Antimigraine Medications Health Article

Complementary and alternative medications (CAM)

There are two herbal preparations used as migraine preventives as of 2004. Feverfew (Tanacetum parthenium) is an herb related to the daisy that is traditionally used in England for migraine prophylaxis. Feverfew contains a compound called parthenolide, which is thought to counteract the inflammatory reaction in the cerebral blood vessels that precedes an acute migraine attack.

The second herb is butterbur root (Petasites hybridus), which is the active ingredient in Petadolex, a preparation that has been sold in Germany since the 1970s as a migraine preventive. Petadolex has been available in the United States since December 1998. Butterbur root contains compounds known as petasines, which relieve inflammation as well as counteract the spasmodic contraction of blood vessels that occurs during a migraine attack. Researchers reported in 2003 that Petadolex reduced the frequency of migraine attacks in subjects in a multicenter trial by 60%. The butterbur root preparation has fewer and milder side effects than conventional prophylactic drugs; it also appears to be safe for children and adolescents.

It should be noted that, contrary to the popular notion, herbals are drugs that can and do cause side effects; they are not the medical "free ride" many people seem to think they are. They should thus be used with care and caution and in consultation with a physician.

CAM preparations

Feverfew should not be used with anticoagulants (blood thinners), as it intensifies their effects. It may also interfere with the body's absorption of iron. NSAIDs reduce the effectiveness of feverfew. No interactions with prescription drugs have been reported for butterbur root preparations.

Diagnosis

Migraine headaches are classified by the International Headache Society (IHS) as primary headaches, which means that they are not caused by other diseases or disorders. Severely painful headaches, however, are not necessarily migraines and may be caused by other conditions, some of them potentially life-threatening. Headaches caused by other disorders are known as secondary headaches. They may be associated with space-occupying brain tumors, meningitis, stroke, head trauma, pain referred from the neck or jaw, or a ruptured aneurysm inside the head. Patients with any of the following signs or symptoms should be carefully evaluated, including those who have been previously diagnosed with and treated for migraines:

• The patient is not responding to appropriate treatment for the headaches.
• The headache is severe and is sudden in onset. Although a small percentage of patients with migraines have what are called "crash" or "thunderclap" migraines, most migraine headaches build up slowly over a period of one or two hours.
• The headache differs from the usual pattern of the patient's migraines.
• The patient has described the present headache as "the worst ever."
• The patient has abnormal neurological signs or symptoms such as a swollen optic disk (papilledema), seeing double, loss of sensation, or alteration of consciousness.

Some patients may be suffering from another type of primary headache in addition to migraines. It is possible, for example, for people to have both chronic tension headaches and migraines, and each type may require separate treatment.

A third consideration is whether the patient has been diagnosed with any comorbid disorders. The doctor must take such conditions as hypertension, depression, epilepsy, heart problems, and other disorders into account when selecting antimigraine medications for the patient.