Drugs for Attacks

Drugs for migraines can be divided into two camps; ones to prevent migraines from starting and ones to treat/terminate an attack once you are aware that the the cascade leading to a migraine has started

Terminating an attack

  • Triptans can be extremely effective in terminating an attack if taken early enough. They are the modern replacement to Ergotamine which has a lot of unwanted side-effects and were largely developed in the 1990s, because they are very much more selective in their actions
  • DO NOT use triptans for more than 10 days a month as they can produce Medication Overuse Headaches. However, provided there are gaps between when you take triptans you CAN take more than one triptan per attack. The idea that you can only take 10 tablets a month is a common but incorrect misunderstanding, and can lead to people splitting up their doses of triptans to use over more than 10 days, thus inadvertently causing medication overuse headaches
    • The headache in migraines is caused by the dilation of blood vessels in the coverings of the brain (called the meninges) and Triptans work by stimulating specific receptors (called 5HT receptors) in the small arteries within the meninges and around the Trigeminal Nerve, blocking the inflammatory process that starts the cascade resulting in a full-blown migraine.
    • The inflammatory response is intimately connected with the stimulation of the sympathetic nerve fibres within the Trigeminal Nerve, as well as where these fibres originate from in the base of the brain. By breaking the cascade of inflammation and sympathetic nervous stimulation the migraine is aborted.
    • Sumotriptan was the earliest triptan produced. There are now several others and if sumotriptan does not work other triptans may well be more effective. However sumotriptan is very effective and is the first line drug because the others are considerably more expensive

 

Treating the migraine once it has started

  • If you were not able to abort a migraine attack with triptans then you will want to control the headache, and in some people the vomiting, that the migraine causes.
  • Vomiting
    • If you suffer from vomiting then it is important to take your anti-emetic at the first sign of a migraine for once you start sickness then it will be difficult to keep any other medication down
    • Occasionally some people will require anti-emetic suppositories, but this is something to discuss with your GP
  • Headache
    • The first line of painkillers are called NSAIDs (Non-steriodal anti-inflammatory drugs). The commonest of these is Ibuprofen (a famous one being Neurofen). Others include Indomethacin, Naproxen and Diclofenac
    • They can be very effective but are not suitable for people with stomach ulcers because of increased risk of gastric bleeding and they may have to be taken with care in people with heart problems because of a small increase in risk of heart attacks. The versions of NDAIDs causing fewer stomach problems are
    • Other NSAIDs include Naproxen. This has the lowest incidence of heart problems but can cause stomach bleeding.
    • DO NOT take versions of ibuprofen that are mixed with codeine (eg Neurofen Plus) as these are very likely to cause Medication Overuse Headaches, which can be difficult to tell apart from migraines and which are difficult to treat. Click here for more information.