Head Ache




Migraine headaches are one of the most common problems seen in emergency departments and doctors' offices. Migraines are due to changes in the brain and surrounding blood vessels.

Migraine headaches typically last from 4-72 hours and vary in frequency from daily to fewer than 1 per year. Migraine affects about 15% of the population. Three times as many women as men have migraines. More than 80% of people with migraines (called migraineurs) have other members in the family who have them too.

Migraines can be treated with 2 approaches: abortive and preventive.

Abortive:

The goal of abortive therapy is to prevent a migraine attack or to stop it once it starts. The prescribed medications stop a headache during its prodrome stage or once it has begun and may be taken as needed. Some can be administered as a self-injection into the thigh; others, as a wafer that melts on the tongue. These forms of medication are especially useful for people who vomit during a migraine, and they work quickly.

Abortive treatment medications include the triptans, which specifically target serotonin. They are all very similar in their action and chemical structure. The triptans are used only to treat headache pain and do not relieve pain from back problems, arthritis, menstruation, or other conditions.

Sumatriptan (Imitrex)

Zolmitriptan (Zomig)

Eletriptan (Relpax)

Naratriptan (Amerge, Naramig)

Rizatriptan (Maxalt)

Frovatriptan (Frova)

Almotriptan (Axert)

The following drugs are also specific and affect serotonin, but they affect other brain chemicals. Occasionally, one of these drugs works when a triptan does not.

Ergotamine tartrate (Cafergot)

Dihydroergotamine (D.H.E. 45 Injection, Migranal Nasal Spray)

Acetaminophen-isometheptene-dichloralphenazone (Midrin)

The following drugs are mainly used for nausea, but they sometimes have an abortive or preventive effect on headaches:

Prochlorperazine (Compazine)

Promethazine (Phenergan)

The next drugs are weak members of the narcotic class. They are not specific for migraine, but they can help relieve almost any kind of pain. Since they are habit forming, they are less desirable than the specific headache drugs listed above. These drugs should be used primarily as a "backup" for the occasions when a specific drug does not work.

Butalbital compound (Fioricet, Fiorinal)

Acetaminophen and codeine (Tylenol with Codeine)

Preventive:

This type of treatment is considered if a migraineur has more than 1 migraine per week. The goal is to lessen the frequency and severity of the migraine attacks. Medication to prevent a migraine can be taken daily. Preventive treatment medications include the following:

Medications used to treat high blood pressure - Beta-blockers (Propranolol - Inderal), calcium channel blockers (Verapamil - Covera)

Antidepressants - Amitriptyline (Elavil), Nortriptyline (Pamelor)

Antiseizure medications - Gabapentin (Neurontin), Valproic acid (Depakote), Topiramate (Topamax)

Some antihistamines and anti-allergy drugs, including diphenhydramine (Benadryl) and cyproheptadine (Periactin)

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