Migraine Management: The Options and the Obstacles
WebMD News Archive
As well as they work, the triptans are not for everyone. Silberstein says
some migraine patients only get relief from that older and cheaper class of
drugs, the ergot alkaloids. These compounds, derived from a fungus on rye,
cause intense constriction of blood vessels -- so much so that misuse can cause
tissue in the fingers and toes to die and become infected -- a condition called
gangrene. Coleman suffered just such a side effect on his left foot because of
ergot overuse as a child.
Jries says the potential for this problem with the ergot alkaloids can be
intensified with use of "macrolide" antibiotics -- such as
erythromycin, Biaxin, or Zithromax. These cause blood levels of the ergots to
Once a migraine happens, pain relief is of the utmost concern. And for that,
many patients rely on narcotics. The only trouble, Coleman tells WebMD, is that
the medical community in the U.S. isn't always receptive to the idea of
treating long-term pain with medications that have potential for abuse. It's
one reason his organization recommends migraine patients develop good working
relationships with a doctor and a pharmacist. Not every headache will respond
to the same medication. It is important that a treatment regimen is worked out
between the doctor and headache sufferer. With the newer medications now
available, the majority of headaches can be effectively managed.
"Most headache sufferers are not drug addicts, Silberstein says.
"They take the medication to treat the headache. The occasional use of
powerful [pain killers] is not wrong."
- Patients who suffer migraines sometimes avoid the newer triptan drugs,
either because the medicines do not work for them or they fear side effects
such as chest pain. Older drugs also are available, as well as potent
painkillers, but these drugs have concerns of their own.
- Experts say heart patients should steer clear of triptan drugs, but for
most patients, triptans are safe and can often help stop a migraine from
- With the medications now available, the majority of migraine headaches can
be effectively managed.