Migraine Medications: the Lowdown (The Good, the Bad, and the Ugly)

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.

READ Do You Suffer From Migraines? Follow These Tips To Lower Your Risk

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.

Prescription Painkillers

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).

Anti-Nausea Medication

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.

• Domperidone
• Metoclopramide
• 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.

READ Prodrome: Signs A Migraine's On The Way

Triptans

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:

• Sumatriptan
• Rizatriptan
• Zolmitriptan
• Naratriptan
• Frovatriptan

Beware that:

• 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)

Ergotamine

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.

More Migraine Medications: Preventatives and Natural Health

Prescription-Only Preventatives

If your migraines become frequent, you might benefit from a prescribed migraine preventative. These medications are designed to reduce the frequency of your migraines. Talk to your doctor.

Beta Blockers

Originally developed to treat high blood pressure, beta blockers like propranolol and timolol have been found to reduce the risk of migraine. It's taken daily. Diabetics should avoid it. Ask a doctor before drinking grapefruit juice.

Side effects include: cold extremities, pins and needles, insomnia, and fatigue.

Amitriptyline

Amitriptyline is an anti-depressant, and is commonly used at low-doses to prevent migraines (so don't become offended if your doctor suggests them). They can be effective for migraineurs for whom insomnia is a contributory factor to their migraines, or who do not sleep well during their migraines.

It's believed it helps prevent migraines by altering the amount of serotonin in the brain. Low serotonin is believed to be partially-responsible for migraines.

Topiramate

Topiramate (also known as Topamax) is an anti-seizure medication, used in the treatment of epilepsy. It's been shown to help prevent migraine if taken daily.

It should not be taken by pregnant women as it can harm the unborn baby. You should take double the precautions to not fall pregnant, as Topiramate also reduces the effectiveness of contraception.

BOTOX

Otherwise known as Botulinum Toxin Type A. In Jun 2012, NICE recommended that Botulinum Toxin Type A be considered as a treatment-option for the prevention of headaches that occur for 15 days or more every month (at least eight days of which are migraine), if it hasn't responded to three previous treatment options. Injected in between 31 and 39 sites in the head and back of the neck, it paralyses the muscles, and it's not clear exactly why this works as a preventative.

Natural Health

Alongside medical treatments from your doctor, these natural therapies may help reduce your migraines' severity and frequency.

READ Headaches: Home and Natural Remedies for Migraine

Acupuncture

Acupuncture is an ancient natural treatment where very fine sterile needles are inserted into pressure points in your body. Painless (if done by an experienced and qualified professional), NICE (the UK regulatory body for medical treatments) have recognised that it's a valuable preventative if medical preventatives such as propranolol and topiramate do not work or are unsuitable.

Studies by Linde (2009) and Wang (2008) show that Acupuncture works at least as well as prophylactic (preventative) migraine medication.

Be aware, in many countries you don't need a specific license to call yourself an acupuncturist. Unlicensed, unprofessional, amateur acupuncturists are a risk to your health, potentially causing HIV with unsterile needles, and even puncturing an organ with a needle. Always see a professional: check with the British Acupuncture Council (UK) or the National Certification Commission for Acupuncture and Oriental Medicine (the NCCAOM, US) [see links].

Magnesium

Magnesium is a mineral found in such foods as: beans, nuts, wholegrains, and seeds. A study found that, after taking a daily 600mg magnesium supplement for 12 weeks, 41.6% found a reduction in the number of their migraines, compared to only 15.8% taking the placebo.

Be aware that high doses can cause diarrhoea (18.6%) and abdominal discomfort (4.7%), as well as nausea, and low blood-pressure. If you get these side-effects, see a doctor. Migraineurs with kidney disease should consult a doctor before taking magnesium supplements, as impaired renal function prevents magnesium being removed from the body, making side-effects more likely.

Feverfew

Dried feverfew leaves are used as an herbal supplement in the treatment of migraine. 4-6 leaves are used daily, and may be brewed to make a tea on the advice of a professional herbalist.

Always consult an herbalist for feverfew. The feverfew available in health shops is likely to be of a low-grade. Additionally, a shop-assistant may be unable to adequately advise you.

Long-term usage may lead to withdrawal symptoms if stopped abruptly. If you take feverfew daily for a week or more, do not stop suddenly but gradually taper your usage.

Never give to a small child. Avoid feverfew if pregnant, planning to become pregnant or breastfeeding.

READ Chronic Migraines: Is the relief possible?

Vitamin B2

Vitamin B2 (riboflavin) is a vitamin found in many foods, including: cheese, milk, green leafy veggies, and poultry. A high dose (400mg) of riboflavin has been found to help migraineurs.

A 1998 study found that it halved the number of headache days in 50% of migraineurs (compared to 15% in the placebo group). A 2004 study agreed with that study and found that migraineurs also took only 4.5 units of painkiller per migraine (compared to 7 before).

The use of riboflavin in migraineurs is relatively new. It should not be taken by people with cataracts at more than 10mg per day. Be aware, too, that it may cause bright yellow urine and a small number of users report diarrhoea.

Complex B vitamins

B6, B12 and Folic Acid (the synthesised form of folate) may all help reduce your number of migraines. A 2009 study tested 52 migraineurs with aura, giving half 25mg B6, 400mcg B12 and 2mg folic acid and the other half a placebo.

They found that those taking the vitamins had fewer attacks and those who reported disability with their migraines halved, falling from 60% to 30% (there was no change with the placebo group). This is thought to be partly due to lowered levels of the amino acid homocysteine (which are raised in migraineurs), and partly due to raised pyridoxine (a chemical in Vitamin B6, which boosts the neurotransmitter, serotonin).

Do not take more than 500mg of Vitamin B6 a day, which may lead to severe side effects, including nerve damage to the arms and legs.

Finding the Right Medication

It may take time to figure out the best medication. If you're struggling (especially if your migraines are getting more frequent, or are not improving), go back to see your doctor and discuss the best option.

Sometimes, every migraineur will have a migraine that will be incapacitating. However, if your migraines are frequently debilitating, it's a sign your medication is not working. It's not a sign of failure. It just means that not every medication works for every person.

Sometimes it might take a wholly different medication; sometimes you might just have to increase the dose of your current medication; sometimes a combination of medications is what you need

You just have to be persistent.