The question of whether or not migraine medications work is a long running debate. Most are expensive and few are very effective. It is estimated that around 12% of the population suffers from migraine headaches and many have 4 or more migraines a month. They tend to be more prevalent in women. Researchers estimate that around 18% of women , 6% of men, and 10% of children have migraines.
Axon Optics interviewed Medical Director & Principal Investigator of Medvadis Research Corporation Egilius L.H. Spierings, M.D., Ph.D. to learn more about migraine medications. Also a Clinical Professor of Neurology & Craniofacial Pain at Tufts University Schools of Medicine & Dental Medicine Dr. Spierings works with migraine patients and conducts clinical research on migraines. He is well acquainted with the struggles that migraineurs go through to find a migraine treatment that really works.
“Good treatment is hard to find,” Dr. Spierings says. “I tell patients to educate themselves so that they know what’s out there.”
The Cost of Migraines and Migraine Medications
Research shows that migraines are expensive – and the migraine medications aren’t the only things that are costly. People who have chronic migraines spend almost twice as much on their healthcare as non-migraineurs. The also use more than twice the amount of prescription medications and have six times as many medical services and diagnostic tests. The monthly average costs for healthcare for migraine sufferers versus those who do not have migraines is substantial:
- Chronic migraine: $145 per month
- Non-migraine: $89 per month
Prescriptions for migraines can be cost prohibitive for many patients. One study found that:
- 64% of patients surveyed said they had avoided migraine medication because it was too expensive.
- 62% of patients surveyed said that had asked their doctor if he or she could prescribe a medication that was less expensive.
- 50% of patients surveyed said they had skipped a dose of their medication in order to make it last longer.
- 49% of patients surveyed said they had taken less than the prescribed dose so that they could make their prescription last longer.
On a national scale, it is estimated that the cost of migraines is around $17 billion a year. This factors in medications, physician services, emergency room visits, diagnostic and laboratory services, hospitalization, and treatment for the migraine medication side effects. This does not even take into consideration the time lost from work and loss in productivity.
New medications are being developed every day for a variety of conditions and migraines are no exception. This guide will introduce you to the various migraine medications and remedies that are available as well as the best way to take your medicine so that you can better minimize your migraine pain or prevent migraine attacks.
Prescription Migraine Medications
There are two types of migraine medications: Abortive and preventative. Abortive migraine medications are intended to stop an attack from happening while preventative migraine medications prevent attacks from ever starting. In addition to staying hydrated and avoiding triggers, these medications can make life somewhat easier for the migraineur. The problem is that many migraine medications are not effective or not effective enough to stop an attack completely. This is why there are the two types. Together, they deliver the one-two punch that so many migraineurs need in order to get relief.
Abortive medications are intended to stop the migraine attack. These types of medications may be over the counter or prescription.
Triptans (serotonin receptor agonists) have been found to be very effective as abortive prescription migraine medications. Common drugs found in this category include zolmitriptan – brand name Zomig (available as a nasal spray) and sumatriptan – brand name Imitrex. However, there are many drugs on the market that fall into this category. Your doctor may prescribe something different. Ergotamine (Cafergot, Ergomar) is another medication that gets good patient reports, but like the others works better during the earlier stages of the attack.
Opioids are sometimes used to manage migraine pain, but many doctors are moving away from this practice. One reason is because they simply are not as effective as other medications on the market, especially when the factor in the numerous side effects and high risk of addiction and abuse – which is the second very compelling reason. There is an opioid epidemic in the United States. These drugs have high rates of abuse and addiction. Some of the most commonly abused opioids include:
- Hydrocodone (Lortab, Vicodin, etc.)
- Oxycodone (Percocet, OcyContin, etc.)
- Hydromorphone (Dilaudid, etc.)
- Morphine (Kandian, MS Contin, etc.)
- Fentanyl (Duragesic, etc.)
- Meperidine (Demerol, etc.)
While these medications can be taken safely, they do carry a higher risk of addiction, abuse, and overdose. It is vital that you explicitly follow your doctor’s orders for taking the drug and contact him or her immediately if you experience any unusual effects or have any problems with it.
Abortive medications should be taken at the earliest sign of the headache. Once the attack is full blown, there is little that can be done to stop it. A good rule of thumb is, the earlier in the attack, the easier it is to stop, reduce intensity, or shorten the duration.
“Triptans are very effective stopping migraine headaches in their tracks,” Dr. Spierings says. “However, you have to know how to use them, which unfortunately many people, including physicians, don’t. One important issue is that they should be taken at the first sign of a migraine headache, which most patients do not do because they are not properly instructed by their physicians.”
The job of preventative medications is to keep the migraines from occurring. These are always prescriptions and may be taken every day although doctor recommendations may vary and they may be taken at certain intervals.
There are quite a few drugs that are prescribed to prevent migraines. The migraine type is often a significant determining factor in what the doctor will choose to give you. Beta blockers like propranolol are commonly prescribed. These types of drugs are also given to patients with high blood pressure because it lessens the strain on the heart by reducing the heart rate and blood pressure. Certain seizure medications like topiramate may as well. Calcium channel blockers (verapamil) widen the blood vessels by relaxing them. Calcium cannot enter cells in the blood vessel walls and heart which lowers blood pressure.
Antidepressants may be effective as well as histamine and antihistamine, but Botox (botulinum toxin) has been getting a lot of attention recently. Yes, that is the same toxin from the bacteria (clostridium botulinum) that causes the type of food poisoning known as botulism. You may be familiar with Botox as a way to remove wrinkles on the face, but many people have found it very useful for preventing migraines. It is administered via injections, but the amount is so small, there is very little risk of getting botulism.
Some people who get migraines also suffer from depression. If you experience depression, it could be linked to your headaches so it is important to talk to your doctor. Depression can make you more sensitive to pain and less able to handle it emotionally. Both the depression and the migraine need to be treated, but they may even both benefit from the same medication.Talk to your doctor and tell him or her about your migraines and depression.
Side Effects of Migraine Medications
Just like a number of prescription medications, most migraine medications do have some side effects. They include:
- Nausea and/or vomiting
- Diarrhea or constipation
- Excessive thirst
- Fuzzy, disoriented, or euphoric feeling
- Difficulty thinking or focusing
- Muscle weakness
- Warm sensations
- Chest pressure
Not all drugs will have the same side effects so you should talk to your doctor or pharmacist so you know what to expect. Not all drugs affect people the same way either, so even if two people take the same drug, one may experience side effects while the other may not notice any at all. If the side effects are too troubling (such as with nausea, constipation, or diarrhea), your doctor may prescribe medication for you that helps offset those side effects or you may need to change prescriptions entirely. The types and severity of side effects will vary from medication to medication as well as from person to person. Very rarely does a person find success with the very first migraine medication that they try.
For many drugs, the side effects will subside and may eventually disappear as your body adjusts to the medication. Other times, though, your body simply cannot tolerate the substance. It is often left to the patient to decide whether they want to ride it out for a few weeks to see if their body adjusts to the medication or if they want to try something else. There really is not right or wrong answer here; it is all about what you can handle. Some people won’t wait to see if their bodies will adjust because the side effects from the medication affects their job or home duties, like parenting or caregiving. In these cases, it is in the best interest of the patient to move right on to another treatment option.
If you experience side effects with your migraine medicine you should call your doctor. You may need to change your dosage or the medication itself. You can also report side effects of drugs:
- In the U.S. – FDA – 1-800-FDA-1088 or at www.fda.gov/medwatch
- In Canada – Health Canada – 1-800-234-2345
There is no one medication that works for everyone, you may have to try several different types and dosages before finding the right one. It is a process that takes time and requires good communication on both the part of the patient and the doctor. Often the doctor will start with the medication that has the fewest side effects, but certain types of migraines respond to certain drugs so that is a factor as well.
If you do choose to ride out the unpleasantness of side effects from a medication, there are some things you can do to get a little relief:
- Talk to your doctor about any side effects that you are experiencing – even the embarrassing stuff. Bring a list of the other medications and supplements that you take as well because some medications don’t mix well with other supplements or medicines and that could be causing the problem.
- If you experience nausea or stomach upset, try taking the medicine with food.
- Alcohol may worsen the side effects for some medicine and make other non-effective. It can also be dangerous, even deadly when taken with certain drugs, like opioids. It may be best to avoid it.
- You may find that certain foods help or exacerbate the side effects of migraine medications. Try some different things and see what works.
- Ginger tea with honey can help settle an upset stomach. Shave some fresh ginger into a small pot and add some water. Bring to a boil, reduce heat and simmer for about 7 minutes. Use a small strainer, cheesecloth, or coffee filter to strain the tea, add honey and sip. If the taste bothers you, add a few slices of apple (gala, honeycrisp, ambrosia, or pink lady are good and sweet) or pear when you are simmering the tea.
- Stay hydrated. Drink lots of water, plain water. This is good for your migraines and for your medication – plus it’s great for your body.
- If you hear or read about a medication that doesn’t have as many side effects, talk to your doctor about it. It may be that you can switch and it will work well for you.
- Try to schedule your doses at times that are quiet, where you don’t have many demands. This may be during your child’s scheduled nap time or mid-morning when you have a break at work.
- Saltine crackers and ginger ale are an age old remedy for stomach upset that does work. You can also sip on some broth which can be very soothing as well.
- Know what side effects could pose a risk to you. There are some medications that just aren’t worth it for certain people to take. For instance, dizziness can result in significant injury or even death. This is particularly true for older adults. If your medication is making you dizzy you need to talk to your doctor about changing it.
- If your medication makes you drowsy, see if you can take it in the evening.
- Some patients will cut a pill in half and split up the dose to lessen the side effects. You should never do this without first getting your doctor’s OK!
- Always talk to your doctor before altering your dose in any way or stopping any medication.
Over the Counter
Most over the counter migraine medications are intended to stop an attack once it starts. Many people who opt for over the counter ways to manage their migraine typically mix in some natural remedies (especially for prevention) as well as lifestyle changes. The top drugs currently available without a prescription that are somewhat effective on migraine pain include:
- NSAIDS (non-steroidal anti-inflammatory)
- Ibuprofen – Motrin, Advil
- Aspirin– St. Joseph, Bayer, Ecotrin, Buffrin
- Naproxen – Aleve
- Migraine Formulations
- Advil Migraine
- Excedrin Migraine
Most of these, except for the migraine formulations, are not specifically designed to treat migraine headaches. They work best then they are taken at the onset of an attack, as early as possible. They are generally considered to be ineffective for severe migraines. However, they usually have no side effects when taken occasionally. NSAIDS can cause stomach irritation and Acetaminophen has been linked to liver disease and pancreatitis. If your migraines are so bad that you find you are taking several a day, you should talk to your doctor about finding a treatment method that is more consistent and reliable.
Over-the-Counter Migraine Medications
Over-the-counter migraine medications are often more attractive because they don’t require a prescription and they are less expensive. This means that people with a low income who can’t afford medication, or a doctor’s visit, can still get this medicine to help them get through a migraine attack. It should be noted though that most of these medications are not effective for a severe migraine attack; they are most effective early in the attack, before it is full-blown.
Just as with migraine pharmaceuticals, different people respond to different medications. What works for one person may not work for another. There also may be some side effects. It is important to know what they are and be able to identify an allergic reaction or serious reaction to the drug. Your pharmacist can answer those questions for you.
Another concern with over the counter migraine medications is rebound headaches, also known as medication overuse headaches. These headaches occur when you take too much of a medication like ibuprofen. Instead of easing your pain, it can actually make it worse. While any pain medication can cause rebound headaches in people who have a headache disorder, NSAIDs tend to be some of the worse culprits. These types of pain relievers are not intended for everyday use. They are for occasional headaches so if you take them more than one or two times a week, you could find that you have more pain and your headaches are more frequent.
Looking Ahead at the Future of Migraine Medications and Treatments
Migraine research is sorely lacking, but there is some potential good news on the horizon. A group of doctors is exploring a new class of drugs that could stop a migraine before it starts. The product could be available as early as late 2017, but most estimates put it sometime in 2018. At this point, though, the drug would be cost prohibitive for many people. Migraine medication is useless if the people who need it can’t afford it. We need researchers to explore options that are both effective and affordable.
Whether you take medication, use herbs, or take a nutritional approach to treating your migraine headache, you are taking proactive steps to make a difference in your life and that is fueled by the desire to live a life that is pain free. Someday there will be a migraine medication that works for everyone and migraines will be a thing of the past.
The best weapon migraineurs have against their headaches is knowledge. Take ownership of your condition, do the research, stay abreast of new technologies, treatments, and medications on the horizon. Don’t be afraid to ask your doctor about new medications or treatment options that you’ve discovered. Also don’t be afraid to talk to your doctor if a medication he has prescribed to you is not working. Many people try several migraine medications before finding one that works.
Doctors who don’t specialize in migraines may not understand many of the nuances of the condition – things that are integral to preventing or shortening your attacks. Take responsibility for your condition and educate yourself. Keep a migraine diary, do your own research, and learn as much as you can about your migraines so that you know your triggers and when an attack is beginning. Identifying an impending migraine will also help you shorten, minimize, or even prevent it. The earlier you can detect an attack, the more likely it is that your migraine medication will be able to do its job.
Knowledge is power. Never stop learning. Never stop believing that one day there will be a cure for migraines.
Gelfand, A. A., & Goadsby, P. J. (2012, April). A Neurologist’s Guide to Acute Migraine Therapy in the Emergency Room. Retrieved August 01, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3737484/
Gilmore, B., & Michael, M. (2011, February 01). Treatment of Acute Migraine Headache. Retrieved August 01, 2017, from http://www.aafp.org/afp/2011/0201/p271.html
Guide to Migraine Relief. (n.d.). Retrieved August 01, 2017, from http://migraineadvocate.org/guide/
MBA, L. D. (2005, June 15). The Cost of Migraine and Its Treatment. Retrieved August 01, 2017, from http://www.ajmc.com/journals/supplement/2005/2005-06-vol11-n2suppl/jun05-2069ps62-s67/
Medication Overuse Headache. (n.d.). Retrieved August 01, 2017, from https://americanmigrainefoundation.org/understanding-migraine/medication-overuse-headache-2/
Migraine. (2017, April 26). Retrieved August 01, 2017, from http://www.mayoclinic.org/diseases-conditions/migraine-headache/diagnosis-treatment/dxc-20202471
Migraine is more than just a bad headache1. (n.d.). Retrieved August 01, 2017, from https://www.scienceofmigraine.com/en/Overview-and-Statistics
Responsible Use of Opioids. (2015, October 20). Retrieved August 01, 2017, from http://www.headaches.org/2007/11/19/responsible-use-of-opioids/
Henry Hu, MD, MPH, PhD. (1999, April 26). Burden of Migraine in the United States. Retrieved August 01, 2017, from http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/485012
Migraine Advocate (2017) The Definitive Guide to Migraine Relief. Retrieved August 01, 2017, from http://migraineadvocate.org/guide/
Zomig Website: http://zomig.com/
Imitrex Website: www.imitrex.com/