Treatment of migraine: an armory of therapeutic drugs from which to choose

Nutrition Health Review, Summer, 1994

Mild Episodes of Migraine

Simple analgesics, like aspirin or acetaminophen, may be all that is required for mild episodes of migraine.

For more intense cases of migraine, various nonsteroidal anti-inflammatory drugs (NSAIDs) are usually prescribed:

Indomethacin -- Not recommended for patients with liver disease, ulcers, or other stomach problems. Inform your doctor if you are taking medications to prevent blood clots. Report bloody stools or blurred vision.

Ibuprofen (Motrin, Advil, Nuprin) -- Side effects can include diarrhea, dizziness, constipation, dry mouth, fluid retention, stomach ulcers, damage to the cornea, kidney damage, and reduced white blood cell count. Report other medication use.

Naproxen -- Has risen to prominence in the treatment of migraine because of reported tolerance and record of safety.

Moderate to Severe Episodes of Migraine

Ergotamine -- Ergotamine tartrate has been in use since 1928 (similar formulas are Cafergot, Ergomar, Ergostat Gynergen). Rectal suppositories of ergotamine are available and are more rapidly absorbed. Excessive use of ergotamine can result in cold, clammy extremities (vasoconstriction), chest pain, claudication of legs, and numbness of hands and feet. Inform your doctor immediately of severe abdominal pain. Do not take if you are hypertensive or have a peptic ulcer, kidney disease, or a liver disorder.

Sumatriptan (Imitrex) -- Heralded as the innovation of the decade, sumatriptan is considered a major advance in migraine therapy. Injection preparations are available in the United States. Oral preparations can be procured in some other countries (Canada). Glaxo, the maker of Imitrex, promises availability in the United States by late fall, 1994.

Sumatriptan is a quick-acting drug. Not only is the pain relieved within an hour, the makers say, but it also reduces the symptoms of nausea, vomiting, and photophobia (intolerance of light).

Sumatriptan is reported to have superiority over ergotamine, in that by itself it does not produce nausea, nor does it cause grogginess, drowsiness, or hangover.

The most common side effects could be a stinging sensation at site of injection and a feeling of heaviness at the chest or neck area.

Sumatriptan should not be combined with ergotamine or dihydroergotamine. In cases of coronary artery disease, the drug should be used with watchful care.

Clonidine (Catapres) -- Prevents migraine episodes. Side effects may include dry mouth, dizziness, constipation, upset stomach, appetite loss, depression, nightmares, impotence, fluid retention, and weight gain. Consult your doctor before taking clonidine if kidney or heart disease are present. Do not stop medication abruptly.

Beta-Adrenergic Blocking Agents -- Propranolol (Inderal) and timolol (Blocadren) are the only two beta blockers approved by the Food and Drug Administration. The only side effects reported by the makers are fatigue, lethargy, and muscular weakness of the lower extremities.

Contraindications for beta blockers include active asthma, congestive cardiac failure, and hypotension. Sufferers of these ailments are warned against using these drugs.

Zoloft, Prozac -- Selective serotonin uptake inhibitors are useful adjuncts in the treatment of chronic headaches. Although it has not been demonstrated that these had antimigraine effect, they may be effective in combination with beta blockers prescribed by the attending doctor.