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In the immediate treatment of a
migraine headache, the simplest remedy that circumstances may permit
is self-medication with an analgesic or pain-relieving drug. Many
preparations are widely advertised and readily available in the form
of powders and tablets containing mixtures of drugs. Preparations
that contain amidopyrine or phenacetin may be harmful and are best
avoided. It is safer to use a simple drug, for example aspirin in its
soluble form, or if aspirin gives you indigestion, then paracetamol
is an effective alternative. The recommended dose can usually be
repeated after three or four hours if necessary. With this simple
measure, your headache may disappear, or your migraine attack may be
cut short.
Excedrin Migraine: which
contains acetaminophen, aspirin, and caffeine is the first over the
counter medication to be approved by the US Food and Drug
Administration for migraine. It is important to remember that the
clinical trials excluded patients with severe migraine.
Non-steroidal anti-inflammatory
drugs: (NSAIDs), such as naproxen sodium, also known as
‘Naprosyn’, available in 275 to 550 mg and ibuprofen, for
example, ‘Motrin’, 400 to 800 mg tablets are also effective.
Anti-nausea drugs: can be
obtained over the counter, 50 to 100 mg of dimenhydrinate by mouth or
in suppository form or with a prescription, 10 mg metoclopramide. A
combination of acetaminophen, a vasoconstrictor and a relaxant
(dichloralphenazone) This medication is know as ‘Midrin’ and is
available in the United States and has proved effective in clinical
trials.
Beta Blockers: these are
another form of medication for migraine sufferers, such as
propranolol hydrochloride (Inderal), atenolol (Tenormin) have proven
efficient in migraine prevention. Adverse effects can include
fatigue, reduced exercise tolerance, impotence, and depression.
Beta-blockers may take 12 weeks at an adequate dose to begin to work.
The effective dose range for propranolol is 60 to 240 mg per day.
Tricyclic Antidepressants:
Amitriptyline hydrochloride (Elavil) and nortriptyline
hydrochloride (Aventyl HCI, Pamelor) are effective treatments for
migraine. Contraindications for their use are glaucoma and heart
disease. Adverse effects include drowsiness, making it useful for
patients with sleep disorders, dry mouth, weight gain, and blurred
vision. The effective dose range is 20 to 75 mg per day.
Calcium Channel Blockers: Both
verapamil hydrochloride and flunarizine are effective. Side effects
include weight gain, edema, constipation, and depression. The
suggested dose range of verapamil is 180 to 320 mg per day;
flunarizine is effective at 5 to 10 mg per day.
Antiepileptic Drugs: Valproic
acid (Depacon, Depakene, Depakote), are effective in preventing
migraine. All of the anti-epileptic drugs can cause drowsiness and
impaired cognition, which can be minimized by a "start low, go
slow" approach. Valproic acid can cause weight gain, hair loss,
and liver dysfunction; The suggested dose ranges are: valproic acid,
1,250 to 2,000 mg per day.
(Silberstein SD. Practice parameter:
evidence-based guidelines for migraine headache (an evidence-based
review): report of the Quality Standards Subcommittee of the American
Academy of Neurology. Neurology 2000;55(6):754-62 [Erratum, Neurology
2000;56(1):142]).
(Ferrari
MD, Roon KI, Lipton RB, et al. Oral triptans (serotonin 5-HT1B/1D
agonists) in
acute migraine treatment: a meta-analysis of 53 trials. Lancet
2001;358(9294):1668-75).
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