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Migraine Management: The Options and the Obstacles


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 rise.

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."

Vital Information:

  • 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 developing.
  • With the medications now available, the majority of migraine headaches can be effectively managed.
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