Migraine Therapy

Migraines are recurrent headaches associated with nausea and vomiting.  These incapacitating, severe headaches can last for hours to days to weeks.

Let’s go through the physiology of a migraine headache.  First we get a contraction of intra-cranial vessels.  This is not the migraine yet, but the person gets an aura (getting a sensation that’s telling them it’s coming) in the form of changing vision or hearing.  Something strange may be going on with their vision or in their hearing or both.  Typically this is the time they need to take the medication before it hits.  To compensate for these blood vessels contracting, serotonin is released, causing dilation of these vessels which impinges the nerves and causes the headache pain.  We want to take the medication before the vasodilation occurs.

If a person is prone to migraine headaches, some of the triggers include tension, medications (birth control pills) and some foods such as chocolate and milk.

Acute Therapy

Again, just like with gouty arthritis we have acute and prophalactic therapy.

If we have a migraine already, then we need to constrict the blood vessels so it won’t impinge on the nerves anymore.  The problem with these drugs is they are not selective to the intracranial blood vessels.  This will put a strain on the heart because all the blood vessels constrict.

The most commonly utilized drugs are the triptans.  They are limited to 2 doses only.  Again, just like for depression and rheumatoid arthritis, there’s no science to this, it’s a guessing game.  These can also lead to nausea.

• Sumatriptan (Imitrex) – inj, p.o., inh  – You could inject it or inhale it nasally because it can lead to nausea.
• Rizatriptan (Maxalt) – p.o. – Oral but also come with under the tongue solubilized tablets.
• Zolmitriptan (Zomig) – p.o.
• Ergotamine (Caffergot) – If they can’t have the triptans, they could have ergotamine.

Prophylactic Therapy

If a person is prone to migraines too often, we need to do something about it.  That means they have to do something every day of their life to decrease the risk of migraine.

Beta-blockers:  Nobody knows why they work.  It was found people taking beta blockers for other reasons were not getting migraines and it got approved for that use.  Some anti-seizure drugs have been approved as well but they are harder to tolerate.

• Propranolol (Inderal)
• Atenolol (Tenormin)