Migraines headaches can be very severe and often leave people crippled for days. They may afflict as many as 28 million Americans. Migraines are often preceded by an “aura,” which may consist of visual disturbances such as flashing lights. The headaches are often associated with nausea, sweats, dizziness, and slurred speech. Light and sound sensitivity can also be severe.
There is still marked debate over the cause of migraines. For decades, researchers thought that these occurred because of excessive contraction and expansion of the blood vessels in the brain. Others thought that this blood vessel problem occurred because of inadequate serotonin, the neurotransmitter that controls sleep and mood, which also plays a role in how blood vessels expand. Muscle spasm and nutritional imbalances and deficiencies can also contribute to migraines as can food sensitivities. Most likely, it is a common endpoint for many different underlying problems.
What Medications Can I Take to Get Rid of an Acute Migraine Headache?
Although preventing migraines naturally (see below) is a much more effective approach, migraine treatment is an area where using a "Comprehensive Medicine" approach shines, so we’ll also briefly review medications. In the U.S., medications in the Imitrex® family still remain the first choice. This new family of medications, called triptans, has increased our ability to dramatically treat migraine headaches effectively. Imitrex has been found to be effective in eliminating an acute migraine attack in 34 to 70 percent of patients within 2 hours. Unfortunately, at least 30 to 40 percent of patients remained unsuccessfully treated. Axert® (almotriptan 6.5 to 12.5 mg, which can be repeated in 2 hours) is similar in effectiveness to Imitrex but less expensive ($10.50 vs. $16.50).
Other treatments may be effective for acute migraine when Imitrex is not. Aspirin family medications do not work well in migraines because the absorption of aspirin is delayed during the migraine attack. To combat this problem, medications that enhance absorption can be added to the aspirin and/or it can be given by suppository. For example, a combination of indomethacin (a "super-aspirin”", prochlorperazine (for nausea and to enhance absorption), and caffeine in suppository form were compared with Sumatriptan® rectal suppositories for acute migraines. Forty-nine percent of patients were pain free at 2 hours on the first treatment as compared to 34 percent with the Sumatriptan. Another study using a similar approach had the same result. Aspirin (lysine acetyl salicylates 1620 mg—equivalent to 900 mg of aspirin) was combined with Metoclopramide®, 10 mg. The latter medication returns the absorption of aspirin to normal during migraine attacks and also combats nausea and vomiting. In the two placebo-controlled studies, this combination was more effective than 100 mg of Imitrex by mouth and was better tolerated. These combinations can be made by compounding pharmacists. It is quite likely that regular aspirin, especially if chewed, would be as effective as the form used in the study. Metoclopramide is readily available.
Other medications can also be helpful for acute migraines. Many patients get relief with Midrin®, which is a mix of three medications. Take 2 capsules immediately followed by 1 capsule every hour until the headache is relieved (to a maximum of 5 capsules within a 12 hour period). It can also be helpful for tension headaches in a dose of 2 capsules 4 times a day, as needed. Many patients find this to be quite helpful and it is not addictive. Fiorinal® can also be effective but is addictive, and I prefer not to use this medication.