Just your average apothecary (pharmacist), feet firmly planted behind the pharmacy counter, whose mortar and pestle are hitched to a star.
Migraines Are the Worst
Do you get migraines? Migraines affect approximately 29.5 million Americans. According to a study published in the Journal of the American Medical Association, nearly 18% of women and 6% of men suffer from one or more migraines per year.
There are many causes of migraines. According to the Mayo Clinic, these include, but are not limited to:
- Hormonal changes
- Environmental changes
What can be done? This article is aimed specifically at informing you about the prescription medications that are indicated for the prevention and/or treatment of migraine headaches. I hope the information provided is useful.
Prescriptions to Prevent Migraines
They say that an ounce of prevention is worth a pound of cure. This is certainly the case with respect to migraines. Several prescription medications are currently available that have been shown to reduce the frequency and/or severity of migraine headaches.
The following medications are prescribed to prevent migraine headaches:
Divalproex (also known as Depakote, Depakote ER or Stavzor):
- Traditionally used only to treat seizures, Divalproex has been shown to reduce migraine frequency and severity. The original Depakote brand, sometimes called Depakote DR (delayed-release) is now available generically at a substantially reduced price!
- The effectiveness of Divalproex in preventing migraines has been demonstrated in clinical studies. One advantage of the newer Depakote ER is that it can be taken once daily, as opposed to twice daily with the original Depakote or Stavzor.
- Possible side effects include nausea, vomiting, indigestion, diarrhea, drowsiness, dizziness, asthenia (weakness), tremor, hair loss, pancreatitis, hepatotoxicity, and skin rashes.
Propranolol (also known as Inderal or Inderal LA):
- Typically used to reduce blood pressure, Propranolol belongs to a family of medications known as beta-blockers. It is available generically and is relatively inexpensive. The LA (long-acting) form is also available generically and can be taken once daily.
- Propranolol has been studied for migraine prevention for over 30 years, and recent studies continue to support its effectiveness.
- Possible side effects include drowsiness, dizziness, fatigue, short-term memory loss, visual disturbances, vivid dreams or nightmares, and decreased libido.
Topiramate (also known as Topamax):
- Topiramate is also traditionally used to treat seizures. A large study documented the effectiveness of topiramate to reduce monthly migraine frequency by nearly 50%.
- This therapy is not approved for use in children.
- Possible side effects include drowsiness, dizziness, confusion, difficulty with memory, weight loss, nervousness, and speech difficulty.
On October 15, 2010, Botox-A was approved for use to prevent chronic migraines and headaches. This was a novel approach but has received mixed reviews from patients. Botox is a potent neurotoxin produced by the bacterium Clostridium botulinum. It has been used for other medical and cosmetic purposes.
Dr. Merle Diamond of Diamond Headache Clinic says this: “Does it work for everybody? No. And we certainly don't know about its safety for pregnant women. But we are excited for our patients and think it gives them more options.”
Read More From Healthproadvice
A few other prescription medications that are sometimes used (though not FDA approved) are:
Prescriptions to Treat Active Migraines
Prescription medications approved to treat an active migraine headache can be divided into two groups: ergotamines and triptans. The latter is a family of drugs specifically targeting serotonin receptors.
These medications are used to treat migraine headaches:
- The mechanism by which this family of medications works is not fully understood. They are thought to stimulate receptors in blood vessels responsible for constriction.
- Examples of this type of medication include the prescription nasal spray Migranal, Ergomar, and Cafergot tablets (ergotamine and caffeine combination).
- Possible side effects include nausea and vomiting. Migranal nasal spray can also cause throat nasal irritation, congestion, burning, and dryness.
- The discovery of this family of medications revolutionized migraine therapy. They work by specific stimulation of serotonin receptors (known as 5HT1-D receptors) in the brain to reduce both inflammation and vasodilation.
- Several prescription triptans are currently available on the market and include Amerge, Axert, Frova, Imitrex, Maxalt & Maxalt MLT, Sumavel Dosepro, Treximet, and Zomig.
- Sumavel Dosepro delivers the active ingredient, sumatriptan, directly through the skin using a burst of pressure when the device is activated. This allows for rapid and worry-free relief!
- Treximet is the newest addition. It combines the active ingredient, Imitrex, with a pain reliever called naproxen.
- Possible side effects of triptans include dizziness, lightheadedness, muscle cramps, nausea, vomiting, and fatigue.
Since these triptans are amongst the most popular and effective treatment options, I have included a more comprehensive list below:
|Brand Name||Generic Name||Dosage form(s)/Strengths||Usual Dosage||Generic Available?|
Tablets: 6.25mg, 12.5mg
1 tablet - may repeat in 2 hours if necessary
Tablets: 20mg, 40mg
1 tablet - may repeat in 2 hours if necessary
1 tablet - may repeat in 2 hours if necessary
Tablets: 1mg, 2.5mg
1 tablet - may repeat in 4 hours if necessary
Tablets & Rapidly Dissolving Tablets (ODT): 5mg, 10mg
1 tablet - may repeat in 2 hours if needed
Tablets: 25mg, 50mg, 100mg Nasal Spray: 5mg, 20mg Injection: 4mg, 6mg
1 dose - may repeat in 2 hours if necessary
1 dose - may repeat
Zomig, Zomig ZMT
Tablets & Rapid Dissolve Tablets (ZMT)
1 tablet - may repeat in 2 hours if necessary
The following websites have additional information for migraine patients:
The Migraine Research Foundation: A great site filled with good information and resources for migraine sufferers!
The Migraine Resource Network: American Headache Society
M.A.G.N.U.M: The National Migraine Association
Disclaimer: The information provided in this article, and any subsequent questions and answers, are not intended to replace or substitute for the advice of your personal physician.
This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
do u need too get blood work done with migraine meds on October 03, 2013:
Do u need too get blood work done with the mediation ur on for migraine
Jason Poquette (author) from Whitinsville, MA on June 01, 2012:
Check out this great list of triggers: http://uhs.berkeley.edu/home/healthtopics/pdf/trig...
Tad on June 01, 2012:
I was just wondering what will trigger migraines?? I'm 33 & I have been suffering from them since the second grade.
Jason Poquette (author) from Whitinsville, MA on May 01, 2012:
Allow me to pass along an article I was just reading today. Maybe it will provide you with some material to talk to your doctor about: http://www.pharmacynewsflash.com/masspharmacists/S...
Carebare on May 01, 2012:
I have suffered from migraines since I was about 10 years old I am 22 now. I have tried a lot of different medications, some made my migraine worse and some just didn't do a thing. My doctor gave me Trexmit to try out, thankfully I haven't had to use it quite yet. In the event that Trexmit does not work for me, what should I ask my doctor about next?
Jason Poquette (author) from Whitinsville, MA on March 30, 2012:
Ask your doctor for generic Imitrex. And take, with his/her permission, the generic Imitrex with 2 tablets of Aleve (OTC). Same as Treximet. Exactly. Best wishes.
Brandi on March 30, 2012:
Dear Pharmacist- Hub Author,
I have been suffering from migraines since I was 6 or 7 years old. I am now 27 years old. The problem i'm having is my new health insurance not covering my Trximet anymore. Treximet works great for me, gets rid of my migraine within 30 or 45 minutes, which is great! Do you know of anything like Treximet that United Healtcare may cover? I was told it was going to cost $233.00 for 9 pills.. crazy! I have 2 pills left now, time to try something else.
Jason Poquette (author) from Whitinsville, MA on February 10, 2012:
Any medicine which has "good" effects may also have some unwanted "side" effects. However, the medicines I mention in this article have been used by many people very successfully. Best wishes.
mangalge. m.g on February 10, 2012:
Sir Last 45years I have suffering migrane piane i am 52 years old Please suggest me powerful without side effect medicine or treatment
Jason Poquette (author) from Whitinsville, MA on January 16, 2012:
Sometimes we just sort of become "immune" to meds we have been using for a while. May be time for a switch. Always consult with your own physician when making changes. Best wishes.
Suleman on January 16, 2012:
Batteling with migraine for 8years now and am on cafergot. But it doesn't seem to work out for me anymore so am thinking of trying excederin or tylenol1000mg.
Jason Poquette (author) from Whitinsville, MA on October 04, 2011:
Not much different. Maxalt offers a fast acting "MLT" tablet. Otherwise, like the others, it will provide relief within 2 hours for about 70% of patients.
vikrant chilate on October 03, 2011:
my question, what is the benefite of rizatripton benzoate compaire to other drug use in migraine
Eugene Brennan from Ireland on September 24, 2011:
The use of Botox and the system for injecting sumatriptan under the skin using pressure is news to me.
I have used a product for over twenty years available in Europe called Syndol. It is paracetamol based but includes the ingredient doxylamine succinate. This is a muscle relaxant/ sedative / antihistamine and is very effective at treating migraine and the sometimes accompanying tension headache.
Roy Perrin from Jacksonville, NC on August 03, 2011:
My wife has suffered from debilitating migraines for years and the most effective preventive that we've found has been the liberal use of BOTOX. There is an "experimental" surgery that can be done for the treatment of migraines, but it's still a bit risky from what I've read. What are your thoughts about the surgery? Also, if "Botox can market their injectable product for the prevention of CHRONIC of migraine headaches" does that mean that insurance will start to cover the cost of the injections and Botox itself? At nearly $1K every three months or so, I can't afford to keep my wife's migraines under control!!!
Jason Poquette (author) from Whitinsville, MA on June 21, 2011:
Sun-Girl from Nigeria on June 20, 2011:
Nice and well written hub which i enjoyed reading from.
Jason Poquette (author) from Whitinsville, MA on June 14, 2010:
Good question. Tramadol (brand name Ultram) is not referred to here because, although useful for pain, it is not specificially indicated for migraines. That does not mean it isn't used for migraines, as many pain medications can be used to treat migraine headaches. But the focus of this article was just those drugs specifically indicated (by the FDA) for the treatment of migraines. I do mention tramadol in a more general article on "pain" : https://hubpages.com/health/Prescriptions-for-Pain
Jason Poquette (author) from Whitinsville, MA on March 04, 2010:
I was going to check with some folks in the Migraine group on Facebook. Then I noticed you already posted there! :)
I hope you find a good group. If so, please feel free to leave a link here for others.
Jennifer on March 04, 2010:
Does anyone know of any good online support groups for teens and their parents?
My son just started the migraines this winter, following a couple rounds of the flu and respiratory infections.
Jason Poquette (author) from Whitinsville, MA on February 19, 2010:
Thanks for the comment! Great quote by the way!
William Cobb from Columbia, SC on February 18, 2010:
It is rather amazing because I have used many of these meds to prevent my migraines. Great hub.
"What does it profit a man to gain the whole world and lose his soul?"
Jason Poquette (author) from Whitinsville, MA on February 11, 2010:
Happy to share the information. It sounds like you have had quite a long battle. As you have found, there ARE others like you out there and it can be helpful to connect with them and share stories and advice. I do hope your doctor is right and that you outgrow them in time. In the mean time, God bless and best wishes as you manage this challenge.
annaoj05 on February 09, 2010:
I was diagnosed with Chronic Migraines at age 2. 20 years later, I still have them. I also developed a daily headache at age ten. I manage extremely well I can put on a pretty good show to get done what I need to get done, and collapse when I have finished. I have tried every medication on your list including an inpatient protocol of DHE, except for the Sumavel Dosepro. So thanksful for another thing to ask my doc about. My doctors say I am still young enough to hope to grow out of them as things continue to change so I am hanging onto that. I was always told growing up I was the only one like me and the only child with migraines like mine. Resources like this really help to show that that is not the case and help to find support from ohters like yourself. Thanks for spreading the word about migraines.
cflynn from Ireland on November 27, 2008:
Im really hopig he does grow out of them
Jason Poquette (author) from Whitinsville, MA on November 26, 2008:
Thanks! Migraines in children are especially challenging since most of the prescription medications are not approved for pediatric use (due to the lack of studies to prove their safety and effectiveness). For now, my advice to parents is:
1) Continue with moderate and appropriate doses of Tylenol (or, as you call it over the pond: paracetamol) and Ibuprofen
2) Watch for triggers and avoid them when possible (diet and environmental triggers especially)
3) If they get progressively worse (many do grow out of them) then consider seeing a specialist such as a Pediatric Neurologist.
Hope that helps...
cflynn from Ireland on November 26, 2008:
Hi great Hub. My 5yr old suffers from migranes....sometimes when he refuses to eat and sometimes when he is stressed. He seems to be getting them less and less as he has learned to eat when he feels one coming on and to tell me as soon as he feels a little bit of a headache and we can get some paracetamol or ibruprofen into him. I really hope he can grow out of them??? do you have any info or advice re paediatric migranes?