The treatment of migraine is based on drug therapy. Migraine treatment can be divided into acute and prophylactic. Temporary medications are designed to relieve the patient's pain, while the prophylactic preparations are to reduce the frequency of migraines. Migraine management must always be carried out with caution. Using too much painkillers may result in … drug-induced headaches.

Migraine is considered to be one of the most severe headaches to bear. It is estimated that out of 100 people in the general population, as many as 15 struggle with migraine headaches.

Treating migraine- which often leads to serious difficulties in daily functioning - can therefore certainly be considered a very important issue. The therapy has various effects: in some patients it produces clear results very quickly, while in others, it is necessary to use many different therapeutic options to achieve a therapeutic effect.

Fortunately, there are many medications for migraines: there are preparations available to reduce the intensity of migraine pain and agents that can reduce the frequency of migraines.

Migraine treatment: Non-steroidal anti-inflammatory drugs (NSAIDs)

In the acute treatment of migraine, agents from the group of non-steroidal anti-inflammatory drugs (NSAIDs), ergotamine along with other ergot derivatives and preparations from the triptans group are used.

The first of these drugs - NSAIDs - are generally the most commonly consumed drugs. This is due to several aspects, such as their cost or availability (many drugs in this group are available over the counter). Examples of non-steroidal anti-inflammatory drugs used in the treatment of migraine include:
- acetylsalicylic acid,
- naproxen,
- diclofenac,
- ibuprofen, - ketoprofen.

Drugs from this group come in various forms - there are soluble forms (as is the case with acetylsalicylic acid), but they are also available in the form of oral tablets or suppositories. It is worth noting that in the acute treatment of migraine, much higher doses of NSAIDs are used than in the case of other types of pain.

This can be illustrated with a simple example. As for analgesic treatment, usually 200-400 mg of ibuprofen is taken at one time, in the case of migraine headacheseven 800 mg of this drug may be recommended to the patient.

NSAIDs should be taken with extreme caution in the treatment of migraine. Overusing them increases the risk of side effects, which may be, among others nausea and vomiting, but also kidney dysfunction and gastrointestinal bleeding. If you use painkillers too often, you may also experience more headaches, but more on that later.

Migraine treatment: ergot derivatives

The second group of medications used in the acute treatment of migraine is ergot derivatives. They are available in the form of inhalation, as well as suppositories, tablets and ampoules.

Until some time, these drugs were considered to be one of the best in the acute treatment of migraine, but eventually their use in migraine patients was limited due to the fact that these drugs have many side effects (e.g. they may constrict blood vessels) coronary in the heart).

It is also suggested that ergotamine and its derivatives should be used with great caution - it is recommended that these agents be used no more than 6 times a month.

Migraine Treatment: Triptans

Triptans are currently considered to be the most effective agents in the acute treatment of migraine. These drugs are antagonists of histaminergic (5-HT) receptors and the following can be mentioned as examples:

  • sumatriptan
  • zolmitryptan
  • eletryptan

Similarly to the above-mentioned preparations, triptans are available in various forms: oral, injectable or suppository. Triptans are effective not only in relieving migraine pain, but also in contributing to related ailments such as nausea, vomiting and photophobia.

A contraindication to the use of triptans may be, among others coronary artery disease, hypertension or diseases of the brain vessels.

Although these measures do achieve the best results, not all patients struggling with migraines can take them. Among the contraindications to their use are, inter alia, coronary artery disease, poorly controlled arterial hypertension and vascular diseases of the brain.

There are also some disadvantages of triptans: they are mainly their cost and side effects. People with migraines often suffer so much that they are able to do a lot to make their pain go away, but the price of triptans is so high that not all patients are able to afford these drugs.

In addition, patients tolerate triptans differently - in some of them side effects practically do not appear, while in others they even havehigh intensity. The side effects of taking triptans include: reddening of the skin, a feeling of tightness in the chest, dizziness, and a feeling of heat and drowsiness.

Migraine treatment: other medications

In the acute treatment of migraine, however, not only painkillers are important. One of the other troublesome migraine symptoms (apart from pain) is nausea and vomiting. If the patient has severe symptoms, it may be beneficial to add anti-emetic agents to the painkillers - an example of this is metoclopramide.

Important

It is worth emphasizing the fact that patients should always ask their doctor about how to take reliever migraine medications.

Usually the drug should be taken as early as possible. However, NSAIDs can be taken already during the aura, and other drugs - ergot derivatives and triptans - can be taken only when a migraine headache occurs.

Migraine treatment: prevention

The second - apart from emergency - element of management of patients with migraine is prophylactic treatment. In this case, completely different drugs are used and their use is to reduce the frequency of migraine headaches.

However, it is not the case that every patient who develops migraines is immediately offered prophylactic treatment. There are some indications for it - among them there are:

  • migraine attacks that do not resolve with emergency treatment
  • Inability to use emergency treatment (e.g. due to the presence of contraindications for taking such medications in the patient) or poor tolerance of it
  • very common migraine attacks
  • migraine attacks where the patient takes large amounts of pain medication
  • Migraines that are severe or persistent for a long time.

In the prevention of migraine attacks, agents belonging to very different drug groups are used. The first drugs that are usually recommended are beta-blockers (e.g. propranolol and metoprolol), calcium antagonists (e.g. flunarizine) or anti-epileptic drugs (e.g. valproic acid, topiramate). The prophylactic treatment of migraine also includes tricyclic antidepressants, 5-HT2 antagonists, riboflavin and even botulinum toxin.

There is really ongoing research on the use of other drugs in the treatment of migraine. We can mention here, for example, the work on erenumab. It is an antibody that targets a gene-related peptide in the braincalcitonin (CGRP).

It has been suggested that this substance is associated with the occurrence of migraine pain and sensitivity to light and sounds, which often coexist with it - this was the observation underlying the development of a drug that would block CGRP. Preliminary results of studies on the efficacy of erenumab appear to be promising. however, the safety of using this drug will probably continue for some time.

Important

It often takes a long time to develop a migraine prevention regimen that is effective for a given patient. There are times when it is necessary to try several different medications to find the one that will actually reduce the frequency of migraine attacks.

It should be mentioned that prophylactic drugs do not work right away. Sometimes it takes several weeks, and sometimes even several months, for the preventive treatment to reduce the frequency of migraines in a patient.

Migraine Treatment: Migraine State

The above describes the management of patients with a typical course of migraine. The treatment of patients who develop migraines is slightly different.

This problem may require treatment in a hospital, and will give the patient many different medications. The use in migraine conditions is found in both subcutaneous injections of triptans and intravenous administration of steroids or dihydroergotamine and valproic acid.

In patients with this problem, it is also necessary to balance the fluid and electrolyte balance, as well as intravenous glucose administration (both elements of the procedure may lead to a reduction in the severity of headache).

Migraine treatment: difficulties

Whoever has never experienced a migraine is unaware of how severe the pain associated with it is. To alleviate it, patients take painkillers - unfortunately, quite often it happens that patients use these drugs too often and in too high doses.

Such a procedure is definitely not beneficial, because it may result in the occurrence of a problem, which are drug-induced headaches. It is quite a serious disturbance, related in a way to the vicious circle mechanism.

If you suspect you are experiencing drug-induced headaches in addition to migraines, consult your he althcare professional. This requires modification of the existing migraine treatment.

The patient takes painkillers in increasing doses, which - at least initially - brings him relief. With time, however, the effectiveness of these agents decreases and the patient uses painkillers even more often, and whenhe just stops taking his medication, his headaches start to get worse.

The characteristic features of drug-induced headaches include: the pain spreads over the whole head and usually starts in the morning. Such a problem may also be suspected by the fact that after the appearance of pain and taking the drug, the improvement appears, however, the pain recurs in a short time and repeats this periodically. In such a situation, a medical consultation and a change in the treatment of migraines is necessary.

Migraine Treatment: Alternative Therapies

Migraines can certainly be considered a serious problem. The search for newer and newer methods of their treatment is constantly being carried out. There are reports of a beneficial effect on the condition of acupuncture patients. The positive effects of aromatherapy are mentioned, as well as the alleviation of migraine headaches through physical activity and the use of tension and stress reduction techniques.

More and more centers are also carrying out the surgical treatment of migraine. According to the authors of such therapeutic methods, migraines can be provoked by compression of various nerves within the head. When treating migraines with surgery, different muscles are removed, which is expected to decompress the nerves and reduce the frequency of migraine headaches.

The effects of such treatment, however, are difficult to quantify, so surgical treatment of migraines is currently considered quite controversial and is not routinely described among other migraine headache treatments.

Migraine Treatment: Prevention

Care is taken of all patients initiating migraine therapy to avoid factors that may trigger a migraine attack. Different factors can lead to migraine pain in different people (therefore the patient must take note of what is causing the headache).

What, according to doctors, most often causes migraines? As such factors the following are mentioned:

  • stress
  • some foods (e.g. chocolate, fatty foods, cheeses - especially moldy)
  • fatigue
  • significant physical exertion
  • rapid temperature changes
  • certain medications (e.g. ranitidine, estrogens)
  • bright light
  • sleep too long or too short

Of course, all these factors cannot be completely avoided, but it is worth trying, because avoiding them really can reduce the frequency of migraine headaches.

Category:

Neurology