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Migraineurs frequently struggle to find the right medication, one that knocks-out the headache, eases the other symptoms (such as nausea and light sensitivity) and enables you to get back to work in the shortest possible time.
Here, we explore the vast array of medications that are available to treat migraine.
OTC (Over-the-Counter) Medications
These are often your first port-of-call when a migraine strikes. They can be purchased from a pharmacist without a prescription and are considered safe and effective as long as you follow the instructions.
OTC medications usually have simple instructions and a low potential for abuse.
Some common OTC medications for migraineurs are
Ibuprofen: popular to treat younger migraineurs, ibuprofen is the second most popular OTC painkiller. 55.6% of patients using ibuprofen reported migraine pain-relief after two hours (compared to 9.6% taking a placebo). 41% were still experiencing pain relief 24 hours later.
- Caution: patients with stomach problems ought to beware, as ibuprofen can aggravate - or even cause - them. Do not take ibuprofen if you are on blood thinners. Talk to your doctor first if you have heart disease or kidney disease.
Paracetamol/Acetaminophen: No-one is quite sure how paracetamol/acetaminophen works, however it is clear that it does help, even for the other symptoms of migraine. Many adults using paracetamol/acetaminophen for migraine report feeling "significantly larger" relief to symptoms such as nausea when they take 1000mg. 52% of adults feel migraine relief in 2 hours, compared with a placebo.
- Caution: Do not take paracetamol/acetaminophen if you have liver problems or have three or more alcoholic drinks daily.
Naproxen: Naproxen is a NSAID (nonsteroidal anti-inflammatory). Not only can it reduce pain, and shorten the length of a migraine, it can also reduce symptoms such as light sensitivity and nausea.
- Caution: Do not take Naproxen if you use Aspirin. Talk to your doctor if you have heart disease, as it may raise your risk of heart attack or stroke. Be aware that, like ibuprofen and all other NSAIDs, it may cause or exacerbate stomach problems.
Prescription-Only Abortive Medications
These are the medications that you can be prescribed by your doctor to get rid of your migraine once it has started.
If the OTC medication doesn't work, your doctor may choose to prescribe some prescription painkillers. This may include:
- Narcotic painkillers: About 50% of migraineurs are prescribed a narcotic painkiller (such as codeine, dihydrocodeine, or Vicodin) for migraine. If you don't have regular headaches, these may work for you. However, if you have migraines for ten days or more each month, you should see your doctor about an alternative because frequent use of opiates for headache can lead to more frequent headaches.
- Prescription-only NSAIDS: Such as diclofenac. These medications can shorten the length of migraine and reduce other symptoms, but you shouldn't take them if you have stomach problems.
- Combination medications: Medications which have pain-relieving and nausea-reducing effects such as Paramax (paracetamol and the anti-emetic metoclopramide) and Migraleve Pink (paracetamol, the narcotic codeine, and the anti-emetic buclizin).
Sometimes, when you're having a migraine, the stomach can slow its normal reactions. This can make painkillers react slowly (if at all). This is called "gastric stasis", which prevents anything (including medications) being digested and absorbed into the bloodstream. One of these specific anti-emetics can speed up your digestive system. As a bonus, they can reduce your nausea.
- Buccastem M
- Caution: These medications can all bring nasty side-effects. Long-term use of Domperidone has been linked to heart problems, and metoclopramide can cause serious effects including uncontrollable twitching, chronic insomnia, muscle spasms and severe headache.
Simple, over-the-counter Gaviscon may also help with general nausea and vomiting during a migraine attack.
If painkillers are failing to control your migraines, you might want to try a Triptan. Not every Triptan works for every migraineur, so you might have to try a few to get one that works with you. Triptans reduce the swelling of blood vessels in the brain.
Common Triptans include:
- Triptans should not be given to people under the age of 18, or over the age of 65
- They should not be given to people with a Hemiplegic migraine
- Triptans should not be taken on the same day as any other serotonin agonist (certain anti-depressants, the painkiller Tramadol, etc)
Produced for subcutaneous injection (as dihydroergotamine), as nasal spray (as dihydroergotamine), and as tablets (as ergotamine tartrate and caffeine). However, due to difficulties in absorption, Ergotamine is mostly avoided now, replaced by other preparations. If it is used, it is recommended that migraineurs limit its use to twice a month.