Prescription Migraine Medications

All migraine sufferers wish to find a migraine treatment that will end their misery. Even though there are non-drug therapies for treating migraines, the first thing most of us will turn to is medication. Society today looks for quick answers found inside a pill, tablet or capsule. There is nothing wrong with choosing to use medication, however it is important to know what kind you are using. Each type of medication may cause certain side effects and may have negative reactions with other types of medication or physical condition.

Migraine sufferers have two goals in mind when it comes to treatment:

1. Stop a current migraine attack from getting worse.
2. Try to prevent from getting one.

Therefore, doctor prescribed migraine treatments help you to accomplish one or the other. Abortive medications are used at the first sign of a migraine in an attempt to halt the process that causes the headache pain. They work by constricting the blood vessels, bringing them back to normal and relieving the throbbing pain. Abortive medications are not to be taken for long periods.

Preventive medications may not prevent you from getting a migraine headache but are intended to reduce both the frequency and the severity of the headache. This type of medication is usually taken daily. Preventive medications are prescribed for severe headaches that occur more than twice a month, and that significantly interfere with daily activities. Unlike abortive medication, preventive medication does not provide relief from the pain of a migraine in progress. Furthermore, it may take weeks or months before you see any improvements.

Below is brief rundown on prescription migraine medication in their following categories:

ABORTIVE MEDICATIONS

1. Triptans
These are the newer migraine specific medicines. They are widely prescribed and effective. The following are FDA approved triptans:

• Sumatriptan: Imitrex, Imigran injections, tablets and nasal spray.
• Zolmitriptan: Zomig tablets and nasal spray, Zomig-ZMT tablets
• Naratriptan: Amerge, Naramig tablets
• Rizatriptan: Maxalt tablets, Maxalt-MLT orally dissovable tablets
• Almotriptan: Axert tablets
• Frovatriptan: Frova tablets
• Eletriptan: Respax tablets

It is found that sumatriptan (Imitrex) helps improve symptoms in 70% - 80% of migraineurs. If using one triptan doesn't work for you, do not hastily abandon trying the others. Different triptans work on different serotonin receptors, and thus may produce different results and effects.

Some common side effects of triptans are increase in blood pressure, fatigue and tingling in hands and feet. Triptans are not recommended if have any of the following:

• high cholesterol
• uncontrolled hypertension
• heart disease
• susceptible to developing strokes
• uncontrolled diabetes

Also take note that triptans are also not for children and women who are pregnant or breastfeeding.

Do not use triptans when you have taken ergotamine medication (Ergostat, Ergomar, Cafergot, DHE-45) or selective serotonin reuptake inhibitors, SSRIs (Prozac, Paxil, Zoloft, Serzone and Effexor).

2. Ergotamines
Helps to stop migraine headache by narrowing the dilated blood vessels to the brain.

The following are available ergotamine preparations: Ergostat, Ergomar, Cafergot, DHE-45, Migranal.

Ergotamines are “older” migraine medicines compared to triptans. It has been described as difficult to use with severe side effects, therefore many prefer the newer triptans. If used incorrectly it can become toxic to the body resulting in symptoms such as burning in fingers and toes, disturbed vision and weakness of the extremities. This group of symptoms are collectively referred to as ergotism.

As mentioned above, do not use ergotamines along with triptans. Ergotamines are also not for you if you have high blood pressure, hardening of the arteries, angina, glaucoma, or disorder of kidneys and liver. It is also not for children or for women who are pregnant or breastfeeding.

3. Sympathomimetic Agents
Midrin is a combination of isometheptene (a blood vessel constrictor), acetaminophen (a pain reliever), and dichloralphenazone (a mild sedative). This medication has been found effective in treating milder migraine headaches. Most common side effects are hypertension, rash and dizziness. Do not consume alcohol when on this medication. Do not take Midrin if you have glaucoma, kidney disease, heart disease or liver disease.

4. Barbiturate and Analgesic Combinations
Doctors will only recommend these drugs only when other medications do not work or cannot be used. The reason being there is potential for abuse. Long term use can result in dependance. There is concern about overuse, rebound headaches and withdrawals. Therefore, use of these drugs must be limited and carefully monitored. The following medicines fall under this category: Fioricet, Esgic Plus, Fiorinal and Phrenilin.

5. Narcotics
Using narcotics to treat your migraine is very risky. It is a very potent pain medication that may bring desperately sought after relief. However, before moving on to this hard stuff be aware that these medications are often habit-forming and should be used with extreme caution and only as absolutely needed. This type of treatment is usually administered as a last resort. In other words you should meet some of the following criteria:

• Your usual medications do not work and other types do not help as well
• The pain and symptoms are very severe that it could lead to dehydration.
• When the migraine has lasted beyond 72 hours with less than four pain-free hours while awake. Such migraine is termed as Status Migrainous which increases the risk of a stroke.

The more common narcotic pain relievers used to treat migraines are:

• Demerol
• Toradol
• Dilaudid

They are usually administered with other medicines that reduce nausea such as Phenergan, Compazine or Vistaril. These other medicines also help the narcotic medicines to work better and faster. Common side effects of using narcotic painkillers include sedation, dizziness and constipation. Do not drive or operate dangerous machinery when taking this medication as it can impair judgment and coordination.

PREVENTIVE MEDICATIONS

1. Beta Blockers
Beta blockers not only help migraineurs but are also used to treat high blood pressure (hypertension), relieve angina (chest pain) and to prevent heart attacks. Beta blockers help to maintain the size of blood vessels thus limiting its tendency to over-dilate. Below are examples of beta blockers:

• Propranolol (Inderal)
• Atenolol (Tenormin)
• Metoprolol (Lopressor, Toprol XL)
• Nadolol (Corgard)

You may experience side effects such as fatigue, loss of memory, reduced exercise tolerance, impotence, dizziness, depression, sleep problems and vivid dreams. Take extra caution of you have diabetes, asthma, chronic obstructive pulmonary disease or high cholesterol.

2. Antidepressants
Antidepressants are not only quite effective in preventing migraines but are also ideal for migraineurs with concurrent depression or sleep problems. All three conditions are related to serotonin levels in the brain. However, there are risks to using antidepressants to combat migraine. The U.S. Food and Drug Administration (FDA) has warned that antidepressants should not be taken with the migraine specific triptan medications. Combining the two could lead to serotonin syndrome which is a life threatening condition. Also, FDA has advised that adults and children who are taking antidepressants need to be carefully monitored for signs of suicide, especially when they first begin to take the medication or when the doses are changed. Do not stop your antidepressant medication abruptly. Taper off with the help of your physician.

Below are three classes of antidepressants:

A. Tricyclic Antidepressants
Medication under this class includes: Amitriptyline (Elavil, Endep), Nortriptyline (Pamelor, Aventyl), Doxepin (Sinequan), Trazodone (Desyrel) and Imipramine (Tofranil).

It may take two to four weeks before you feel the full benefits of this class of medication.

Side effects are dry mouth, constipation, weight gain, loss of libido, blurred vision and low blood pressure when you stand up quickly.

Do not use this medication if you have heart rhythm disturbances, a recent heart attack, epilepsy, enlarged prostate gland and glaucoma.

B. Monoamine Oxidase Inhibitors (MAOIs)
MAOIs includes: Tranylcypromine (Parnate), Phenelzine (Nardil) and Isocarboxazid (Marplan).

This is the oldest class of antidepressants. There are doctors who avoid prescribing MAOIs as there are significant side effects, food limitations and it interacts with many other drugs. With so many other choices, the use of MAOIs have been replaced with newer antidepressants.

C. The Selective Serotonin-Reuptake Inhibitors (SSRIs)
SSRIs include: Fluoxetine (Prozac), Paroxetene (Paxil), Sertraline (Zoloft), Nefazodone (Serzone), Fluvoxamine (Luvox) and Venlafaxine (Effexor).
Most common side effects are insomnia, loss of sexual desire or ability, weight loss, nausea, diarrhea, anxiety and nervousness.

SSRIs may interact with other medications such as MAOIs. The two cannot be taken together. If you are switching medication from one to the other, allow two to five weeks in between. Pregnant women taking SSRIs also need to know that their baby is at risk of acquiring persistent pulmonary hypertension. This warning was issued by the FDA.

3. Anticonvulsants
These are also known as anti-seizure drugs or anti-epileptics. Anticonvulsants helps prevent nerve cells from over firing, thereby quieting the electrically irritable migraine brain.

Anticonvulsants include: Phenytoin (Dilantin), Topiramate (Topamax), Carbamazepine (Tegretol) sodium Valprote (Depakene), Divalproex sodium (Depakote), and Gabapentin (Neurontin),

Phenytoin has be shown to be suited for childhood migraines.
Side effects you encounter vary according to the type of drug you take. For example, Topamax may cause weight loss whereas Depakote can cause weight gain.

4. Calcium-Channel Blockers
Not only helps with migraines but also with cluster headaches and cardiovascular disorders. It relaxes blood vessels thereby reducing it's amount of constriction (narrowing).

Calcium-channel blockers used in preventing migraine includes verapamil (Calan, Verelan, Isoptin) diltiazem (Cardizem, Dilacor, Tiazac) and amlodipine (Norvasc). According to the National Headache Foundation, use of calcium channel blockers for migraine prevention has yet to be approved by FDA. However, in research studies, verapamil has shown to be effective for migraine prevention. It may work even better than beta blockers in treating migraines with auras.

Possible side effects for taking this class of medicine includes constipation, dizziness, redness in the face, nausea, decreased blood pressure and fluid retention in the legs. Be aware that verapamil and diltiazem can cause symptoms of heart failure to worsen as it reduces the ability of the heart to pump blood.