Prescription Pain Relief
| Q: |
When is it appropriate to use prescription analgesics for migraine attacks?
| | A: |
Analgesics, both simple and combination, must be avoided, unless
no other medications are available. During pregnancy and for people who
cannot take triptans, ergotamine-related medications, or NSAIDs, the use
of prescription analgesics may be the only option. If analgesics are
used, they must be limited to no more than twice a month. They should
never be the first choice for attacks simply because they are cheap as
overuse can lead to medication overuse headaches.
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Prescribed analgesics
Medications that are
prescribed to combat the pain of migraine may be combination analgesics
or an opioid analgesic on its own. The combination analgesics consist of
acetaminophen and/or aspirin together with one or more of the
following: caffeine, codeine, or sedatives (butalbital, isometheptene,
or dichloralaphenazone).
Prescribed analgesics
are generally much stronger than their over-the-counter equivalents.
They should be taken carefully and never excessively because if they are
overused they can cause more headaches and also place you at
significant risk of addiction.
Opioids
Hydrocodone 5mg Codeine 30–60mg
Combination analgesics
Acetaminophen 325mg with caffeine 40mg and codeine 30mg Aspirin 325mg or acetaminophen 325mg with caffeine 40mg plus butalbital 50mg with or without codeine 30mg Acetaminophen 325mg, isometheptene 65mg, and dichloralaphenazone 100mg
Prescription Abortive Therapy
| Q: |
Which prescription medications are used to stop a migraine attack?
| | A: |
Prescription medications used to abort migraine attacks include
NSAIDs, triptans, ergotamine, and dihydroergotamine. These medications
may be used alone, in combination with each other, or with adjunctive
therapy, depending upon the attack. The headache and associated symptoms
of a migraine attack vary; therefore your abortive therapy regimen also
needs to be flexible.
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| Q: |
How will I know which medication to use?
| | A: |
Several prescription medications can be used for abortive
migraine treatment. Your doctor must tailor your abortive therapy to
your attacks. This may take time and means trying various medications
until you find a medication that completely aborts your attacks in 2
hours or less.
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| Q: |
How will I know when to use my abortive therapy?
| | A: |
You need to use your abortive medication as soon as a migraine
attack starts. During a migraine attack, you develop gastric stasis
(delayed emptying of the stomach), which decreases absorption of
medications. Abortive medication must be absorbed into the bloodstream
quickly for it to stop a migraine attack.
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| Q: |
How often can I take medications for a migraine attack?
| | A: |
You should not overuse abortive therapy. Ideally, you should not
have to use your abortive therapy more than 1 day a week. If you are
experiencing more than 1 attack a week then you need preventive
medication, or a medication change if you are using preventive therapy.
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| Q: |
How can I be more confident about my migraine attack treatment?
| | A: |
An effective abortive therapy is the key. It secures you in the
knowledge that if and when you have a migraine attack, you can control
it, instead of getting stressed and triggering another attack. As time
passes, you will become more confident in your abortive therapy.
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| Q: |
What are triptans?
| | A: |
The triptans are a group of medications that abort the migraine
process and stop the headache of a migraine attack. Their effectiveness
is time-dependent; if triptans are used too late in an attack they do
not work well. The addition of triptans to your abortive treatment can
help with the final step in “switching off” the migraine attack.
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| Q: |
How do triptans work?
| | A: |
The triptans “switch off” a migraine attack. A migraine attack
occurs because the “calming” brain chemical serotonin does not function
properly, resulting in the overactivity of brain cells and nerves. The
triptans work like serotonin, attaching themselves to serotonin
receptors and “switching off” the brain cells and nerves that are
excited during a migraine attack.
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| Q: |
Are there different types of triptan?
| | A: |
There are several different triptans: almotriptan, eletriptan,
frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan.
Each can be very effective, although they vary in effectiveness among
different people: what works for one person may be less helpful for
another. Your doctor will supervise you while you try each one to
determine which triptan is best for your migraine attack and has the
least side effects.
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| Q: |
Can medications combine a triptan and an NSAID together?
| | A: |
Yes. There is a new combination pill containing sumatriptan and
naproxen that is pending approval from the Food & Drug
Administration (FDA). It makes use of technology that allows the
different medications to be absorbed in a timely fashion. The triptan is
absorbed quickly to allow it to stop the migraine. The NSAID has been
changed to be absorbed quickly but stay longer in the blood, allowing
the pill to better abort the attack.
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| Q: |
What are the potential side effects of triptans?
| | A: |
The common side effects caused by the use of triptans are
tingling, warmth, dizziness, flushing, chest discomfort, and sensations
of pressure. These side effects vary from one person to another. One of
the triptans may cause you to experience side effects while another does
not. The side effects do not cause harm and usually last only a few
minutes. People with medication overuse headache may experience more
intense side effects.
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| Q: |
What are the safety precautions for the use of triptans?
| | A: |
Triptans can cause coronary vasospasm (spasm of arteries in the
heart), and therefore should not be given to people with coronary artery
disease or who have had a heart attack or to people with symptoms or
findings that indicate significant underlying cardiovascular disease.
The triptans can raise blood pressure so they should not be given to
people with uncontrolled hypertension. Hemiplegic and basilar migraine should not be treated with triptans, and triptans should not be used
during pregnancy. You need to avoid using different triptans, or a
triptan and an ergotamine-related medication, on the same day.
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| Q: |
How are ergotamine and dihydroergotamine used to treat migraine attacks?
| | A: |
Medications containing ergotamine are now rarely used because of
the development of triptans. However, dihydroergotamine can be
especially effective for severe migraine and migraine of long duration,
such as menstrual migraine. Dihydroergotamine is available in the form
of a nasal spray and an injectable formulation. The dose for the nasal
spray is 5mg and the dose for the injectable formulation is 0.5–1mg.
Ergotamine causes significant nausea and has more potential for causing
artery spasm than does dihydroergotamine.
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Prescribed NSAIDs
Most NSAIDs, except
aspirin, ibuprofen, and naproxen sodium, require a prescription. If the
migraine is not aborted in 2 hours or less with aspirin or other NSAIDs,
then these medications need to be combined with another migraine
abortive therapy, using either triptans or dihydroergotamine .
Table | NSAID | Form | Dosage |
|---|
| Tolfenamic acid | pill | 1,000mg | | Pirprofen | pill | 200mg | | Indometacin | suppository | 75–100mg | | Ketoprofen | suppository | 100mg | | Diclofenac | suppository | 75mg | | Ketorolac | injection | 60mg |
Safe use of NSAIDs
NSAIDs in pill form should be taken with food and water to avoid gastrointestinal upset. The
overuse of NSAIDs can cause stomach problems and should be avoided if
you have medical problems associated with gastro-intestinal bleeding or
ulcers, and/or are taking medications that interact with NSAIDs. NSAIDs
can complicate high blood pressure and heart disease; make sure your
doctor knows if you have one of these medical conditions.
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