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Carene's Wellness Corner

Migraines: The most effective treatments

People with mild to moderate migraines may opt to take over-the-counter medications containing ibuprofen or naproxen for relief. But for some of them, this treatment can actually cause more migraines (called rebound headaches).

S.M. Arshad Iqbal, MD, neurologist and director of the Stroke Program at Kent Hospital, says a better plan of action might be to take prescription medications, and fewer of them.

"Seek medical attention early on because good treatments are available," he suggests simply.Treatment for migraines

Linda Gare, 51, of West Greenwich, knows the value of finding the right medications. She was getting bad migraines every month that would last up to three days at time, and a prescription from her primary care physician wasn't working well.

When she suddenly started to get tremors (another neurological condition), she sought care from Dr. Iqbal, who prescribed propranolol.

"I was pleasantly surprised to find out that the medication helped my migraines. I can function through them now," says Gare, adding that the frequency and severity of her migraines have decreased substantially.

Interestingly enough, some medications, such as the one Gare takes, were not specially designed to treat migraines, but have had great success for patients.

Abortive treatments

Dr. Iqbal explains that migraine medications fall into two categories: acute treatment (or abortive treatment) and preventative (or prophylactic treatment). People take an abortive medication to get rid of a migraine, and Dr. Iqbal suggests it at the first sign of a migraine so it will be the most effective. Abortive drugs, he says, fall into two different drug classes:

  1. Non-steroidal anti-inflammatory drugs (NSAIDS), which include low-dose over-the-counter medications such as ibuprofen or naproxen.
  1. Triptans. A migraine can occur when the level of serotonin, a chemical in the brain, is level. This causes blood vessels to constrict and lowers your pain threshold. Triptans, which increase levels of serotonin, are effective in about 50% of patients, Dr. Iqbal says. The most common drugs in this class are sumatriptan, eletriptan, and naratriptan. The latter lasts longer in the body and is ideal for patients whose migraines tend to return later in the day. If your migraines are accompanied by nausea, rizatriptan (an oral medication that dissolves under your tongue) may be your best choice. If nausea is severe, consider using an injectable form of medication that you can administer under your skin like an epipen. It works much faster than oral medications.

Patients who dread using a needle may want to try an injectable form of a sumatriptan that doesn't require one. Simply put the injector tip on your belly and firmly press a button on the end. The substance will penetrate your skin.

Preventative treatments

These are medications that must be taken daily. Start at a low dose and allow them to build up in your body. There are three classes:

  1. Beta blockers, which were originally created to treat certain heart conditions. "Propranolol seems to be the most effective drug in this class for migraines," Dr. Iqbal says.
  1. Anticonvulsants or anti-epileptic drugs. Originally developed to control seizures, these work well for migraine sufferers. Dr. Iqbal commonly prescribes topiramate and levetiracetam.
  1. Tricyclic antidepressants. Designed as anti-depressants, these drugs also relieve migraines. Drugs in this class include amitriptyline and nortriptyline.

Other options

These prescription medications may not work for some patients, due to the person's genetic makeup or how the body processes medications. Other people may experience undesirable side effects from them or cannot take them with other medications.

If this is the case, Dr. Iqbal may prescribe another type of drug - botox. This drug is injected intMigraine reliefo the scalp, neck, and shoulder muscles every three months.

Get relief

With all of the medication options and forms available today, there is no need to suffer through a migraine if you don't want to. A neurologist can help determine which medication is the best choice for you.

- By Karen Appold

Care New England
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