Headache Treatment Center

Common Questions About Migraine Treatment

1. I have a severe headache at least once a week, and I usually just rest until it goes away. Sometimes I have to take the day off, and I lose the entire day. What is the best treatment for these severe headaches?
   A number of strategies can be used to treat severe migraine headaches. Generally, just about any pain medicine that you can think of has been tried for migraines. Some people respond to a certain drug or type of drug and others prefer something different. Your doctor will work with you to meet your individual needs. 
2. Sometimes the headaches are not too severe and don’t last very long. How do I know when I need to take something to avoid a really severe migraine?
   A headache diary is the most effective way to learn about your migraines and how your headaches can vary from one to the other. Some symptoms such as the migraine aura, light sensitivity, nausea can indicate that a migraine episode is going to be severe. It is important to recognize your individual pattern. Many people successfully “abort” any migraine episodes to keep them from becoming severe. This allows them to be confident that they don’t have to wait to see if the headache is going to be severe.
3. What types of over-the-counter migraine drugs are available to treat severe migraines?
   All pain medications have been used to treat a severe migraines, but with varying success rates. The anti-inflammatory medications like ibuprofen (Advil®, Motrin®) and naproxen sodium (Aleve®, Naprosyn®) are effective in many people. One major disadvantage of these medication is stomach upset, and can cause ulcers and bleeding in some individuals. The other types of over-the-counter pain medications contain acetaminophen (Tylenol®) with or without caffeine. For people that receive benefit from these medications and do not need them frequently (no more than once per week), the medications are generally safe. The primary disadvantage of these medications is that they are not effective in many people. 
4. What types of prescription medications are available to treat severe migraines?
   The prescription medications for migraine include the triptans (drugs like Imitrex, Maxalt, and Relpax), ergots (Cafergot®, Ergotamine®) and opioids or “narcotics” such as Lortab®, Percocet®, and Vicodin®. The triptans are drugs that work directly on the hormone (serotonin) in the brain and blood vessels responsible for migraine. The ergots work mainly to constrict the blood vessels, and opioids are potent painkillers that reduce the pain but are not known to work specifically on the mechanism that causes migraines.
5. How do I know which acute treatment is safest for me?
   It is important to have this discussion with your prescribing physician. Your medical history will be important to discuss prior to beginning a migraine treatment. If you have heart disease, kidney disease, stomach ulcers, or a history of strokes, your physician will likely avoid certain types of migraine medications such as the ergots, triptans, and anti-inflammatory medications. Some people with migraines have severe neurologic symptoms such as paralysis, difficulties with vision, or speech impairments during their migraines. These persons need to avoid the migraine medications which cause blood vessel constriction, called “vasoconstrictors.” 
6. What other medications are available for acute migraines?
   Two other medications that are commonly used for severe migraines are drug combination preparations called isometheptene/dichloralphenazone/acetaminophen (Midrin®) and butalbital/caffeine/acetaminophen combinations (Fioricet®, Fiorinal®). These medications have a combination of a pain reliever (acetaminophen or Tylenol®), a muscle relaxant with sedative properties, and a vasoconstrictor (caffeine, isometheptene). These medications should be used on a limited basis since they have been linked to the development of chronic headaches. 
7. I have severe headaches around once per month and I have to go to the emergency room because nothing my doctor prescribed works for my headaches. What should I do?
   Most persons with migraines who get severe, incapacitating attacks will need a migraine preventive medication for control of the severe attacks. It may take several weeks or a few months for the medication to be most effective in preventing the attacks, and most people can find a regimen which is effective. Some migraine treatments such as buprenorphine nasal spray (Stadol®), dihydroergotamine nasal spray (DHE nasal), and oral opioids can be used to prevent visits to the emergency room. 
8. Once my headache is relieved, I still have a lot of nausea and vomiting. Are there any medications which can help with this?
   Many persons with severe nausea and vomiting during migraine attacks will benefit from medications which directly address this symptom. Oral medications such as promethazine (Phenergen®), prochlorperazine (Compazine®) and metaclopramide (Reglan®) can be very effective during a migraine complicated by nausea. In persons who cannot keep medications or fluids down without vomiting, suppositories may be required. Consult your doctor immediately if your vomiting persists and you become faint, dizzy, or experience other symptoms of dehydration. 
9. I have been to the emergency room and had CT scans of my brain because of my headaches. Why are these scans performed?
   When a person experiences a severe headache, doctors must perform a thorough evaluation to determine whether or not the headache is a symptom of another, more serious, neurological condition. Headaches that are “the worst headache of my life”, and/or associated with neurological signs or symptoms can be signs of serious conditions such a cerebral aneurysm (enlarged blood vessel in the brain), hydrocephalus (too much fluid on the brain), or meningitis (infection in the lining of the brain).