A First-Line Drug For Abortive Therapy in Simple Migraine
As a first-line drug for abortive therapy in simple migraine headaches, triptans or another agent that inhibits pain-modulating receptors like calcitonin gene-related peptide (CGRP) receptors or metoclopramide should be considered. These agents can be taken orally or intravenously and have proven successful for many acute migraine headache sufferers.
Triptans such as sumatriptan (Imitrex), rizatriptan (Maxalt), and imigran are the most commonly prescribed. All three drugs work by binding to 5-HT 1b/1d receptors in descending brainstem pain-modulating pathways and inhibiting dural nociception. Furthermore, they reduce nausea and vomiting associated with migraine attacks by inhibiting CGRP production.
They are not suitable for individuals with epilepsy, as there is the theoretical risk that they could trigger seizures. Furthermore, postmenopausal women should abstain from using them since they may cause atypical menstruation.
Rimegepant is an oral calcitonin gene-related phosphodiesterase inhibitor that blocks pain-modulating receptors and has been found to be effective for treating acute migraine headaches in those who do not respond well to oral NSAIDs or other combination analgesics. Available in tablets, it should be taken orally at the first sign of a migraine headache.
Other migraine-specific abortive agents are ergotamines such as dihydroergotamine (DHE). DHE works similarly to triptans and often works in combination with other abortive medications for greater effectiveness than ergotamine alone, making it suitable for patients who do not respond to triptans or who are allergic to them.
Oral ergotamines can be diluted with water and taken either in the morning or with a meal to maximize their availability. Dihydroergotamine comes in various preparations, and studies have suggested that using an effective delivery system to deliver it directly into the upper nasal cavity may improve systemic absorption.
NSAIDs such as Aspirin and ibuprofen have been demonstrated to be effective in relieving migraine-associated pain. They should be taken orally, preferably with food to avoid gastric stasis that could reduce their effectiveness.
Acetaminophen and caffeine — When taken with or without food, the combination of acetaminophen and caffeine can be effective at relieving migraine headaches that are uncomplicated in nature. It’s safe to take this medication during pregnancy or if there are other illnesses which could increase one’s likelihood of developing asthma or bronchitis.
TMS — Transcutaneous electrical nerve stimulation, commonly referred to as TENS, has been found to be effective for relieving migraine-associated pain in a small number of patients. In one randomized controlled trial, one dose of TMS delivered through an implanted device significantly reduced both headache frequency and intensity in 57 individuals suffering from chronic migraine.
In a separate trial [154], TMS proved effective for treating occipital headaches. A single dose of TMS reduced pain and nausea in patients with persistent or severe headache who hadn’t responded to other medications.
Other medications that are effective for preventing migraines include amitriptyline and verapamil. Amitriptyline is a short-acting, nonselective serotonin reuptake inhibitor that can be used similarly to beta blockers in order to prevent migraines; it comes in daily dosages ranging from 25-150 mg. Verapamil, on the other hand, is a calcium channel blocker often prescribed as a secondary option when treating migraines in some patients.
