Medicines for prevention

The so-called “prophylactic” drugs do not cure migraine but they aim to decrease the intensity and frequency of attacks. They constitute a background treatment and should generally be taken every day. THE’preventive effect may take 2 to 3 months to appear.

These drugs are usually only prescribed for people who have migraines frequently (3 or more attacks per month) and whose activities are sufficiently disturbed to justify medication. But there is not really an established rule: the initiation of treatment is discussed on a case-by-case basis with the doctor. Be aware that some drugs have side effects and their long-term effectiveness is not guaranteed. However, for people with severe and frequent migraine headaches, prophylactic drugs can be a blessing.

The most commonly prescribed medications are:

• The beta-blockers, for example, propranolol (Inderal®) and timolol (Timol®). Apart from migraines, these drugs are commonly used to treat hypertension and cardiovascular disorders. Other blood pressure medications, such as lisinopril (Zestril), may also be effective. (see Mayo);
• The calcium channel blockers, in particular flunarizine;
• The anticonvulsants (such as valproate, topiramate, gabapentin), which can however cause significant side effects at high doses (nausea, vomiting, diarrhea, etc.);
• The Antidepressants low dose tricyclics (amitriptyline). Other antidepressants, such as venlaflaxine (Effexor), are also used. (see Mayo);
• La vitamin B2 (riboflavin) to fill certain gaps in brain cells in people with frequent migraines;
• THEhormone therapy substitutive (estrogen gel), for women of childbearing age whose migraines are linked to hormonal fluctuations during the menstrual cycle.

Remark

Le Botox®, a bacterial toxin mostly used to reduce wrinkles, can also help relax tight muscles in the head and neck. In October 2010, the Food and Drug Administration (FDA) approved the use of Botox injections for the preventive treatment of migraines chronic³⁴. This indication concerns the rare cases where migraines appear at least 15 days per month. However, thetherapeutic effect Botox® is low when compared to that of a placebo. Indeed, according to 2 studies conducted on 1 subjects (partly funded by the manufacturer of Botox®)^35-37 , a treatment placebo would shorten the duration of migraines by 6,2 days per month; Botox®, for 8,2 days.

It is important to discuss with your doctor the potential risks of Botox®, which should be administered every 3 months. The health authorities of Canada and France are studying the possibility of approving this therapeutic indication. Doctors can, however, use it in ways off label, that is, for “unintended use”.

Treatments in the event of a crisis

There is no cure for the migraine. Seizures should be treated with pain relievers when they occur. All medications, whatever they are, will be more effective in relieving pain if they are used as soon as the symptoms appear. warning signs migraine, or from beginning headache if there are no warning signs.

People who only have a few migraine attacks per year are likely to consume pharmaceuticals occasionally without worrying too much. The situation is different for those who suffer from frequent migraines. Indeed, many studies indicate that, on the one hand, drugs can lose their effectiveness if consumed in large quantities and, on the other hand, that they can even lead to an increase in the frequency of migraines. It is important to see your doctor if you are taking any Pain killer more than 10 to 15 days per month, because there is a risk of headaches due to overuse of drugs (“rebound” headaches). People who have frequent migraine attacks are therefore better off choosing a preventive approach to decrease their symptoms.

Over-the-counter drugs

THEacetylsalicylic acid (aspirin), theacetaminophen (Tylenol®) and anti-inflammatory Non-steroidal over-the-counter drugs (ibuprofen, Advil®, Motrin®, etc.) will often be sufficient to break a mild migraine attack if taken at the onset of symptoms. Some preparations have been specifically designed to relieve migraines. This is the case with Liqui-Gels Advil® (and Liqui-Gels Advil Extra-Fort®), which contain a solubilized form of ibuprofen, with a slightly faster effect.

Warning. Used regularly, nonsteroidal anti-inflammatory drugs can irritate the stomach and cause ulcers. Ask the pharmacist or your doctor for more information.

Some drugs contain a combination molecules with an anti-pain effect. This is the case of Tylenol Ultra-Effective®, which contains a mixture of acetaminophen (500 mg per tablet) and caffeine (65 mg).

Prescription drugs

If over-the-counter medications are not enough, doctors can offer a wide range of more powerful products, depending on the case and personal tolerance.

• Nonsteroidal anti-inflammatory drugs. Your doctor may prescribe stronger anti-inflammatory drugs, such as naproxen, diclofenac, or ketorolac. However, these drugs are probably not more effective than ibuprofen, in equivalent dose;
• Triptans. This class of drugs is very effective in case of failure of conventional painkillers. Sumatriptan (Imitrex®) was the first drug in this class. Since then, other triptans have appeared on the market: almotriptan (Axert®), eletriptan (Relpax®), frovatriptan (Frova®), naratriptan (Amerge®), rizatriptan (Maxalt®) and zolmitriptan (Zomig®). These synthetic molecules mimic the action of serotonin and cause constriction of blood vessels. Some are in the form of nasal sprays, others in the form of swallowable or oral dissolving tablets. Imitrex® is also available as a self-injectable device;

   

  Triptans are generally well tolerated and effective even after the seizure has started. In some people, however, they can cause nausea, dizziness, muscle weakness and, very rarely, cardiovascular problems. Sometimes it is necessary to try several before finding a suitable one;

• Ergotamine. Ergotamine, whether or not combined with caffeine (Ergomar®, Cafergot®), in tablet form, is also prescribed to help reduce pain. It is less effective than triptans and can cause nausea and vomiting. There is also dihydroergotamine (Migranal®), an ergotamine derivative that causes fewer side effects and is administered by nasal spray;
• Antinauséeux. For migraines that are accompanied by severe nausea, metoclopramide or prochlorperazine may help relieve this symptom. It is sometimes used in hospitals, intravenously, to treat resistant migraines;
• Butalbital and other pain relievers. For a more powerful analgesic effect than those found over the counter, there is among others Fiorinal®, which contains butalbital (a sedative), acetylsalicylic acid and caffeine. They tend to be neglected in favor of other more effective drugs.

Advice in the event of a crisis

• Lie down in a dark and quiet room;
• Put a cold compress on his forehead;
• Massage the scalp;
• Put pressure on his temples.