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Information on Migraine – Part II

Patient information on Migraine Part II

What treatment is available for Migraine?

  • Migraine headache treatment depends upon the frequency, severity, and symptoms of your headache.
  • There are 3 parts to your MEG physician’s approach to treatment:
    1. Trigger Avoidance: refers to dietary and lifestyle modifications to avoid the identified triggers of your migraine.
    2. Acute Treatment: refers to medicines you can take when you have a headache to relieve the pain immediately.
    3. Preventive Treatment: refers to medicines you can take on a regular (usually daily)basis to prevent headaches in the future.

More information about Migraine Part I

Trigger Avoidance

  • Patients may be encouraged to keep a diary of migraine triggers, and then avoid those triggers if possible (SEE PART 1)

Acute treatment

  • The pain of migraines can be tough to get rid of. Treatment is most likely to work if you take it at the first sign of an attack (e.g.at the first sign of aura if one occurs, or when pain begins).
  • In some people, an aura occurs before the migraine. Therefore, an aura can serve as a reliable warning that a migraine headache is on the way, and should be the signal to take migraine medication.
Pain RelieversMild migraine attacks may respond to pain relievers, some of which are available without a prescription.

Often recommended first for mild to moderate migraine attacks. However, they should NOT be used too often because overuse can lead to medication-overuse headaches or chronic daily headahces.

If you respond to a pain reliever, continue taking it with each attack, as long as you do not take it more than once or twice per week.

Specific NamesRoute of AdministrationPossible Side EffectsPrecautions
Aspirin (Disprin®)Oral Tablet Dissolvable solutionGI irritation, increased bleeding time, sensitivity Active peptic ulcer, bleeding tendency, severe liver disease, 3rd trimester pregnancy
Paracetamol (Panadol®)Oral Tablet Dissolvable solutionVery Rare – rash, bronchospasm.Patients with severe liver or kidney disease should avoid.
Non-Steroidal Anti-inflammatory Drugs (NSAIDS) Ibuprofen (Nurofen®, Advil®, Panfen®) Indomethacin (Indocin®) Naproxen (Advil®)Oral Tablet, Dissolvable solution SuppositoryOral Tablet, Dissolvable solution SuppositoryGI upset, increased risk bleeding, dizziness, fatiguePatients with a history of Gastric ulcers, Asthma, and Pregnant women should avoid
Anti-Nausea Medications

Often in combination with pain-relievers

Specific NamesRoute of AdministrationPossible Side EffectsPrecautions
Metoclopramide (Maxolon®) Prochlorperazine (Stemetil®)Oral Tablet Injection Suppositorydrowsiness and fatigue, movement disorderPatients with severe kidney and/or liver disease should avoid.
Triptans

Migraine-specific drugs. Prescribed if a simple pain-reliever doesn’t control your headache.

>70% of people get pain relief within one hour of using a triptan.

>90% of people notice improvement within 2 hours.

Specific NamesRoute of AdministrationPossible Side EffectsPrecautions
Sumatriptan (Imigran®) Zolmitriptan (Zomig®, Zoltrip®) Naratriptan (Naramig®) Rizatriptan (Rizatriptan®) Eletriptan (Relpax®)Oral Tablet Injection Intranasal Sprayunpleasant taste (spray), dizziness, feeling of warmth or flushing (tablet/injection), tingling in arms or legs (Injection)People with high blood pressure, coronary artery disease, pregnancy, severe kidney or liver disease should not use

Preventive treatment

  • Preventive treatment effectively controls migraine headaches in most people
  • Benefits of this treatment may not be evident for three to four weeks.
  • In some cases, both acute treatment and preventive treatment are necessary to adequately control migraines
Tricyclic Anti-depressants

Originally developed to treat depression

Used in much lower doses than traditionally used for depression

Specific NamesRoute of AdministrationPossible Side EffectsPrecautions
Amitriptyline (Endep®)

Nortriptyline

(Allegron®)

Oral TabletDrowsiness, dry mouth & eyes, constipation, palpitations, weight gain at higher doses, blurred vision, urinary retention. Confusion can occur, particularly in older patients.Patients who have a history of seizures, significant psychiatric disease, liver disease, urinary retention or glaucoma should avoid these medications
Anti-Nausea Medications

Often in combination with pain-relievers

Specific NamesRoute of AdministrationPossible Side EffectsPrecautions
Metoclopramide (Maxolon®) Prochlorperazine (Stemetil®)Oral Tablet Injection Suppositorydrowsiness and fatigue, movement disorder Patients with severe kidney and/or liver disease should avoid.
Beta Blockers

Originally developed to treat high blood pressure

Specific NamesRoute of AdministrationPossible Side EffectsPrecautions
Topiramate (Topamax®)Oral TabletAbnormal sensations (tingling), fatigue, nausea, changes in taste, loss of appetite, diarrhoea, and weight loss. More severe side effects can occur, including difficulty with thinking and concentration.Avoid if pregnant. Avoid if strong history psychiatric illness
Valproate (Valpro®) Works as well as BetaOral TabletWeight gain, hair loss, altered liver function, memory impairment,Avoid if pregnant or sexually active without
Blockers for preventing migraineOral Tabletconfusion, altered bloodcontraception
GabapentinOral TabletLightheadedness, drowsiness, dizziness, and balance problems.Avoid abrupt withdrawal, use in severe psychiatric disease
Calcium-Channel Blockers

Originally developed to treat high blood pressure

Specific NamesRoute of AdministrationPossible Side EffectsPrecautions
Verapamil (Isoptin®, Isoptin®) Nifedipine (Adalat®, Addos XR®)Oral TabletConstipation, low blood pressure, dizziness, nausea Calcium channel blockers may lose their effectiveness over time, but this can sometimes be remedies by taking a higher dose, or switching to a similar drug.Avoid in patients with low blood pressure, heart failure, aortic stenosis.

Concerns or questions?
You can contact your ENT Specialist at the Melbourne ENT Group (MEG):

  • Phone: 1300-952-808
  • Email: admin@melbentgroup.com.au
  • Website: www.melbentgroup.com.au

Your GP is also the best contact for ongoing care and concerns.

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