Prevention: The Future of Migraine Therapy
Stopping a migraine headache before it ever begins is the new focus of treatments.
Migraine Headaches Connected to Hormones, Lifestyle continued...
Too many people ignore those very early symptoms, Solomon tells WebMD. "These people get lots of headaches, which are often tension headaches, and they hope against hope that this one isn't a migraine. So by the time the window is past, it's too late to stop it."
In the early days of migraine research, a class of drugs called ergots (short for ergotamines, such as dihydroergotamine or DHE) was aimed at stopping migraine pain in progress. Then came the triptan drugs, which were even more effective at halting pain. They include:
- Imitrex (sumatriptan)
- Axert (almotriptan)
- Amerge (naratriptan)
- Maxalt (rizatriptan)
- Zomig (zolmitriptan)
- Frova (frovatriptan)
- Relpax (eletriptan)
Both ergot and triptan drugs are still prescribed today, Solomon says. However, because both drugs work to constrict swollen blood vessels, not all patients can take them. "If a patient has heart disease or high blood pressure, they just can't take those drugs," he tells WebMD.
Preventing Migraines in the First Place
More recently, to try to stop migraine headaches from developing at all, doctors have prescribed drugs used to treat other disorders. These drugs are taken daily to suppress the brain chemical or blood vessel activity that leads to migraines. The hope is to prevent a migraine from getting started. These drugs include:
- Antiseizure drugs such as Topamax and Depakote, used to treat epilepsy
- Beta-blockers such as Inderal, used to treat high blood pressure and abnormal heart rate
- Calcium channel blockers such as Cardizem, also prescribed for high blood pressure and abnormal heart rhythms (arrhythmias)
- Nonsteroidal anti-inflammatory drugs (NSAIDs), over-the-counter painkillers such as Aleve and Anaprox
- Tricyclic antidepressants such as Elavil and Norpramin
"All these are able to keep migraines from happening," says Silberstein. The problem with most, however, is side effects. Topamax can cause numbness, tingling, heat sensations, slowed thinking, and weight loss. Some calcium channel blockers, tricyclic antidepressants, and Depakote can cause weight gain.
"The bottom line is, you pick side effects," says Silberstein. "I tell the patient, 'This drug may have cognitive side effects in some people, may make you lose weight, or here's one that may make you gain weight. Which one do you choose?' With Topamax, you know right away if you'll have side effects. With the others, the side effects [such as weight gain] sneak up on you."
Despite all these advances, some patients still suffer. "One in 10 migraine patients cannot tolerate certain migraine medications. So we're better than we were, but we're still not perfect," Silberstein notes.
For some desperate people, the muscle-paralyzing drug Botox, usually given via injection to facial muscles to reduce the appearance of wrinkles, is a saving grace, he says. "Botox seems to work for patients who get frequent migraines, more than those with infrequent ones. If it works, the treatment is every three or four months." However, Botox treatments can be expensive. "Sometimes insurance covers it, but often it doesn't," he notes.