Which Migraine Treatment is right for you? : Migraine

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Headache : Migraine

Last Updated: Oct 6, 2009 - 12:07:30 PM

Which Migraine Treatment is right for you?
By Migraine prevention treatment
Oct 5, 2009 - 2:10:27 PM

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When deciding on preventive therapies, it is important to review with your doctor several important management principles:

Ask your physician what you can expect from the medication regarding its efficacy. In other words, as “What is the benefit likely to be for me when I take this medication?”
Low doses are used at first and gradually increased to higher doses as needed. Therefore, you may need to increase medication dose until the desired response is achieved.
Lower dosing frequency is often convenient; however, some medications may need to be taken twice or even three or four times a day. Discuss the dosing frequency of the medications and make sure it is a plan that is convenient and easy to follow. Otherwise, you may not take the medication as prescribed and the efficacy benefits may not be achieved.
It may take 2 to 3 months before you notice a decrease in the frequency or severity of attacks even after reaching “the beneficial dose”.
Treatment may be required for 6 to 12 months or longer.
All medications have potential side effects so any unusual symptoms should be reported to your physician. It is important to discuss potential side effects and how they may be avoided or treated if they appear. Different medications have different safety and costs factors and these may play a factor in deciding which medication is right for you.
Side effects can often be limited by using low doses, increasing the dose slowly, or allowing time to adjust to the medication. If you are not tolerating the medication and if you start to have side effects, contact your doctor to discuss changes to the treatment plan.
You should not suddenly stop taking preventive medications because of the risk of rebound headache or other side effects. Preventive medications need to be gradually tapered off after a period of sustained benefit.
Discuss any other possible health condition that may have an influence on your headaches including depression, hypertension, seizures, diabetes, menopause, anxiety, and asthma, among others. These illnesses may play an important role in deciding causes of your headaches and choosing treatment.
Preventive drugs can be used in a variety of different dosing strategies such monotherapy or polytherapy (several different medications) as:

One drug titrated to the ideal dose (monotherapy)
Two drugs typically from different drug classes used to less than maximal dose but used to complement each other and reduce the risk of side effects associated with each of the medications given in high doses
One drug switched for another drug in order to improve tolerance or efficacy
Three or more drugs in either maximal or submaximal doses typically added one after another due to inadequate response. Your preferences can strongly influence the selection of this process This is much like a trial and error process and may take a while before treatment success is identified and the desired efficacy is achieved

Adding different medications may be a preferred treatment strategy as many patients have migraine in addition to another condition that is commonly associated with migraine such as depression, anxiety or obesity. Recognizing that there may be several medical concerns is the first step in making sure each condition is treated optimally. Sometimes this is achieved with monotherapy, but often this may require polytherapy.

Commonly used preventive medications

Type of medication	Medication class	Generic name	Side effects
Blood pressure medications	Beta-Blockers	Atenolol Metoprolol Nadolol Propranolol Timolol	Fatigue Depression Nausea Insomnia Dizziness
Blood pressure medications	Calcium channel blockers	Verapamil Diltiazem Nimodipine	Weight gain Constipation Dizziness Low blood pressure
Antidepressants	Tricyclic antidepressants	Amitriptyline Nortriptyline Imipramine	Weight gain Dry mouth Sedation Decreased libido (sex drive)
Antidepressants	Selective Serotonin Reuptake Inhibitors (SSRI/SSNRI)	Fluoxetine Paroxetine Sertraline	Weight gain or loss Decreased libido
Anticonvulsants		Divalproex sodium Gabapentin Topiramate	Weight gain or loss Sedation Skin rash
Serotonin antagonists		Methysergide Methylergonovine	Blood vessel spasm Abdominal scarring (very rare)
Unconventional treatments	Magnesium salts	Magnesium oxide, magnesium diglycinate, magnesium chloride slow release	Diarrhea
	Vitamins	Riboflavin	Urine discoloration
	Herbals	Mig-99 (Feverfew), Petasites	Burping, GI

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