Precautions for Migraine Medicines
Here are several suggested precautions for using any migraine medicine, whether it’s a prescription or over-the-counter drug:
- Start slowly. Try over-the-counter medications in the lowest dosages first. Keeping to low doses may help you avoid or reduce drug side effects. Only move to stronger medications, prescription drugs and higher doses as needed and with your doctor’s supervision.
- Take as directed. Do not exceed the recommended dosage or deviate from your doctor’s prescription.
- If you are pregnant, have a bleeding problem, asthma, kidney, liver disease or any medical condition talk with your doctor before starting any migraine medicine. Also, let your doctor know about other medications you’re taking.
- Do not mix medications with herbal remedies without your doctor’s approval.
Non-prescription Migraine Medicine
Aspirin is the most common analgesic in this class. It also works as an anti-inflammatory and is classified as a nonsteroidal anti-inflammatory drug (NSAID). Research shows aspirin is an effective migraine pain reliever.1 Extended use, however, can lead to stomach problems, including abdominal pain, bleeding and ulcers.
Acetaminophen works directly on the central nervous system to help numb pain. The most commonly listed side effects include nausea, diarrhea, swelling and liver damage. Sticking with small dosages may contribute significantly to reducing your chances of side effects.
Nonsteroidal Anti-Inflammatory Drugs
NSAIDs are a category of anti-inflammatory drugs that block Cox-1 and Cox-2 enzymes, helping to slow the production of prostaglandins that can cause swelling and pain. The most common side effects include gastrointestinal problems, nausea, vomiting, high blood pressure, allergic reactions, bleeding and liver damage. Many patients can minimize side effects with low dosages. Over-the-counter NSAIDS include:
Prescription Migraine Medicine
The prescription formulations of NSAIDS work primarily in the same way as over-the-counter NSAIDs. While non-prescription and prescription NSAIDs both are pain relievers, the prescription doses are stronger anti-inflammatories and have a greater likelihood of severe side effects, including heart attack or stroke. Here are three NSAIDs prescribed for migraine pain:
As a serotonin receptor agonist that constricts blood vessels, triptans help relieve migraine pain, especially when taken at the first indication that a migraine is coming on.2 Reported side effects include flushing, sleepiness, tingling, light sensitivity, throat and chest tightness. Examples in this class include:
Doctors have prescribed ergotamine (or ergots) for migraine pain relief since the 1920s. The source of this medication is a fungus that grows in wheat and barley. When combined with caffeine, it helps constrict blood vessels. While probably not as effective as triptans, ergots have fewer side effects: dizziness, nausea and vomiting and muscle pain.
Opiates and opioids are effective migraine medicines for short-term use that block the release of neurotransmitter Substance P. However, because their effectiveness is short and patients tend to build tolerance, migraine sufferers can become dependent or addicted to the analgesics in this class. Drugs in this category include:
Avoid the Rebound Headache
For anyone who has experienced the throbbing pain of a migraine headache, it’s easy to understand why overuse of medications is such a major concern. Rebound or medication overuse headaches (MOH) are caused when drugs are taken for extended periods or when a patient tries to go cold turkey. The result is that migraine headache pain can transform into almost constant tension headache pain, which are called transformed migraines. Overuse, misuse or sudden withdrawal of either over-the-counter or prescription medicines can bring on rebound headaches.
When using medications to prevent migraines and alleviate the pain, make sure you follow the precautions. First, consider the lowest dose possible of over-the-counter drugs to minimize side effects. If not effective, consult your doctor and move up to prescription migraine medicine as required. Finally, try not to overdo it. You don’t want to end up with a rebound headache.
1 Kirthi V, Derry S, Moore RA. “Aspirin with or without an antiemetic for acute migraine headaches in adults.” http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008041.pub3/abstract. Accessed April 4, 2016.
2 Cady R, Martin V, Adelman J, Diamond M, Sajjan S, Hu XH. “Migraine treatment with rizatriptan and non-triptan usual care medications: a pharmacy-based study.” http://www.ncbi.nlm.nih.gov/pubmed/15447699. Accessed April 4, 2016.