Drugs Used in Prevention of Migraine
There are several drugs that can be used for prophylaxis of migraine headache. Some of the drugs which have efficacy as a preventive agent for migraine but have considerable side effects and are not commonly used. Many of the drugs with efficacy as preventive agent in migraine are not approved by the FDA and some are approved by FDA for prophylaxis of migraine (local rules should always be sought before prescribing a drug for prophylaxis of migraine). Some drugs are not available in some countries and availability is an important factor.
FDA has approved propranolol, timolol, sodium valproate, and topiramate for prophylactic treatment of migraine. Methysergide is also approved by FDA for prophylaxis of migraine, but not available in the United States. There are also many more drugs which shows efficacy in prevention of migraine but not approved by FDA for prophylaxis of migraine.Categories: Migraine Headache Tags:
Prevention of Migraine
“Prevention is better then cures” and in case of migraine also this is true. But the question is who should be given prophylaxis treatment for migraine?
The right candidates for prophylaxis of migraine are patients with high frequency of migraine headache or if frequency is increasing, if patient is not responding adequately to abortive treatments or if patients are not responding to abortive treatments of migraine are good candidates for prophylaxis treatment of migraine. Clinicians/doctors generally give prophylactic medication for migraine if a patient is getting 5 or more attacks of migraine headache per month. This is a rough guideline, but migraine patients may require prophylaxis with lesser number of acute attacks per month, especially if the attacks are severe.Categories: Migraine Headache Tags:
Complications in Migraine Treatment
Patients of migraine may have certain complications, which may cause problem in treating the patients with migraine headache. The complications that may be present in managing migraine headache are recurrence of headache, poor tolerance to common and acute treatment of migraine, very rapidly developing symptoms of migraine headache. All of these complications can pose a problem in managing patients with migraine.
What to do if there is recurrence of migraine headache even after treating the patient adequately?Categories: Migraine Headache Tags:
Rapidly Developing Migraine
Migraine in some patients may develop very rapidly, which need to be managed promptly. The commonly used drugs for management/treatment of migraine may not be effective in case of rapidly developing symptoms of migraine. If a patient is developing symptoms of migraine headache very fast, the treatment should be initiated as early as possible before the symptoms become severe. Prompt administration of correct drugs by correct route of administration is important in managing the patients with rapidly developing migraine.
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What to do if Nausea & Vomiting Occurs in Migraine?
The commonly used medications in management/treatment of migraine headache are generally given by oral route. If early nausea or vomiting occurs while treating the patient with migraine, it may cause some technical difficulty in managing the patients with migraine headache.
The early nausea or early vomiting may be due to the drugs used (as many orally used drugs can cause nausea and/or vomiting as their side effects) for management of migraine. The early nausea and vomiting may not be related to the drugs administered for management of migraine. Nausea and vomiting are also common symptoms of migraine headache. Nausea is a very common side effect of migraine and it occurs in approximately 87% of the patients with migraine. Vomiting is also a common symptom of migraine (vomiting occurs in approximately 56% of patients with migraine), although it is not as common as that of nausea.Categories: Migraine Headache Tags:
What to do in Menstrual Cycle Related Migraine?
Some women may complain of getting headache (may be migraine headache) in relation to menstrual cycle. Management or treatment of these type of migraine in women may be difficult and commonly used drugs for migraine (like NSAIDs, analgesics) may not work in these women, even for mild to moderate migraine headaches where generally NSAIDs and analgesics works well for others. The menstrual cycle related headache (migraine) may be occur during menstrual cycle or just before menstrual cycle starts.
The migraine headache that occurs in relation to menstrual cycles can be managed in two ways, the first and preferred way is to give preventive treatment and the other option is to treat the symptoms as and when the symptoms of migraine headache appear.Categories: Migraine Headache Tags:
What to do if NSAIDs/analgesics fail in Migraine Management?
It becomes difficult to decide what to do if a particular regimen of treatment of migraine fails. Here are some of the clinical situations when one regimen of migraine management fails and what to do after it fails: What to do if common analgesics and commonly used non steroidal anti inflammatory drugs fails in managing migraine? In mild to moderate migraine attacks, generally NSAIDs/analgesics are used as first line of management. If commonly used non steroidal anti inflammatory drugs and analgesics like aspirin or paracetamol fails, than there are a few treatment/management options available to a patient with migraine headache and the options are given here:
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Role of NSAIDs in Migraine Management
NSAIDs or non steroidal anti inflammatory drugs have and play a very important role in treatment/management of migraine headache, especially in mild migraine. Commonly used non steroidal anti inflammatory drugs in migraine are naproxen (at the dose of 220 to 550 mg orally two times a day), ibuprofen (at the dose of 400 mg every 3 to 4 hourly), tolfenamic acid (at the dose of 200 mg, the dose can be repeated after 1 to 2 hours) etc.
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Role of Other Drugs (non dopamine agonists) in Migraine Management
Here the word “other drugs” means, other than commonly used 5-HT1 agonists, common and simple analgesics (pain relievers), NSAIDs, dopamine antagonists etc. The roles of the other drugs are also very important in management of migraine headache, especially if migraine is not controlled by the commonly used drugs.
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Role of Dopamine Antagonists in Migraine Management
Dopamine antagonists have their role in management of migraine headache. The main role of an oral dopamine antagonist is being the role of adjuvant. The common dopamine antagonists which are used in management of migraine are metoclopramide, chlorpromazine and prochlorperazine.
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