If you suffer from chronic migraines, you likely already know the medication game plan. It starts with the regular use of preventative medication to avert an attack from occurring. If a migraine presents anyway, abortive medication is taken to curb symptoms and stop the attack from progressing. If abortive medications fail, rescue migraine medications are the last resort attempt for relief. But do you really know what your rescue medication is and how it works?
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To begin with, rescue migraine medications do not cure migraines, they mask symptoms until an episode passes. In minor cases, or instances where stronger medications cannot be safely taken, over-the-counter NSAIDs are recommended as a form of rescue. In moderate to severe cases, rescue medication with opioids (narcotic pain killers) may be prescribed. Rescue medication can also include anti-nausea medication, muscle relaxants or sedatives to help make patients more comfortable as they await the end of their excruciating migraine episode. You may be prescribed one or more from the following categories:
NSAIDs
- Indocin
- Toradol
- Orudis
- Mobic
Barbiturate Hypnotics (Sedative)
Opiates (pain killers)
- Codeine
- Fentanyl (Duragesic)
- Hydrocodone (Vicodin, Lortab)
- Hydromorphone (Dilaudid)
- Meperidine (Demerol)
- Morphine (MS Contin, Kadian)
- Oxycodone (Oxycotin, Percocet)
Steroids (anti-inflammatory)
- Prednisone
- Dexamethasone
Anti-nausea medications
- Reglan
- Zofran
- Compazine
- Phenergan
Muscle relaxants
- Lioresal
- Soma
- Flexeril
- Robaxin
- Zanaflex
Rescue Migraine Medication Delivery
Rescue migraine medications may be taken orally, rectally or as a nasal spray or injection. Most rescue migraine medications can be prescribed for use at home, however, in the most severe instances, patients should seek professional emergency care, where medication can be administered via an intramuscular or intravenous injection to deliver the strongest and fastest relief from debilitating pain.
How Opioids Work
Opioid drugs are comprised of chemicals that attach to proteins called opioid receptors, which are located in the brain, spine, gastrointestinal tract and elsewhere. Upon attachment, the chemicals block pain signals that travel between receptors, thereby decreasing the body’s perception of pain.
Rescue Medication Risks
Rescue medications containing opioids are strong, fast acting, narcotic pain killers that present a number of side effects. In addition to drowsiness, impaired judgment, nausea and constipation, pain killers are highly addictive for some and should be taken exactly as prescribed with careful consideration. They may also give sufferers a false sense of well-being or increase symptoms like nausea and vomiting.If you have a psychiatric disorder, including clinically diagnosed depression, opioid-containing medications may not be ideal for your consumption.
Rescue medications containing steroids should not be taken long-term and will require strict adherence to doctor’s orders. Common side effects related to prednisone and dexamethasone include weight gain, diabetes, stomach ulcers and high blood pressure.
Overuse
Overuse of rescue medications can lead to rebound headaches and an increased tolerance for the drugs, rendering them less effective. This can also lead to dependency issues, which will require patients to take higher (more harmful) doses to reach the same effect. These medications are strong and powerful chemical-based drugs and as such, there is also a risk for overdose, which can result in death.
Because rescue migraine medications can be powerful and addictive, they are only prescribed as a last resort to manage pain associated with a moderate to severe migraine attack. This class of treatment is effective and hugely beneficial, but does not come without noteworthy risks, including addiction and physical dependency. For this reason, doctors will be more inclined to suggest NSAIDs for rescue migraine medication before considering opioid-containing drugs. As with all medications, it is extremely important that migraineurs follow the instruction of their treating physician, paying particular attention to dosage and the number of times per month they feel they need to take rescue medication. It’s highly recommended that migraineurs closely track and monitor how many times per month they take rescue medication to identify if a dependency issue may be developing. A free migraine diary can help support regular tracking.
Image Source: Jonathan Cohen
