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Migraine Medication
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Migraine Medication

Ok I'm 25 years old. I have been suffering Migraines for almost 15 years . Maybe its me But .. Does any medications work .. I have been on almost everything..  I'm so sick of popping different pills every 6 hours
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768044_tn?1294227036
Hi MsConfusedone,

You mention that you have been on almost everything, can you be more specific? It would help knowing exactly what you have tried so that I could suggest medications that you have not tried.

Also, how many migraines do you get per month?

Yes, most migraine medications do work well for most people. But, not everyone has the same success with all medications.

For acute treatment of migraine headaches, first line treatment is triptans. There are currently 7 triptans on the market, plus one triptan that is also mixed with an NSAID called Naproxen. I believe that fast acting triptans are the best in most situations because they work the fastest. Fast acting triptans come in orally disintegrating tablets or nasal sprays. I personally use Zomig Nasal Spray and find it works extremely well. I also have found great success with Maxalt-MLTs. Statistically, compared to the other triptans, Imitrex Injection, Zomig Nasal Spray and Maxalt-MLTs have the highest success rates for total pain relief in the shortest amount of time. Although, everyone is different and all of the triptans on the market have been proven effective in clinical trials, so which one is best for you is really a personal choice that should be made by you and your doctor.

Analgesics are also sometimes used to treat migraines, but normally, these should be used in combination with triptans or if triptans fail to provide pain relief. Over-the-counter analgesics such as ibuprofen, acetaminophen and ASA can cause rebound headaches and it is often suggested that migraineurs avoid over-the-counter pain killers. Instead of over-the-counter analgesics, prescription analgesics that are more appropriate for migraine headaches are often prescribed. There is an NSAID called Naproxen that is often prescribed for migraine headaches and Naproxen is less likely to cause rebound headache than the other NSAIDs. Barbiturates are sometimes prescribed, but for most these are not as effective as other treatments and they can cause rebound headaches. Barbiturates also have some side-effects associated with them and addiction potential. Opiates are another analgesic that is sometimes prescribed for migraines, although these too do not work for the vast majority of migraine headaches and also can have high side-effect profiles and high-dependency profiles. If an opiate is prescribed, it is important that it is not an opiate with a high side-effect profile, as such a medication will only worsen the migraine symptoms of nausea and vomiting. Morphine, for example, has a high side-effect profile and causes nausea and vomiting in the majority of migraine patients. There are opiates with much lower side-effect profiles than morphine that are usually more appropriate for treating migraine headaches, such as hydromorphone, although such prescribing decisions should be left entirely up to your physician.

Antiemetics can be used in combination with triptans or in combination with analgesics. There is a specific antiemetic called Metoclopramide that helps with migraine pain as well as nausea and vomiting. Since Metoclopramide helps with migraine pain as well as being an antiemetic, it can be taken on its own as an acute migraine medication. Usually Metoclopramide is prescribed with another migraine medication though, such as a triptan or an analgesic.

These are the "usual" first line and second line acute migraine treatments that pop to mind. I can go into more specifics or suggest others if you would like, but please give me more information on what you have tried in the past so that I don't suggest something you have already tried.

Also, there is preventative migraine medication. Preventative migraine medication is often prescribed if someone gets 15 or more migraines a month.

There are 3 first-line daily preventative treatments to choose from: antidepressants (in the tricyclic category, specifically Amitriptyline or Nortriptyline); anticonvulsants (such as valproic acid or topiramate); and beta blockers (such as nadolol or propranolol). If none of those work, then options include: Botox injections or calcium channel blockers. Amitriptyline works very well and is the first-line treatment in the anti-depressant category, but only at the correct dose (at least 30mg), which can be accompanied by side-effects so many people stop before they see improvement due to side-effects. I couldn't personally take Amitriptyline due to side-effects. Divalproex sodium/sodium valproate is a first-line treatment in the anticonvulsant category because it is the most successful in that category, but Topamax is becoming very popular. Propranolol is the first-line treatment in the beta-blocker category, also because it is the most effective in that category. In the Calcium Channel Blocker category, Verapamil seems to be the most effective.

Supplements that can be taken for preventative treatment include: Vitamin B2 @ 400mg per day; Magnesium @ 400mg to 600mg per day; Coenzyme Q10 @ 300mg per day. Out of these, the B2 and Magnesium have been proven and shown effective in scientific clinical trials. The Coenzyme Q10 has shown some effectiveness, but it has also failed to show effect in some trials as well.

Hope some of that information helps. Let me know.

- marilee
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534785_tn?1329595808
I'm currently taking the beta-blocker Propranolol (120 mg/day), which requires I only take one pill per day. Aside from feeling really lethargic throughout the day, it has done a great job of preventing migraines and the daily headaches I used to get. If you haven't given beta-blockers a try yet, I definitely recommend doing so!

Good luck and I hope you find relief soon.
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1125820_tn?1265288046
Hi, Ok my list ..
Hydrocone, Tylenol3, Maxalt,Elavil, zomig ,ultram, Relpax, amerge ,demerol, morphine, topamaxx, floricet,Imitrex, Naproxen .. OTc's make me sick when I have a migraine. nasle sprays,Effexor. thats the ones I remember I get at lease three a week . not to sure what all my triggers are yet . I wake up with them .

The only time I don't get Migraines is when I'm pregnant
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768044_tn?1294227036
Hi MsConfusedone,

Thank you for replying!

Okay, well, as for the acute medications:

Which Imitrex delivery methods have you tried? If you have not already tried Imitrex Injection, that is one of the triptans that works the best, so I would suggest asking your doctor about Imitrex Injection. The bioavailability of Imitrex tablets is pretty pathetic, honestly, so Imitrex Injection is VERY different then Imitrex tablets or Imitrex Nasal Spray.

Also, which Maxalt did you try? Did you try the regular Maxalt tablets or the Maxalt-MLTs? The Maxalt-MLTs are the orally disintegrating tablets. The Maxalt-MLTs work better than the regular Maxalt tablets. If you haven't tried Maxalt-MLTs yet, I would suggest giving those a try too.

Which Zomig did you try? If you haven't tried the Zomig Nasal Spray yet, then I highly recommend Zomig Nasal Spray. The bioavailability of Zomig Nasal Spray is even better than Zomig by IV... so it is also much better than Zomig tablets or Zomig rapid melts. Statistically, according to trial results, Zomig Nasal Spray is one of the best triptans.

I also don't think you mentioned any antiemetics. I think it would be really worth it talking to your doctor about Metoclopramide. It is really worth taking it along with your other migraine medications. It's been shown to improve pain relief if taken along with other migraine medications.


As for the preventative medications:

I don't think you mentioned a Beta Blocker. Like Jules77733 suggests, if you haven't tried a beta blocker yet, you might want to give that a try. Propranolol usually works the best. I personally take the beta blocker Nadolol.

I also don't think you mentioned a Tricyclic Antidepressant. Amitriptyline is a first-line preventative that has been proven to work very well. You might want to give Amitriptyline a try. If Amitriptyline has too many side-effects, you may want to try Nortriptyline.

You did mention that you have already tried an anticonvulsant, Topamax, but the other often prescribed anticonvulsant is Divalproex sodium/sodium valproate. In fact, Divalproex sodium/sodium valproate has been shown more effective than Topamax in trials. So, you may want to talk to your doctor about Divalproex sodium/sodium valproate.

You may also want to try Botox Injections.

You may also want to talk to your doctor about Calcium Channel Blocker. Verapamil is usually the Calcium Channel Blocker that is prescribed because it is usually the most effective.

Also, have you tried any of the supplements I mentioned yet? I think it would be worth trying the B2 @ 400mg daily and the magnesium @ 400mg to 600mg daily. I would personally start at no more than 400mg than magnesium daily, although trials have used between 400mg and 600mg of magnesium daily. But, higher doses of magnesium can result in stomach upset. So, it's better to start at 400mg of magnesium daily and then increase the dose slowly to 600mg if you don't see an improvement at 400mg.

Feverfew is also something that some people use. I wouldn't personally use it, but lots of people do use it for migraine prevention and find relief with it. Although it can be dangerous taking herbal treatments without consulting a doctor first, so please consult a doctor prior to taking Feverfew or any other herbal treatments, just as you would with prescriptions.

As for what you have already tried:

The Tylenol 3s and the Morphine aren't things I usually recommend to people, so I am not surprised that they didn't work. That is pretty normal that they didn't work. It is also normal for over-the-counters to nor work, like I said before, it is often suggested that over-the-counter medications should be avoided. Morphine tends to make migraine symptoms worse. A better opiate than morphine in terms of treating migraines is hydromorphone. You didn't mention hydromorphone, so you may want to talk to your doctor about hydromorphone.

The Effexor is an SSRI. SSRIs aren't a first-line migraine treatment, and there isn't much evidence that they work for migraines. So, I'm not surprised that the Effexor didn't work for your migraines either. Tricyclic antidepressants are the only antidepressants that have really shown to work in trials for migraines. Tricyclic antidepressants are antidepressants like Amitriptyline or Nortriptyline.

Let me know if there is anything in this list that you haven't tried yet! :) If you've tried all of these, then I will try to think of other medications. Keep in touch!

- marilee
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534785_tn?1329595808
I tried Topamax, myself, and it seemed to do an okay job at a low dose. I didn't have a chance to increase the dosage because my neurologist felt the side-effects were outweighing the benefits for me (particularly "feeling stupid", not being able to think of the right word or thought to finish my sentences, memory loss)--even at such a low dosage. I was only recently diagnosed with migraines (it's been about a year) even though I've experienced them for as long as I can remember, so I haven't tried too many drugs--I just stopped experimenting once I found that Propranolol improved my headache situation and I no longer had daily headaches. From what I understand, my neurologist went with a beta-blocker after trying Topamax because it was the next type of drug that was well-received by patients and resulted in few side-effects. He said I could try some other drugs, but the side-effects would become more serious and he didn't want to have me deal with that if I didn't need to.
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1125820_tn?1265288046
The Elavil is the Amitriptyling ... The only these you mentioned that I have yet to try are the Supplements (witch I'm going to go get today.)  metoclopramde , Propranolol, Nadolol  and the Verapamil .. So I will talk to my doctor anad see what he has to say ...
The Effexor and the Elavil  worked by the side effects was messing up my life ..
I took a beta blocker before and only worked for a little while.

Most medications I take don't work for me longer then four or five months
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