Medicines The type of medicine you use will depend on how painful your migraine attacks are and what other symptoms you experience, eg feeling sick. - Simple painkillers can be bought over-the-counter from a pharmacy. These include acetaminophen (also known as paracetamol), aspirin, ibuprofen and codeine. Some products available will contain a combination of painkillers, perhaps even combined with something to stop you being sick (an antiemetic).
- Overuse of these painkillers can sometimes cause a ‘rebound headache’. This is a headache which is actually caused by the painkiller, which is then relieved by taking more painkiller. You should talk to your doctor if you feel you may be using too many painkillers.
If your attacks are more severe, you may require a prescription from your doctor. The introduction of a group of medicines known as the triptans has improved the control of the migraine attack. - Although the precise way they work is not known, the triptans activate serotonin receptors in the brain.
- There are a number of different triptans available, eg almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan and zolmitriptan.
- These medicines are available in a range of different formulations, such as tablets, orodispersible tablets and wafers (both of which dissolve quickly in the mouth), nasal sprays, suppositories, and as an injection. You may find that one specific formulation will be best for you. Triptans are more effective if you use them early in the migraine attack.
Ergotamine and ergot derivatives used to be commonly used to treat the migraine attack. - These medicines act by narrowing (constricting) blood vessels in the brain.
- Their use is not as common now as they sometimes cause blood vessels in other parts of the body to narrow, causing unwanted side-effects.
- If you are using ergotamine or an ergot derivative, you need to take the preparations as early as possible in the migraine attack.
If you are sick during a migraine attack, your doctor may prescribe something to stop you feeling sick (an antiemetic) such as metoclopramide. It is important to realise that any medicine taken by mouth and swallowed may be less effective if you are sick within two hours of taking it. Medicines which dissolve quickly in the mouth may be of use if you experience sickness. Your doctor may decide to prescribe you some preventive medicines if acute therapy fails to control the symptoms or if you experience more than one attack per month. It is important to take the medicine every day as directed by your doctor even if you feel well. Your doctor may tell you to stop taking the medicine, for example every six months, to check that you still need to take it. Medicines used as preventative treatment include: - Pizotifen – pizotifen is a useful medicine in preventing migraine attacks. However, it may cause drowsiness, especially when starting therapy and longer term use may be associated with weight gain.
- Beta-blockers – beta-blockers such as metoprolol, nadolol, propranolol, and timolol, have been found to be useful in preventing a migraine attack.
There are other medicines which your doctor may decide to treat you with depending on the severity and associated symptoms which you experience. - The exact medicine which you use to control your migraine will depend on a number of factors. It is best that you discuss your medicine with your doctor to ensure that you have the best treatment and formulation for you. If one medicine does not work or causes side-effects, another medicine may be more suitable.
- It is sometimes useful to make a note of any questions that you have before you go to see your doctor, either about migraine in general or about your medicines. In this way you won’t forget what you wanted to ask. Your doctor will not mind if you take notes whilst you are talking to him/her. It is not unusual for people to forget some of the things the doctor said after leaving the surgery. Taking notes will help you remember the important points.
Many migraine sufferers have found that complementary medicine can help relieve their migraine attacks. - It is important to be aware that most of the complementary therapies have not been shown to be effective in appropriately designed clinical trials, but they may bring some relief to you.
- Complementary medicines which may be of benefit include hypnosis, herbalism, homeopathy, transcutaneous electrical nerve stimulation (TENS) and acupuncture.
- Relaxation therapy helps reduce stress which is a common trigger for a migraine attack.
- Cognitive-behavioural therapy involves identifying factors which cause the individual stress and anxiety. Changing these behaviours can reduce the number of migraine attacks.
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