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:
- Trigger Avoidance: refers to dietary and lifestyle modifications to avoid the identified triggers of your migraine.
- Acute Treatment: refers to medicines you can take when you have a headache to relieve the pain immediately.
- 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 Relievers Mild 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 Names | Route of Administration | Possible Side Effects | Precautions |
| Aspirin (Disprin®) | Oral Tablet Dissolvable solution | GI irritation, increased bleeding time, sensitivity | Active peptic ulcer, bleeding tendency, severe liver disease, 3rd trimester pregnancy |
| Paracetamol (Panadol®) | Oral Tablet Dissolvable solution | Very 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 Suppository | Oral Tablet, Dissolvable solution Suppository | GI upset, increased risk bleeding, dizziness, fatigue | Patients with a history of Gastric ulcers, Asthma, and Pregnant women should avoid |
| Anti-Nausea Medications Often in combination with pain-relievers | |||
| Specific Names | Route of Administration | Possible Side Effects | Precautions |
| Metoclopramide (Maxolon®) Prochlorperazine (Stemetil®) | Oral Tablet Injection Suppository | drowsiness and fatigue, movement disorder | Patients 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 Names | Route of Administration | Possible Side Effects | Precautions |
| Sumatriptan (Imigran®) Zolmitriptan (Zomig®, Zoltrip®) Naratriptan (Naramig®) Rizatriptan (Rizatriptan®) Eletriptan (Relpax®) | Oral Tablet Injection Intranasal Spray | unpleasant 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 Names | Route of Administration | Possible Side Effects | Precautions |
| Amitriptyline (Endep®) Nortriptyline (Allegron®) | Oral Tablet | Drowsiness, 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 Names | Route of Administration | Possible Side Effects | Precautions |
| Metoclopramide (Maxolon®) Prochlorperazine (Stemetil®) | Oral Tablet Injection Suppository | drowsiness and fatigue, movement disorder | Patients with severe kidney and/or liver disease should avoid. |
| Beta Blockers Originally developed to treat high blood pressure | |||
| Specific Names | Route of Administration | Possible Side Effects | Precautions |
| Topiramate (Topamax®) | Oral Tablet | Abnormal 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 Beta | Oral Tablet | Weight gain, hair loss, altered liver function, memory impairment, | Avoid if pregnant or sexually active without |
| Blockers for preventing migraine | Oral Tablet | confusion, altered blood | contraception |
| Gabapentin | Oral Tablet | Lightheadedness, drowsiness, dizziness, and balance problems. | Avoid abrupt withdrawal, use in severe psychiatric disease |
| Calcium-Channel Blockers Originally developed to treat high blood pressure | |||
| Specific Names | Route of Administration | Possible Side Effects | Precautions |
| Verapamil (Isoptin®, Isoptin®) Nifedipine (Adalat®, Addos XR®) | Oral Tablet | Constipation, 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.