Treating Migraine Pain

If you can't prevent a headache you can still do damage control

Migraine sufferers, especially those with more than two episodes per month, know the importance of medication to halt and ease their pain. Neurologists approach migraine treatment in two ways: prevent the attack, or relieve pain after the headache has begun. Here is an overview of the options available.

Before It Starts
Preventive medications are taken regularly to stave off chronic headaches. The Food and Drug Administration (FDA) has approved four drugs for migraine prevention: blood pressure medications propranolol and timolol (both known as beta blockers), and anti-seizure medications topiramate and divalproex sodium. These are also called prophylactic medications.

Taken daily, topiramate, the most commonly prescribed formula, is believed to work by calming the nerve cells that trigger the pain response in the brain.

Control the Damage
Abortive treatments called triptans (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan) are most effective if taken early on, when symptoms such as auras first appear. "A lot of patients will know a migraine is coming," says neurologist Traci Purath, M.D., medical director of Comprehensive Headache Care at Wheaton Franciscan Medical Group in Racine, WI. "Maybe they're sensitive to light or some patients start yawning 24 hours beforehand. What we want the patients to do is once they get that signal or start feeling that pain, reach for their rescue medication."

Triptans work by increasing the amount of serotonin in the brain, which stops brain vessels from swelling. They are available in many forms, including self-injectable, nasal spray or a rapidly dissolving tablet. The goal is to deliver relief as quickly as possible. There are certain contraindications for taking these medications so consult your physician before starting triptans.

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