Antimigraine Medications

Definition

Antimigraine medications are drugs that are given to lower the risk of a severe migraine attack or to reduce the severity of the headache once an attack begins.

Purpose

Treatment that is given to stop or ease the pain of a migraine headache after it has started is known as acute or abortive treatment.

Preventive treatment for migraine headaches is called migraine prophylaxis or prophylactic therapy. Prophylactic medications are taken when the patient is not having a headache. They have three purposes:

  • lower the frequency and severity of the patient's headaches
  • make acute migraines more responsive to abortive treatment
  • improve the patient's overall quality of life

Not all patients with migraines need prophylactic treatment. Most doctors, however, recommend prophylactic medications in the following circumstances:

  • The patient has two or more migraines per month, with disability lasting three or more days
  • Acute treatment is contraindicated or is ineffective
  • The patient has been using abortive medications more than twice a week
  • The patient has a complex form of migraine such as hemiplegic or basilar migraine
  • The patient is at risk of permanent neurologic injury from acute attacks

Abortive medications

The following interactions have been reported for abortive medications:

  • Triptans: All the triptans narrow coronary arteries by 10–20% and will intensify the effects of other vasoconstrictive drugs, including the ergot alkaloids and drugs given for vascular disorders. With the exception of naratriptan, the triptans cannot be taken together with MAO inhibitor antidepressants because of the risk of a rapid and dangerous rise in blood pressure. Rizatriptan has been reported to interact with the beta-blocker propranolol.
  • Ergot alkaloids: Cannot be taken together with the triptans. Ergot alkaloids should not be taken together with methysergide because of an additive effect. Should not be taken together with other vasoconstrictive drugs (including beta-blockers, some acid-reducing drugs, some antibiotics, and some antifungal drugs) because of the increased risk of gangrene.
  • NSAIDs: These drugs tend to prolong bleeding time and should be used cautiously by patients taking blood-thinning medications. Alcoholic beverages increase the risk of gastric ulcers or bleeding from the use of NSAIDs. In addition, patients should not take more than one NSAID at a time.
  • Combination analgesics: These drugs should not be used together with MAO inhibitors or other drugs that contain acetaminophen. They will intensify the actions of other drugs that may cause drowsiness, including alcohol, TCAs, antihistamines, sedatives, and muscle relaxants.
  • Antiemetics: Should not be taken together with alcohol (intensifies central nervous system depression), tricyclic antidepressants (lowers blood pressure), or phenobarbital. Patients taking anticonvulsants may need to have their dosage increased if they are given an antiemetic.

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