Not everyone has this threshold or central sensitization effect, researchers say. Luckily, these patients can take existing painkillers such as Motrin, Advil, Excedrin, or certain prescription pain drugs. These are nearly 100% effective in kicking their headaches, says Solomon.
But most people with migraines need more effective drugs. They must take them before the headache lasts an hour. After that, some relief will come, but usually not enough.
Too many people ignore those very early symptoms, Solomon tells WebMD. "These people get lots of headaches, which are often tension headaches, and they hope against hope that this one isn't a migraine. So by the time the window is past, it's too late to stop it."
In the early days of migraine research, a class of drugs called ergots (short for ergotamines, such as dihydroergotamine or DHE) was aimed at stopping migraine pain in progress. Then came the triptan drugs, which were even more effective at halting pain. They include:
Imitrex (sumatriptan)
Axert (almotriptan)
Amerge (naratriptan)
Maxalt (rizatriptan)
Zomig (zolmitriptan)
Frova (frovatriptan)
Relpax (eletriptan)
Both ergot and triptan drugs are still prescribed today, Solomon says. However, because both drugs work to constrict swollen blood vessels, not all patients can take them. "If a patient has heart disease or high blood pressure, they just can't take those drugs," he tells WebMD.
Preventing Migraines in the First Place
More recently, to try to stop migraine headaches from developing at all, doctors have prescribed drugs used to treat other disorders. These drugs are taken daily to suppress the brain chemical or blood vessel activity that leads to migraines. The hope is to prevent a migraine from getting started. These drugs include:
Antiseizure drugs such as Topamax and Depakote, used to treat epilepsy
Beta-blockers such as Inderal, used to treat high blood pressure and abnormal heart rate
Calcium channel blockers such as Cardizem, also prescribed for high blood pressure and abnormal heart rhythms (arrhythmias)
Nonsteroidal anti-inflammatory drugs (NSAIDs), over-the-counter painkillers such as Aleve and Anaprox
Tricyclic antidepressants such as Elavil and Norpramin
"All these are able to keep migraines from happening," says Silberstein. The problem with most, however, is side effects. Topamax can cause numbness, tingling, heat sensations, slowed thinking, and weight loss. Some calcium channel blockers, tricyclic antidepressants, and Depakote can cause weight gain.
"The bottom line is, you pick side effects," says Silberstein. "I tell the patient, 'This drug may have cognitive side effects in some people, may make you lose weight, or here's one that may make you gain weight. Which one do you choose?' With Topamax, you know right away if you'll have side effects. With the others, the side effects [such as weight gain] sneak up on you."
Despite all these advances, some patients still suffer. "One in 10 migraine patients cannot tolerate certain migraine medications. So we're better than we were, but we're still not perfect," Silberstein notes.
For some desperate people, the muscle-paralyzing drug Botox, usually given via injection to facial muscles to reduce the appearance of wrinkles, is a saving grace, he says. "Botox seems to work for patients who get frequent migraines, more than those with infrequent ones. If it works, the treatment is every three or four months." However, Botox treatments can be expensive. "Sometimes insurance covers it, but often it doesn't," he notes.
Finding the Window of Vulnerability
In another approach to the goal of preventing migraine headaches, Silberstein and other researchers have looked at "drug timing." This involves finding the window of vulnerability, a critical time period for migraine headache sufferers. If patients can take their drugs just at this point instead of ongoing, some side effects can be offset. They'll also take less medication, cutting out-of-pocket costs.
Two recent studies of menstrual-related migraines produced the first scientific evidence for a pattern of vulnerability in migraine headaches. Researchers say their findings could apply to other types of migraines, not just menstrual headaches.
It's an exciting finding. If altitude changes are your nemesis, then taking a long-acting triptan drug twice a day on the day before you go skiing in Utah and continuing it for a week may nip your migraine from starting at all.
New migraine drugs are also on the horizon. "A lot of drugs are coming down the pipeline, drugs that work by different mechanisms," says Silberstein. One is a class of enzyme-blocker drugs, such as Aricept, currently prescribed to treat mild to moderate confusion related to Alzheimer's. This drug is a contender for migraine prevention, he tells WebMD.
Alternative Choices for Migraine Pain
While medications are the mainstay of migraine treatment, they're not a cure-all. For women who are pregnant or hoping to be, supplements are a safe alternative. For people who can't get enough relief from prescriptions or who dislike the side effects, supplements can also help.
"Almost anyone, including children, can take magnesium," DeRossett tells WebMD. "The only side effect is diarrhea. Some people get it, some don't. For some, it's dependent on how high the dosage is."
She recommends magnesium "more than other supplements, and have found it to have the most robust effect in preventing migraines," she says. "I advise vitamin B-2 if a patient has a predisposition to diarrhea." Some supplements combine magnesium, vitamin B-2, and the herb feverfew. Coenzyme Q10, which the body produces naturally, has also been shown to cut migraine attacks, but it's pricier than the others, she adds.
You have to take magnesium for three months to get a benefit, says DeRossett. "People sometimes give up on it too soon." Taking the correct dosage is important as well: 500 mg magnesium, 400 mg riboflavin (vitamin B-2), and 150 mg coenzyme Q10.
The herb butterbur can also help prevent migraine attacks, she adds. A recent study found that a daily 75 mg butterbur supplement cut migraine frequency by more than 50%.
"Our patients are on all kinds of high-powered migraine headache medications," DeRossett tells WebMD. "These [magnesium, etc.] aren't in the same ballpark as Depakote or Topamax. But for some people, magnesium might be enough. For others, it might provide added benefit in terms of relief."
Published April 2005.
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