Current Drug Treatment of Headaches

Some of the drugs that are used to treat migraines were originally designed to treat other conditions such as high blood pressure and wrinkles.  There are two categories of drugs used for headache treatment, those that relieve the pain, and those designed to prevent the headache from occuring. The use of drugs for headache relief is constantly changing.

Neurologists will usually choose a treatment plan based on the frequency and severity of the headaches.  Those patients who suffer from two or more severe headaches per week, get no relieve from pain medication, or are using large quantities of pain relievers, are placed on a preventative plan.   One of the big issues with current medications is that their side effects can be very serious. Certain medication cannot be used with children while others cannot be taken by women who are pregnant or breast feeding.

Pain-relieving medications are the fisrt drugs of treatment.These drugs are usually taken at the start of a headache. There are a few major categories used. First are the Nonsteroidal anti-inflammatory drugs (NSAIDs). These are the common over the counter drugs like Ibuprofen(Advil, Motrin) , Acetominophen(Tylenol) or Naprosyn(Aleeve), or Aspirin(Bufferin, Bayer).  These drugs are useful with the everyday common headache.  A number of manufacturers market combinations of drugs like these specifically for migraine headache. Excedrin Migraine is an example of such a drug. It contains Acetaminophen, Aspirin , and Caffeine and seems to be effective on slightly more severe pain.  The biggest problem with the NSAID's is that if they are taken to often they can cause ulcers of the stomach, bleeding in the intestines, kidney and liver damage.

The Triptans are the next category of drugs.  Sumatriptan (Imitrex) was the very first drug designed specifically for migraines.   Sumatriptan acts like the neurotransmitter serotonin, binding to those neurotransmitter receptors which results in constriction of the blood vessels in the head. One of the nice things about Sumatriptan is that it can be used in nasal, oral or injectable form. However, the side effects of Sumatriptan can be very serious including heart attack and stroke. Although these side effects are rare, people who have a history of heart disease, angina, high blood pressure, ischemic bowel disease or a heart attack or stroke should not take Sumatriptan.  Other contraindications include people taking MAO inhibitors and certain antidepressants.

Sumatriptan will only treat a headache that has already begun. It will not prevent headaches or reduce the number of attacks.  A number of other drugs similar to Sumatriptan are available. These include Rizatriptan (Maxalt), Naratriptan (Amerge), Zolmitriptan (Zomig), Almotriptan (Axert), Frovatriptan (Frova) and Etriptan (Relpax). These newer agents provide pain relief within two hours for most people, have fewer side effects and cause fewer recurring headaches. Side effects of triptans include nausea, dizziness, and muscle weakness and, rarely, stroke and heart attack.

The next class of drugs are the  Ergots. Drugs such as ergotamine (Ergomar) and dihydroergotamine (D.H.E. 45) and dihydroergotamine nasal spray (Migranal) help relieve pain. These drugs may have more side effects than the Triptans do. . Medications for nausea are often used with other headache treatment drugs. The drug Metoclopramide (Reglan) is useful for relieving the nausea and vomiting associated with migraines, but not the migraine pain itself. It also improves gastric emptying, which leads to better absorption and more rapid action of many oral drugs. It's most effective when taken early in the course of a migraine or even during the aura before the headache begins. The drugs prochlorperazine (Compazine), chlorpromazine (Thorazine), promethazine (Phenergan) and hydroxyzine (Vistaril) also may relieve nausea, but don't affect gastric emptying. Part 2 of this article will discuss more current drugs used for headache treatment.


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