Treatment
How is it treated?
Treatment of migraine is aimed at preventing or reducing frequency of attacks, aborting an attack or relieving symptoms once an attack has started. Many products are available both as prescription-only and over-the-counter medicine. There is a wide variation in individual response to different treatments and patients may try a selection of different products before finding something effective.
Preventative treatment
Drugs that can help to reduce the frequency and severity of attacks are available. Those commonly used are beta-blockers such as propanolol (drugs that block adrenaline receptors), tricyclic antidepressants such as amitriptyline and pizotifen that inhibits the effect of a brain chemical called serotonin.
Sodium valproate (used for treating epilepsy) and methysergide (also a serotonin inhibitor) are sometimes used in persistent cases but only under specialist supervision because of potential serious side effects. A variety of other preparations are also available but the choice in an individual is often empirical.
General measures such as avoidance of trigger factors are important but may not help. Relaxation therapy, hypnosis and cognitive behaviour therapy may be used to improve well being as well as reduce frequency of attacks.
Treatment of the acute attack
Mild attacks may respond to simple measures such as rest in a darkened room. Painkillers (analgesics) of various forms are used. These include soluble aspirin, paracetamol, non-steroidal anti-inflammatory drugs (NSAIDS) and even stronger opiate derivatives in resistant cases.
Drugs that are helpful in aborting attacks are available in a variety of preparations. The more established types are based forms of ergotamine that act on the arterial walls to cause restriction of blood flow. More recent products known as triptans (such as sumatriptan and rizatriptan) have a similar effect and can be given in the form of nasal spray or by injection to enhance speed of action. Many patients experience adverse effects from these and this can limit their effectiveness for regular use.
