Treatment of Acute Migraine Headaches

Two approaches are used in the treatment of migraine headaches: The first, which is preventive, or prophylactic, attempts to prevent the headache from developing in the first place, and the second is abortive, because it attempts to shorten, reduce or eliminate the symptoms once they begin. This article focuses on the second approach, the treatment of the pain of acute migraine headaches once they have begun.

Symptoms

• Symptoms of typical migraine headaches are throbbing or pulsing pain on one side of the head, sometimes behind the eye or near the ear, pain made worse by physical exertion, nausea and sometimes vomiting, visual disturbances such as flashing lights, facial tingling or numbness and sensitivity to light and noise.

Medications

• Three types of medications have been approved for the treatment of the pain of migraine headaches: over-the-counter analgesics, triptans and ergots (drugs containing ergotamine). Non-prescription analgesics work by relieving pain, triptans work by regulating serotonin levels in the brain, and ergots work by narrowing blood vessels in the brain. Triptans and ergots are available only by prescription.

  Analgesics are available over the counter and include aspirin, acetaminophen, ibuprofen and naproxen. Non-prescription analgesics formulated specifically for migraine headaches include Excedrin Migraine, Advil Migraine and Motrin Migraine Pain. Some contain caffeine.

  Triptans are the most-used drugs currently available. When analgesics are not effective, triptans are prescribed because they are effective for most migraine sufferers. The most common triptans available include Imitrex, Treximet, Axert, Zomig, Amerge, Frova, Maxalt and Relpax.

  Ergotamine was the first drug used successfully for migraines. It is not used as often following the development of triptans because it offers no particular advantage and has more side effects. Ergotamine is available by prescription only as a nasal spray, self-administered injection, tablets and rectal suppositories.

Alternative Treatments

• Many migraine sufferers have found relief from migraine pain with other treatments, used alone or in conjunction with drugs. These include the application of ice packs to the head, chiropractic manipulation and acupuncture.

Promising Developments

• Researchers are investigating several new drug therapies that interfere with various migraine headache processes in the brain. In addition, a device called a transcranial magnetic stimulator, or "migraine zapper," is nearing FDA approval.

Warnings

• Drugs prescribed for the treatment of migraine headaches frequently have side effects. Be sure to discuss them with your prescribing physician and pharmacist. If the headache pain persists, do not increase the dosages without contacting your doctor. If the drug doesn't work, your doctor will prescribe an alternative.