications for relief

Migraine medications used for pain relief work best when they’re taken at the first sign of an oncoming migraine – as soon as symptoms and signs of a migraine begin. Medications that can be used to treat it include: 

  • Pain relievers. These over-the-counter or prescription migraine medications include ibuprofen or aspirin. When taken too long, they could cause medication-overuse headaches, and possibly bleeding or ulcers in the gastrointestinal tract.
    Migraine medications that combine aspirin, acetaminophen, and caffeine could be helpful, but usually only against mild migraine pain. 
  • Triptans. These are prescription migraine medications such as rizatriptan (Maxalt) and sumatriptan (Tosymra, Imitrex) used for migraines because they block pain pathways in the brain. Taken as nasal sprays, pills, or shots, they can relieve many migraine symptoms. They might not be safe for people at risk of a heart attack or stroke. 
  • Dihydroergotamines (D.H.E 25, Migranal). This is available as an injection or nasal spray and is most effective when taken shortly after the onset of migraine symptoms for headaches that last for over 24 hours.
  • Opioid medications. Those with migraines who can’t take other kinds of migraine medications, narcotic opioid medications could help. Because they’re highly addictive, these are only used if no other treatments work. 
  • Anti-nausea drugs. These can help if your migraine and aura is accompanied by vomiting and nausea. Anti-nausea drugs include metoclopramide (Reglan), chlorpromazine, and prochlorperazine (Compro). These are usually taken in addition to pain medications. 

Preventive medications

Some medications can help to prevent frequent migraines. Your doctor may recommend preventive medications if you have long-lasting, frequent, severe migraines that don’t respond well to treatment. 

Preventive medication tries to reduce how severe the attacks are, how often migraines occur, and how long they last for. Options include: 

  • Blood pressure-lowering medications. These include beta blockers like metoprolol tartrate (Lopressor) and propranolol (Innopran XL, Inderal). Calcium channel blockers like verapamil (Verelan, Calan) can be helpful in preventing migraines with aura. 
  • Antidepressants. A tricyclic antidepressant (amitriptyline), might be able to prevent migraines. Due to the side effects of amitriptyline, like weight gain and sleepiness, other antidepressants could be prescribed instead. 
  • Anti-seizure drugs. Topiramate (topamax) and valproate (Depacon) could help you have fewer migraines, but can cause additional side effects. 
  • Botox injections. Botox injections around every 12 weeks can help to prevent migraines. 
  • Calcitonin gene-related peptide (CGRP) monoclonal antibodies. Erenumab-aooe (aimovig), galcanezumab-gnlm (Emgality) and fremanezumab-vfrm (Ajovy) are newer migraine medications approved by the FDA. They are given by monthly injection.