Migraine Medication

What is a Migraine?

A migraine is a severe type of headache that can cause strong pain, nausea, vomiting and sensitivity to light and sound. They generally last anywhere between 3 hours 3 days. Due to their severe symptoms, they often debilitate the migraine suffer, making them unable to live normally.

Migraines can affect people of all ages, often tied closely to family history. According to a 2018 report, up to 4.9 million Australians suffer from migraines. Of this 4.9 million 71% are women and a heavy majority (86%) are of working age. The financial cost of this totals 35.7 billion, but more importantly, the physical and mental stress this places on those with migraines is immense. 

Migraine Diagnosis, Symptoms and Types

Diagnosis & Symptoms

A migraine attack can be difficult to decern from the various types of headaches for most people. It is important you do not self diagnose, yet there are some distinct characteristics of migraines that set them apart from headaches. To diagnose a migraine a doctor will run through a series of questions relating to symptoms, looking for identifying characteristics and symptoms to rule out other conditions. Only in exceptionally complex or unusual cases will an MRI or CT scan be required for diagnosis.

Chronic migraines are diagnosed when they occur more than 15 days per month for 3 months or more.

The symptoms will vary from person to person although some are more common than others. The common symptoms can include moderate or severe pain accompanied by nausea, pain on one side of the head, an aura (visual or sensory disturbance), a worsening during movement, pins and needles, dizziness and vertigo, a throbbing sensation, sensitivity to light and sound, vomiting and a long duration.

More severe symptoms are generally the result of more specific types of migraines. These symptoms are generally more debilitating.

Types

Aura

The two most common types are those with aura often called classic migraines, or those without aura often called common migraines. An aura is a visual or sensory disturbance that can cause difficulty focusing, flashes of light in vision, blind spots, and lines in your vision.

Menstrual Migraine

Thought to be the result of the drop in estrogen around menstruation, a menstrual migraine will occur primarily triggered around the time of a period.

Chronic Migraine

Frequent migraines of 15 days a month for 3 months or more are classified as chronic migraines.

Vestibular Migraine

This migraine is accompanied by dizziness and vertigo. Typically this will last for the duration of the attack.

Aura without pain

Some people will experience the effects of a migraine aura but without the characteristic pain of a migraine.

Abdominal Migraine

Most common in young children, this migraine results in abdominal pain, nausea and vomiting.

Migraine Causes

The exact cause of migraines is still unknown. The most likely cause according to research is the temporary widening of blood vessels in the head. It’s also thought that a change in the way the trigeminal nerve and nervous system interacts with the brainstem has a major role in migraine pain.

What is known about migraine headaches is that they often have a trigger. There are a number of general migraine triggers, although each person will generally find their migraine triggers vary.

Triggers can include:

• Stress
• Drinking - alcohol or stimulants such as coffee and energy drinks
• Hormone changes - hormone changes before menstruation, pregnancy, oral contraceptive pills and menopause
• Diet - missing meals or consuming certain foods
• Sleep pattern - too much or too little sleep
• Weather patterns - changes in weather and pressure
• Overstimulation - sensory overload from bright lights, loud noises, strong smells

It is recommended to keep a diary of your triggers may help to prevent migraines in future.

Migraine Treatments

There are three major methods to treat migraines. There are medicines that are used to ease the pain and other symptoms, medicines you can use to prevent the onset of migraines and lifestyle changes you can make to avoid migraines.

Migraine Medications

Triptans

Begin Assessment

These are a class of medicines that are used to ease the symptoms and shorten the duration of a migraine. They come in tablets, wafers and nasal sprays and are most effective when taken at the first sign of a migraine. Their effectiveness will drop the later they are taken in a migraine attack. In studies, up to 76% of patients had their headaches relieved by this class of medicine.

They work by counteracting the widening of the blood vessels in the head, narrowing them back to normal size, allowing for normal blood flow.

The side effects of these treatments can be dizziness, facial flushing, temporary high blood pressure, drowsiness and feeling hot or cold. Not everyone will experience these, however if you do, it is best to speak to your doctor or a health professional. The overuse of these medicines can lead to medication overuse headaches which should be avoided.

Pain Relief

These are usually non-steroidal anti-inflammatory drugs (NSAIDs) or analgesics like paracetamol. These are usually effective in relieving pain brought on by migraines. The regular use of these medicines should be monitored by a doctor as they can cause side effects such as gastric ulcers if used too often. Narcotic or opioid medicines are only reserved for the most severe cases and are not commonly used anymore for migraines due to their risk for addiction and side effects.

Nausea and Vomiting (Antiemetics)

These are used to relieve nausea and vomiting commonly associated with migraines. These medicines will work on the receptors that control nausea and vomiting, greatly reducing nausea and the urge to vomit.

Preventative Treatment

These treatments are used in those who frequently suffer migraine attacks requiring treatment at least 4 days per month. People are often trialled on the medicines for 2-3 months and monitored for effectiveness and side effects.

There are a number of drug classes that can be used to prevent migraines including beta blockers, calcium channel blockers, tricyclic antidepressants, medicines used in epilepsy and CGRP inhibitors. The use of these medicines should be closely monitored by your doctor.

Lifestyle Management of Migraines

In addition to migraine medication, lifestyle decisions can have a great impact on the frequency and severity of migraines. In the beginning, it can be useful to keep a diary listing foods, drinks, activities, weather, stress, hormone changes and other potential triggers in order to find what causes YOUR migraines. While not always possible, once you are aware of your triggers, you may be able to avoid them entirely, effectively preventing migraines.

Other long term strategies include adopting a physically healthier lifestyle with regular exercise, sleep and a balanced diet. This promotes blood vessel health and can reduce risk factors.

Mental relaxation strategies can be useful to relieve tension and stress, two major risk factors for developing migraines. To do this you can take up yoga or meditation which can greatly reduce the impact of stress on the body through stress reduction techniques. For those who do not enjoy these activities, massage or acupuncture can also assist.

If a migraine has already begun, you should avoid outside simulation by resting in a dark and quiet room, away from stress. This should help with the sensory disturbances you may experience by limiting your exposure to light, sound and smell.

If migraines are affecting your ability to work and causing you to take sick leave, you can request a medical certificate if required by your employer.

Migraine Frequently Asked Questions

How to get rid of a migraine?

To get rid of a migraine you can use a combination of medicines and lifestyle advice. Take symptomatic relief such as NSAIDs and analgesics and move yourself to a dark, quiet place to avoid stimulation.

How to cure migraines?

Migraines are cannot be cured permanently however you can greatly reduce your risk of getting one. Having a healthy diet, sleep pattern, avoiding triggers and exercise can all reduce your migraine risk. If migraines occur frequently, speak to your doctor about preventative medicines.

How long can a migraine last?

A migraine will generally last between 3 hours to 3 days depending on the severity and treatment. Some treatments may decrease the length or severity of a migraine if taken at the right time. Speak to your doctor about treatments that would be right for you.

Written by Clinical Pharmacist Tyson Wilkman