- Effective: butorphanol nasal spray
- Probably effective: butorphanol injection, codeine, meperidine, methadone
Migraine Headache Treatment
1 AnswerDr. Darria Long Gillespie, MD , Emergency Medicine, answeredGuidelines for treating migraine attacks published by the American Headache Society list the following opioids as effective or probably effective:
1 AnswerThe normal daily recommended amount of riboflavin for general health in adults is 1 - 2 mg. This amount would be found in about 2 cups of milk or yogurt. High-dose riboflavin (400 mg of riboflavin daily for 3 months) has been shown to reduce the number of migraine attacks by half. Effective doses for children and adolescents are 200 - 400 mg daily. Most pharmacies don't carry the 400-mg tablet, and you may have to ask your pharmacist to order it. Riboflavin is generally very well tolerated. And don't worry about overdosing -- riboflavin is a water-soluble vitamin, and your body will take what it needs and excrete the rest, so it can't build up to toxic levels.
1 AnswerIt's never too late to start using effective non-drug techniques for migraines, even for women well past the menopause. Traditionally, doctors thought that seniors would not get much of an effect from pain management skills. However, a research study proved that these skills are also helpful for reducing headaches in seniors, and menopause is a great time to use effective non-drug techniques, even if you haven't used them earlier. Seniors ranging in age from 60 to 77 years old were taught cognitive behavioral therapy, relaxation, and biofeedback. Headaches were reduced by at least half in two of three seniors learning these techniques. Interestingly, women did better than men.
1 AnswerDr. Egilius L. Spierings, MD , Neurology, answeredIn treating a migraine headache, if one triptan doesn't work, another often will (although you may have to wait 24 hours before taking a different type). If your headache still isn't completely relieved, taking aspirin or another nonsteroidal anti-inflammatory drug (NSAID)—such as ibuprofen, naproxen sodium, or ketoprofen—along with the triptan may help.
1 AnswerOpioids (hydrocodone, oxycodone, morphine, and methadone) have a very limited role in migraine and are generally reserved for migraine rescue therapy. Most opioids are Food and Drug Administration (FDA) risk category C drugs. If you use them, make sure your doctor monitors you carefully. Frequent use of opioids can result in medication overuse headaches. You can also become tolerant to opioids (that is, over time, it takes more medication to get the same effect). You might also experience withdrawal when you stop taking them.
You can also develop a dependency to opioids. Your baby might also develop an opioid dependency from your opioid use and go through withdrawal after birth. Women who have been regularly using daily opioids during mid-to-late pregnancy often need to continue daily opioids for the duration of pregnancy because of the risks to the baby from going through withdrawal before birth. It is safer for the baby to experience withdrawal symptoms after birth under the careful supervision of a pediatrician and hospital staff.
1 AnswerMigraine drugs that use alternative routes of administration include:
- Needle-free injections -- Sumavel DosePro (sumatriptan)
- Inhaled drug -- Levadex (dihydroergotamine), Staccato prochlorperazine (aerosol prochlorperazine)
- Intranasal -- Intranasal carbon dioxide, Intranasal ketorolac, Intranasal sumatriptan powder
- Transdermal -- Zelrix (sumatriptan iontophoresis patch) Diclofenac elastic liposome Rizatriptan elastic liposome
- Transmucosal -- Sumatriptan lingual spray
1 AnswerDr. Egilius L. Spierings, MD , Neurology, answeredPrescription painkillers are more powerful than their over-the-counter (OTC) equivalents, yet they rarely relieve severe migraine pain. In many cases, prescription analgesics just provide higher doses of standard nonprescription products, such as ibuprofen or naproxen sodium. Some prescription analgesics contain barbiturates or opioids. Opioids, such as codeine and morphine, are sometimes indispensable medications, but they have a limited role in the treatment of headache. People who regularly use opioids run the risk of developing a tolerance to them, which means they need higher and higher doses to relieve the pain. They may also become dependent, meaning they develop withdrawal symptoms when they stop taking the medication.
There are alternative treatments for migraine headaches, including the postdrome phase of the headache. These alternative treatments include acupuncture, massage, biofeedback, herbs and vitamins. The herbs and vitamins attempt to correct deficiencies in brain cells that cause migraine headaches. Acupuncture, massage, and biofeedback help you to relax so that you can sleep better and prevent migraine headaches.
2 AnswersMigraine headaches severity can worsen if not treated early within the first hour. The later you take your medication the longer it may take for the migraine headache to subside. If you do not get relief from the medications you should talk to your doctors about this. Some medications are more effective and quicker acting than others.
1 AnswerBoston Women's Health Book Collective , Administration, answered
The first level of response to migraines includes self-help strategies such as stress management, eating well, exercising regularly, and learning to avoid your triggers and respond to your warning symptoms. You may want to try over-the-counter medications or, if you need more help, seek acupuncture or consult with your health care provider. If you experience frequent or severe migraines, consult a neurologist with expertise in managing women's migraines. Migraine treatment is optimal when you are in an active partnership with your health care provider, keeping diaries for headache patterns and triggers, and tracking which medications helped, how soon they helped, and how effective they were.