Migraine stands as the third most common medical condition globally. It is a rather chronic, severely painful and a temporarily debilitating condition. Migraine remains as one of the most underdiagnosed and undertreated illness today. Most people, especially those who fortunately do not suffer from the condition are not aware of the magnitude of a migraine attack.
In a typical scenario, migraine is characterized by a severe, recurring and throbbing headache that affects one or both sides of the head. Patients with migraines would usually be able to tell if they are going to have an attack. Some experience symptoms a few days in advance (prodromal symptoms) such as neck stiffness, food cravings, mood swings, or frequent yawning. There are also patients that experience an aura before or during an attack. Aura is a manifestation of the nervous system. Patients may experience visual disturbances (flashing lights, zigzag vision), touching sensations, movement or speech disturbances. An attack usually lasts from hours to days. In addition to severe headaches, patients may also suffer from nausea, vomiting, blurry vision, light sensitivity or even loss of consciousness. After the attack subsides, patients may have confusion, moodiness, weakness, and dizziness.
Medications remain as one of the most effective ways to treat migraine. There are a plethora of pain medications that are marketed for this condition. What suits best for your pain may not work on someone else with the same problem. The choice of drugs is usually made on an individual basis. Typically, these medications are broadly classified into those that you would take when a migraine attack starts (acute medicines) and medications that you take to prevent an attack (prophylactic or preventive medications). It is vital that your customized cocktail of medications are appropriately prescribed. Migraine medications are taken at the right time, right amount and right composition make a whole lot of difference in the progression of your attack and the general course of the disease.
Acute medications are medications that are to be taken as soon as you experience any typical migraine symptoms. You don’t necessarily have to wait for the headache to start to initiate pharmacological therapy. These medications do not stop an attack, they merely help you cope with the symptoms. It reduces the intensity of your pain and helps with other symptoms that you may experience. The most important medication are painkillers. There are different types of pain medications that are available. The most common ones that are used are Non-steroidal anti-inflammatory drugs (NSAIDs) and triptans. Triptans (sumatriptan, almotriptan, eletriptan, frovatriptan) are specifically used for migraine treatment. With pharmacological advances over the years, there are many preparations that are a combination of both types of medications. Doctors will also prescribe anti-emetics (prochlorperazine, metoclopramide, domperidone) for nausea and vomiting that usually occurs with a migraine.
Preventive therapy is usually only brought into a discussion if a patient has four or more episodes a month. It is not used widely anymore with the advent of more potent triptans and combination medications. Most of these medication used to prevent migraines are medications used for other diseases such as hypertension and depression and epilepsy. These medication carries side effects of their own when used for long periods of time. Some of these drugs are Beta-blockers, anti-5HT drugs, tricyclic antidepressants (TCAs), anticonvulsants and NSAIDs.
Finding the right set of medications for your migraine is a huge interplay with different drugs and dosages. You should always consult a doctor before changing any of your medications. As a patient, be vigilant of your own body. Keep a diary specifically for your migraine. Note down attacks, severity, symptoms, the medications that you take and how your body reacts to them. This may seem tedious but it would help doctors decide on a more suited combination of medication to your situation.