The 3 Classes of Drugs Used For Dealing with Migraines

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The 3 Classes of Drugs Used For Dealing with Migraines

There are 3 different classes of prescription medications being used to deal with migraines. They are:

• Preventive
• Abortive
• Pain Relieving

There are 4 or 5 stages to migraines:

• Prodrome
• Aura
• Headache
• Headache Termination
• Postdrome

Not everyone who has migraine gets aura, but of those who do, they report it and prodrome as early warning signs that a migraine is on the way. That being the case, they can try to take preventive medicines to stop the migraine in its tracks.

A. Preventive

Preventive medications try to stop the migraine before it ever happens. The classes of medications used for preventive purposes include:

Antiepileptic drugs

Valproic acid and Topiramate (Topamax) alter the brain’s chemistry and have proven effective in preventing migraines.

Beta blockers

Beta blockers are usually used to treat heart conditions and high blood pressure. They can smooth out and shrink blood vessels in the head to reduce pain. The best beta blockers for migraine relief are Propranolol (Inderal) and Timolol.

Calcium channel blockers

Calcium channel blockers are also used to lower high blood pressure. Research has shown that Verapamil (Calan, Isoptin SR) is most effective for migraine relief.

Tricyclic antidepressants

This is an older class of antidepressants used to alter brain chemistry. Amitriptyline, Nortriptyline and Doxepin relieve depression and treat migraine as well. Amitriptyline appears to be the most effective of the three.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are the latest generation of antidepressants and includes Paroxetine, Fluoxetine (Prozac) and Sertraline. Prozac has been proven most effective for people with chronic migraines, that is, migraines which occur 15 or more days per month.

If the person takes preventive drugs at Phases 1 and 2 of their migraine but they still advance to a full headache, then it would be time to try abortive drugs.

B. Abortive Drugs

Abortive drugs try to treat the migraine by stopping it as quickly as possible. This group of medications includes certain classes of drugs, including:

Selective serotonin receptor (5-HT1) agonists (Triptans)

These relieve inflammation of the blood vessels and nerves of the brain. The most commonly used is Sumatriptan (Imitrex). It is available via injection, pills, nasal spray and transdermal patches (Zecuity). It offers a high rate of rapid migraine relief. Side effects vary but are generally mild.

https://www.rxlist.com/imitrex-side-effects-drug-center.htm

Naratriptan offers slower relief for migraines than Imitrex, but it lasts longer. In addition, it is less likely to interact with other medicines that might be used to treat migraine, such as MAOIs.

MAOIs (monoamine oxidase inhibitors)

MAOIs are another type of antidepressant used to treat depression and migraine. They also alter the chemistry of the brain. Examples include rasagiline, selegiline and phenelzine. It is important to note that these medications can cause dangerously high blood pressure and can cause a range of side effects.

https://www.mayoclinic.org/diseases-conditions/depression/in-depth/maois/art-20043992

Ergot alkaloid

Ergot is a form of fungus that can affect rye and other grains, and was the first form of successful anti-migraine drugs. It is still used in 2 forms. Dihydroergotamine mesylate can give rapid relief in the case of severe migraines. Triptans are also ergot derivatives.

If the headache continues despite abortive medications, then it is time to turn to pain relieving drugs.

C. Pain Relieving

These medications offer pain relief once the migraine has progressed to Phase 3, headache. There are a number of options, including:

Analgesics

These include pain relievers such as aspirin.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

These include acetaminophen (Tylenol)

The preventive and abortive medications will require a prescription. Keep a migraine diary to track your symptoms and take it with you to your doctor so the two of you can discuss your best treatment options based on your potential triggers and the symptoms and severity of your migraines.