Headache Treatment Options

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38 million Americans suffer from migraines. Of this 38 million, 2-3 million migraineurs have chronic migraines, 5 million migraineurs suffer from migraines at least monthly, and 11 million migraineurs consider their migraines to be the cause of “moderate to severe disability.”

I’m an RN who has suffered from migraines for the past 20 years of my life.

Although I am knowledgeable in the treatment of migraines, I find myself constantly searching for new methods of reducing my migraines. Why? I’m always hoping I’ll uncover a way of making myself feel better – I want to better care for myself so that I can better care for my family and my patients.

Below you’ll find the medical treatment options available for migraines.

Antidepressants

Tricyclic antidepressants have long been used to treat migraines. According to Jerry W. Swanson, an MD from Mayo Clinic, this subclass of antidepressants is thought to treat migraines effectively because they may affect the serotonin levels in the brain, as well as other chemicals that may affect migraines.

Other subclasses of antidepressants – selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) – are not thought to be effective for the treatment of migraines.

Examples include:

  • Amitriptyline
  • Amoxapine
  • Doxepin
  • Imipramine (Tofranil)
  • Nortriptyline (Pamelor)
  • Protriptyline (Vivactil)

Beta Blockers

Beta blockers are most commonly used to treat elevated blood pressure and control rate. However, it is also commonly used to treat migraines.

According to Sara Finkelstein of Migraine.com, beta blockers work to treat migraines by “…blocking chemicals called neurotransmitters in the body from interacting with beta receptors, which sit within blood vessels and other tissues.”

Although this group of medications are used to prevent migraines, recent evidence also suggests that beta blocker eye drops may be effective as an abortive treatment.

Examples include:

  • Propranolol (Inderal)
  • Metoprolol (Lopressor)
  • Carvedilol (Coreg)
  • Nadolol (Corgard)
  • Atenolol (Tenormin)

Antiseizure Medications

Antiseizure medications are often prescribed to treat migraines. Researchers are not quite sure why they work, but one theory is that the nerves in the brain are “excited”. Because these medications cause excited nerves (remember – they are calming the nerves that cause seizures) they also may calm the nerves that cause a migraine.

Although there are several antiseizure medications on the market, there are only two that are FDA approved to treat migraines. Several have actually been studies and have shown to have no effect on the prevention of migraines. The two FDA-approved medications are:

  • Sodium valproate (Depakote)
  • Topiramate (Topamax, Trokendi XR)

Botulinum Toxin

Botulinum toxin, also known as Botox, is prescribed for people with chronic migraine who do not tolerate medications or who are not responsive to medications.

Botox involves injections into various spots by a trained neurologist and is administered every 90 days. It is an effective treatment options for many people, but it can be pricy as it is not always covered by insurance.

Aimovig

And the newest medication to treat migraines, it is the first of its kind. It is also the only medication that is specifically designed to treat migraines. It is a calcitonin gene-related peptide blocker, more commonly known as a CGRP blocker. It works by blocking the CGRP receptors and is given as a once monthly injection.

3-month research studies indicate that people with chronic migraine taking Aimovig had an average of 6-7 fewer migraines per month, while 6-month research studies indicate with episodic migraine taking Aimovig had an average of 3-4 fewer migraines per month.

Abortive & Rescue Medications

There are several options available to treat migraines when they occur; these are called abortive medications.

For an abortive medication to work to its full efficacy, it should be used as early as possible.

Examples of abortive medications include:

  • Triptans: sumatriptan (Imitrex), rizatriptan (Maxalt), zolmitriptan (Zomig), almotriptan (Axert), frovatriptan (Frova), eletriptan (Relpax)
  • Triptan and NSAID combinations
  • Ergotramines: Migranal nasal spray, DHE-45 (injectable)
  • Midrin and midrin equivalent medications

Rescue medications are used when abortive medications fail or if you are unable to take abortive medications. These medications may be pain medications, medications that are designed to aid with relaxation, or medications to reduce nausea.

Examples of rescue medications:

  • Acetaminophen and acetaminophen compounds, such as Tylenol #3
  • Anti-nausea medications: prochlorperazine (Compazine), promethazine (Phenergan), metoclopramide (Reglan), ondansetron (Zofran)
  • Butalbital compounds: Fiorinal, Fioricet
  • Muscle relaxants: carisoprodol (Soma), tizanidine (Zanaflex), baclofen (Lioresal), cyclobenzaprine (Flexeril)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): ibuprofen, ketorolac (Toradol), meloxicam (Mobic)
  • Opioids: butorphanol (Stadol), hydromorphone (Dilaudid), meperidine (Demerol)

The Bottom Line…

If you’re a migraine sufferer like me, there are a multitude of mediation treatment options available to you – and like Aimovig that was recently released, there are new medications on the horizon!

Resources
Amgen (2018, July 8). Aimovig is here. Retrieved from https://www.aimovig.com/

Finkelstein, S. (2018, June). Anticonvulsants – antiepileptic drugs. Retrieved from https://migraine.com/migraine-treatment/anticonvulsants-and-antiepileptic-drugs/

Finkelstein, S. (2016, June). Beta blockers. Retrieved from https://migraine.com/migraine-treatment/beta-blockers-for-migraine-headaches/

Mayo Clinic (2018, February 14). Chronic daily headaches – diagnosis & treatment. Retrieved from https://www.mayoclinic.org/diseases-conditions/chronic-daily-headaches/diagnosis-treatment/drc-20370897

Mayo Clinic (2016, June 28). Tricyclic antidepressants and tetracyclic antidepressants. Retrieved from https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046983

Miles, O. (2010, November). Migraine Statistics. Migraine.com. Retrieved from https://migraine.com/migraine-statistics/

Swanson, J.W. (2018, May 8). Migraine treatment: can antidepressants help? Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/migraine-headache/expert-answers/migraine-treatment/faq-20058410

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About Author

Krystina Ostermeyer RN, BSN, CDE
Krystina Ostermeyer RN, BSN, CDE

Krystina is a 30-something RN, BSN, CDE who has worked in a variety of nursing disciplines, from telemetry to allergy/immunotherapy to most recently, diabetes education. She is also a writer and has enjoyed expanding her writing career over the past several years. She balances her careers as a nurse and a writer with being a wife and a mother. She has a four year old son who is an inquisitive, energetic little guy who is up for anything. She also enjoys reading, traveling, cooking, baking, and yoga (both practicing and teaching).

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