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Sunday, April 17, 2011

Treatment for Migraine

Treatment of migraines is directed at preventing attacks (prophylactic or preventive therapy) and alleviating them when they occur (abortive therapy).

Prophylactic Therapy

Prophylactic therapy includes:

eliminating the controllable triggers, such as chocolate or red wine

improving the person’s physical, mental and emotional health by exercising, biofeedback, relaxation techniques, rest and stress reduction

taking medications to prevent the onset of an attack

Preventive medications are indicated when migraines occur on a regular basis. Different physicians and patients will have different thresholds for determining when migraines are occurring often enough to justify such medications. Preventive medications must be taken every day, whether there is a headache present or not. They will not be helpful if taken only when an attack strikes.

The most widely used preventive drugs are beta blockers, such as propranolol hydrochloride (Inderal), nadolol (Corgard), timolol maleate (Blocadren), atenolol (Tenormin), and metoprolol tartrate (Lopressor, Toprol-XL). Beta blockers have an indirect effect on serotonin, preventing dilation of the blood vessels and decreasing overstimulating impulses from the brain.

Another commonly used class of preventive medications consist of the tricyclic antidepressants, primarily amitriptyline (Elavil) and nortriptyline (Pamelor). Newer antidepressants, including the selective serotonin reuptake inhibitors fluoxetine (Prozac) and sertraline (Zoloft), have also been used to a lesser extent.

A third class of preventive medications includes calcium channel blockers, , such as verapamil and diltiazem hydrochloride (Cardizem).

More recently, other agents such as valproic acid (Depakote), gabapentin (Neurontin), and topiramate (Topamax), have been used.

These medications are only available by prescription. Side effects and precautions should be discussed with a physician.

Abortive Therapy

Once the migraine has set in, there are two methods of reducing the pain: non-drug and drug-based methods. The non-drug methods include:

? sleep, which will often relieve the headache

massage or acupuncture

The drug-based treatment includes analgesics such as aspirin, acetaminophen (Tylenol), ibuprofen (Advil, Motrin), naproxen (Naprosyn), naproxen sodium (Anaprox), and ketorolac (Toradol). In many cases of mild migraine, acetaminophen or ibuprofen plus sleep will be enough to stop the headache. Prescription medications are not always needed.

The serotonin receptor agonists (?triptans?) include almotriptan (Axert), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig). These can be very effective in certain patients. They should not be used in basilar, hemiplegic, and ophthalmoplegic migraine due to potentially serious side effects.

Ergot derivatives are older medications that are today usually used only for severe intractable headaches.

The prescription medications may have serious side effects, which should be discussed with a physician prior to treatment. There is a limit to how frequently they may be used in any given period. If this limit becomes a problem, preventive medications should be considered.

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