RESCUE MEDICATIONS FOR MIGRAINE

Rescue medications for migraine are specifically used when all abortive medication options fail. When looking at resuce medications, you will typically find them to be pain mediations and types that help get through a Migraine. They can be used to reduce nausea and even help those suffering relax in a panicked state. These medications do not have the ability to abort a migraine, but will help ease the pain. Medications used for migraine rescue include:

• Pain relievers: Pain relievers are medications that reduce and/or relieve aches and pains. They are primarily OTC and available without a prescription. However, just because they are available OTC does not mean that there aren’t associated risks. You must still follow the directions on the bottle or per the instructions of your doctor in order to consume the medication safely.
• Non-steroidal Anti-Inflammatory Drugs (NSAIDS): Includes ibuprofen (Advil, Motrin), aspirin, and naproxen (Aleve)
• Anti-nausea medications: Anti-nausea medications may be prescribed by your doctor in addition to a pain abortive medication (such as a triptan or ergot). These medications will offer relief of nausea, a major side-effect commonly associated with migraines. These treatments can be administered orally, by injection, or rectally.
• Compro/prochlorperazine: Compro is used to control severe nausea and vomiting. It is administered rectally as a suppository.
• Reglan/metoclopramide: Reglan increases muscle contractions in the upper digestive tract and increases the rate of the stomach emptying in to the intestines. It is typically used to treat short-term heartburn caused by reflux.
• Glucocorticoids: Glucocorticoids are a group of steroids that are used to decrease inflammation and suppress the immune system. Many doctors believe that prescribing glucocorticoids will decrease the inflamed blood vessels that constrict causing the migraines.
• Prednisone: Prednisone prevents inflammation in the body and suppresses the immune system. It is used to treat many conditions such as allergic reactions, arthritis, skin conditions, lupus, etc. For migraine sufferers, prednisone may be prescribed to help relieve the pain and throbbing commonly experienced during a migraine.
• Dexamethasone: Dexamethasone is a corticosteroid used primarily to treat inflammation in the body. Dexamethasone can be used to prevent the severe migraine symptoms by decreasing the inflammation often associated with migraines.
• Opioid medications: Opioids are a type of narcotic prescription medication. They work by clinging to opioid receptors in the brain, spine, as well as other areas of the body. They block the pain signals to the brain and help to diminish the pain feelings. Below are a list of commonly prescribed opioids. It is important to remember that opioids can have serious side effects and can easily become habit-forming. You must contact your prescribing doctor immediately if you notice any strange side effects or problems.
• Codeine
• Actiq, Duragesic, Fentora/fentanyl
• Lorcet, Lortab, Norco, Vicodin/hydrocodone

These medications combine hydrocodone and acetaminophen

• Dilaudid, Exalgo/hydromorphone
• Demerol/meperidine
• Dolophine, Methadose/methadone
• Avinza, Kadian, MS Contin, Ora-Morph SR/morphine
• OxyContin, Oxyfast, Percocet, Roxicodone/oxycodone
• Percocet is a combination of oxycodone and acetaminophen

ABORTIVE MIGRAINE MEDICATIONS

Abortive migraine medications work to stop the migraine in its tracks along with any symptoms associated with it. However, many migraine sufferers may experience what is known as the postdrome or “hang-over” period.

TRIPTANS

Triptans work primarily to shrink the blood vessels in the brain that have caused the migraine. Triptans are specifically to be used at the onset of a migraine. A triptan will not prevent or reduce migraines in frequency. It is imperative that migraine sufferers discuss all of their history with their doctor in order to determine what the appropriate course of treatment is. Specific triptan medication includes:

• Imitrex: Primarily used as a headache abortive that works by narrowing blood vessels around the brain. It can also diminish typical symptoms associated with headaches including pain, nausea, sensitivity to light and sound, etc. Imitrex will not prevent migraines, it will only treat an attack that has already started. However, Imitrex will not treat tension headaches. Imitrex can be administered as an oral tablet, a nasal spray, or as an injection.
• Maxalt: Primarily a headache drug that narrows blood vessels around the brain. It can also reduce the intensity of common migraine side effects. Maxalt does not prevent migraine attacks; it works to treat the pain and symptoms as they begin.
• Zomig: Shrinks blood vessels around the brain and combating migraine associated symptoms. As with other triptans, Zomig will only treat a migraine once it has begun, it will not prevent attacks or frequency. Zomig can be administered orally or as a nasal spray.
• Axert: Narrows the blood vessels in the brain, but it has the ability to counteract common migraine associated symptoms. Axert should not be used on children and/or adolescents under the age of 12.
• Amerge/naratriptan: Amerge is a serotonin 5-HT1 receptor agonist. It works by narrowing blood vessels in the brain. Amerge should not be used to treat hemiplegic migraines, if you have kidney or liver problems, high blood pressure, a history of heart problems, or if you have taken another 5-HT1 receptor agonist, an ergot-type medicine, or methlysergide in the previous 24 hours.
• Relpax: Like other triptans, is narrows the constricted blood vessels in the brain during a migraine episode. It does not prevent headaches and is used when a migraine starts. It is not to be used to treat tension headaches.
• Frova: Decreases dilated blood vessels during a migraine attack. Frova is not indicated to be used for hemiplegic migraines or cluster headaches.

ERGOTAMINES

Ergot-based medications, also known as ergot alkaloids, are used to treat patients who do not respond to the more common triptan treatment options. Migraine sufferers must provide their doctor with all of their medical history in order to determine if this is a proper treatment method. Specific ergotamine medication includes:

• Ergotamine: Ergotamine works by decreasing blood vessel size in the brain and affecting the blood flow patterns often associated with headaches. As with triptans, Ergotamine will only treat the migraine symptoms, not prevent the migraine from occurring.
• Migergot: Migergot is a combination of Ergotamine and caffeine. In addition to Ergotamine, caffeine is a stimulant that can constrict blood vessels in the brain. The combination of Ergotamine and caffeine can help some to treat the migraine symptoms at the onset of a migraine.
• Cafergot: Cafergot is another medication option that combines Ergotamine and caffeine. The combination helps to contract blood vessels in the brain. The contraction of blood vessels helps to lessen the effects of common migraine symptoms.
• Migranal/dihydrogotamine (D.H.E. 45): Migranal is an ergot derivative medication. It is administered as a nasal spray. Migranal works by tightening the blood vessels in the brain to relieve migraine pain. D.H.E. 45 is the injection version of the drug.

MIGRAINE PREVENTION MEDICATIONS

Migraine prevention medications are considered effective if they significantly reduce the frequency or severity of the migraine attacks. They are taken daily and used when migraine episodes exceed three a month or in the case of the attack being debilitating. Examples of migraine prevention medications that can be used to prevent the occurrence of a migraine or headache are:

• Topiramate: Originally developed and FDA approved for the treatment of epilepsy, Topiramate has shown to be effective for the prevention of migraines. It is FDA approved to treat migraines, due to its successful nature intreating them as well as epilepsy sharing a large number of biological and clinical features to migraine.

• Divalproex/Sodium Valproate: Depakote is an anticonvulsant medication used for treating multiple illnesses and disorders and since 1996 has been FDA approved for treating migraines. It’s successful nature in preventing migraine episodes is unknown, however the decrease in substance in the brain that are related to migraine symptoms is a leading theory.

• Propranolol: Propranolol, the first successful beta blocker developed, is commonly used to treat hypertension, anxiety and panic but has been FDA approved to treat migraine. Much like Divalproex, it is not how propranolol and other beta-blockers work to prevent migraine, but is has been shown to be helpful for people who suffer several migraine attacks each month.

• Timolol: Timolol, a beta-blocker, is commonly used to treat hypertension and has show successful results in preventing migraine episodes. Much like Divalproex and Propranolol, it is not known how Timolol and other beta-blockers prevent migraines, but is has been shown to be helpful for people who suffer frequent migraine attacks.