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decision pointShould I take medicine to prevent migraine headaches?

Deciding whether to take a preventive medicine for migraines can be difficult. These drugs have side effects that range from mild to severe, and they can be expensive. However, they can also be very effective in preventing or reducing migraine symptoms, which will significantly improve your quality of life.

Consider the following when making your decision:

  • For mild to moderate migraines, taking pain relievers, such as acetaminophen (for example, Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin, may be all that is needed to relieve your symptoms. These drugs are safe and cost less than migraine drugs.
  • For moderate to severe and disabling migraines, taking preventive drugs daily can reduce the frequency of your migraines and can help relieve your symptoms quickly and restore your ability to function. You may have less time away from work or school and improve the quality of your life.
  • Certain preventive migraine drugs can have mild to serious side effects in some people. People who have heart problems or conditions such as uncontrolled high blood pressure should not take certain migraine drugs. If you are older than 65, these drugs may not be recommended because of other health condition concerns.

What are migraine headaches?

A migraine is a painful, recurring headache that is accompanied by nausea; vomiting; and sensitivity to light, sound, and sometimes smells. The throbbing headache often occurs on only one side of your head, although the pain can shift from one side of the head to the other or can occur on both sides. Migraines involve changes in chemicals and blood vessels in the brain. These changes trigger pain signals, which lead to the throbbing headache and other symptoms of migraine.

What is a migraine aura?

A typical migraine aura may involve seeing wavy lines, spots, flashing lights, or sparks of bright or colored lights. You may also see distortions in the shape or size of objects. Some people experience numbness or a "pins-and-needles" sensation in their hands just before a migraine begins.

Other less common symptoms of an aura can include tingling or numbness around the mouth and nose or in the arms or shoulders, temporary weakness on one side of the body, and a brief inability to put words in the proper order or difficulty finding the right words.

Symptoms of an aura develop gradually over 5 to 20 minutes, usually within the hour before a migraine headache starts. Not everyone who suffers from migraines develops an aura.

What are common migraine triggers?

Migraines are often triggered by foods, stress, or changes in your environment. Some common migraine triggers include:

  • Foods, such as chocolate, red wine, monosodium glutamate (MSG), and caffeine.
  • Getting too much or too little sleep.
  • Fasting or skipping meals.
  • Changes in the weather or barometric pressure.
  • Stress or intense emotions such as depression or anxiety.
  • Strong odors such as perfume or cigarette smoke.
  • Bright lights or reflected sunlight.

How effective are migraine drugs?

Preventive migraine drugs include beta-blockers, calcium channel blockers, antidepressants, and seizure medicines. These drugs work well to moderately or significantly reduce the frequency of migraines. They may not totally eliminate migraine attacks, however.

What are the side effects of migraine drugs?

Common side effects of preventive drugs are sleep and memory problems, fatigue, dizziness, rapid heart rate, and sometimes sexual performance problems.

You should not take certain migraine drugs if you have heart disease or other heart problems or uncontrolled high blood pressure. If you have other health conditions, be sure to talk with your doctor first before taking a migraine drug.

Because many people who have migraines also have depression, taking prescription medicines for both problems is common. In very rare cases, when a triptan such as sumatriptan (Imitrex) for migraines is taken with an SSRI (selective serotonin reuptake inhibitor) or SNRI (selective serotonin/norepinephrine reuptake inhibitor) such as fluoxetine (Prozac) or duloxetine (Cymbalta) for depression, these medicines can cause a very rare but serious condition called serotonin syndrome. But most people take these two types of medicines together and have no problems. If you are worried about serotonin syndrome, talk to your doctor.

FDA Advisories. The U.S. Food and Drug Administration (FDA) has issued:

  • An advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when the doses are changed.
  • A warning on antiseizure medicines and the risk of suicide and suicidal thoughts. The FDA does not recommend that people stop using these medicines. Instead, people who take antiseizure medicine should be watched closely for warning signs of suicide. People who take antiseizure medicine and who are worried about this side effect should talk to a doctor.

If you need more information, see the topic Migraine Headaches.

Your choices are:

  • Take abortive headache drugs (such as triptans) to stop a migraine as it emerges or pain relievers such as acetaminophen (for example, Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs) to control your symptoms.
  • Take preventive migraine drugs daily to try to prevent migraine attacks.

The decision about whether to take preventive migraine drugs takes into account your personal feelings and the medical facts.

Deciding about preventive drugs for migraine headaches
Reasons to take preventive drugs Reasons not to take preventive drugs
  • You have moderate to severe and disabling migraines.
  • You have frequent migraine attacks.
  • Your symptoms interfere with your ability to function, and you miss school or work when you have a migraine attack.
  • You have tried taking nonprescription drugs (such as NSAIDs), but they do not relieve your symptoms.
Are there other reasons you might want to take migraine drugs?
  • You have mild to moderate migraines that are not disabling.
  • You do not get migraines very often.
  • Your symptoms can be controlled by drugs, such as triptans or NSAIDs.
  • You cannot tolerate the side effects of migraine drugs, which may include increased nausea, or vomiting.

Are there other reasons you might not want to take migraine drugs?

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about taking migraine drugs. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

I have mild migraines that can be controlled by NSAIDs. Yes No Unsure
I have a history of heart disease, uncontrolled high blood pressure, or liver problems. Yes No Unsure
I get very few migraine attacks. Yes No Unsure
I get at least one migraine a month that keeps me from work or school. Yes No Unsure
I think I can tolerate the side effects of migraine drugs. Yes No Unsure
I will work with my doctor to develop the best treatment plan for my migraines, knowing that it could take some time to identify the right drug for me. Yes No Unsure
I have insurance to help me pay for the migraine drugs. Yes No NA*
I have tried the newer, more effective migraine drugs to reduce my symptoms. Yes No NA
I have been able to identify my migraine headache triggers. Yes No NA

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

 

 

 

 

 

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to use or not use preventive migraine drugs.

Check the box below that represents your overall impression about your decision.

Leaning toward taking preventive drugs

 

Leaning toward NOT taking preventive drugs

         
Author Dana L. Rowett
Last Updated October 22, 2009

WebMD Medical Reference from Healthwise

Last Updated: October 22, 2009
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

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