If you have ever experienced a migraine, then you know it’s more than just a bad headache. The migraine attack can be so intense that the pain and throbbing are disabling. It may also be accompanied by nausea, vomiting, neck pain, and sensitivity to light.
Migraines may be caused by any of the following:1
- Lack of food or sleep
- Exposure to light
- Hormonal changes (in women)
For many years it was believed that the dilation and constriction of blood vessels caused migraines. However, more recent research has shown evidence that migraines are a neurological disorder involving both nerve pathways and brain chemicals.2
Medication can be used to help relieve the symptoms of migraines as well as prevent future episodes. It is recommended that pain-relieving medication be taken as soon as possible once you believe the signs or symptoms of a migraine episode are beginning.
Pain relievers such as non-steroidal anti-inflammatory drugs (NSAIDs) are recommended for mild to moderate migraines. Examples include aspirin, ibuprofen, or naproxen.
Acetaminophen may be effective for some individuals as well.
Combination products such as Excedrin Migraine® (acetaminophen/aspirin/caffeine) and Fioricet® (butalbital/acetaminophen/caffeine) are indicated for migraines. It is believed that caffeine improves the absorption of the drugs it is combined with, but the full mechanism of caffeine on the brain is unknown.3
However, it is known that caffeine blocks the receptors of a chemical substance called adenosine, which is responsible for decreased electrical activity within the brain, temporary widening of blood vessels, and some aspects of sleep and movement.4
A common category of medications that are often used to treat migraines are triptans which are serotonin 5-HT 1B,1D agonists. They are available as oral tablets, nasal solutions, and injections. Triptans work by constricting blood vessels and blocking pain pathways within the brain.5
- Sumatriptan (Imitrex®)
- Rizatriptan (Maxalt®)
- Almotriptan (Axert®)
- Naratriptan (Amerge®)
- Zolmitriptan (Zomig®)
- Frovatriptan (Frova®)
- Eletriptan (Relpax®)
It’s not known which triptan is most effective because one that works well for one person may not work well for another. Therefore, triptan therapy would likely have to involve some trial and error to find out which one is most effective.
Triptans work best when taken as soon as migraine symptoms begin. However, some individuals find it helpful to first take a pain reliever, such as an NSAID, before using a triptan.
Triptan dosing is shown below with sumatriptan as an example.
It’s important not to exceed the recommended maximum dosages because overuse of anti-migraine medications can cause rebound headaches.
Common side effects associated with triptans include:
- Dizziness, lightheadedness, or drowsiness
- Tightness in chest
- Dry mouth
- Feeling hot or cold
- Muscle aches or cramps
- Feeling weak or “strange” in some way
- Nausea and/or vomiting
- Nasal spray:
- Burning, pain, or soreness in the nose
- Change in the sense of taste
- Injection: Burning, pain, or soreness at the site of injection