Migraine Headache

Once a migraine begins, the person will usually seek out a dark, quiet room to lessen painful stimuli. Several drugs may be used to reduce the pain and severity of the attack.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are helpful for early and mild headache. NSAIDs include acetaminophen, ibuprofen, naproxen, and others. A recent study concluded that a combination of acetaminophen, aspirin, and caffeine could effectively relieve symptoms for many migraine patients. One such over-the-counter preparation is available as Exedrin Migraine.

More severe or unresponsive attacks may be treated with drugs that act on serotonin receptors in the smooth muscle surrounding cranial blood vessels. Serotonin, also known as 5-hydroxytryptamine, constricts these vessels, relieving migraine pain. Drugs that mimic serotonin and bind to these receptors have the same effect. The oldest of them is ergotamine, a derivative of a common grain fungus. Ergotamine and dihydroergotamine are used for both acute and preventive treatment. Derivatives with fewer side effects have come onto the market in the past decade, including sumatriptan (Imitrex). Some of these drugs are available as nasal sprays, intramuscular injections, or rectal suppositories for patients in whom vomiting precludes oral administration. Other drugs used for acute attacks include meperidine and metoclopramide.

Continued use of some anti-migraine drugs can lead to "rebound headache," marked by frequent or chronic headaches, especially in the early morning hours. Rebound headache is avoided by using anti-migraine drugs under a doctor's supervision, with the minimum dose necessary to treat symptoms. Patients with frequent migraines may need preventive therapy.