- Patients first try general nonprescription pain relievers (NSAIDs, Excedrin Migraine) and stress-reduction techniques.
- If these are not effective within 2 hours, migraine-specific drugs should be tried next. Triptans are the first choice, then ergot derivatives.
- Injected or rectally administered drugs may be used for patients with migraines associated with severe nausea or vomiting. Nausea itself should be treated with specific anti-nausea drugs, such as metoclopramide (Reglan).
- If migraine medications fail to relieve symptoms within 4 hours, rescue drugs (opioids, corticosteroids) may be used.
Stratified Approach. Many doctors and patients now prefer the stratified approach. The doctor first estimates the severity of the patient's condition based on his or her history. Then, based on the severity of a typical attack, the doctor decides whether the patient should start with more or less potent drugs at the first signs of the migraine:
- Patients with less disabling migraines start with general pain relievers.
- Patients with a history of moderate to severe migraines start with migraine-specific prescription medicine, such as a triptan, at the onset of mild pain.
Some studies report dramatic relief with the stratified approach. In a 2002 study, zolmitriptan, a newer triptan, reduced the intensity of headaches within 2 hours in 70% of patients with moderate pain but only in 44% of those with severe headaches.
Side effects can be severe with many migraine drugs, although newer drugs, such as the recent generation triptans, may provide effective early relief without significant adverse effects.
Guidelines for Migraines in ChildrenStudies estimate that between 5 - 10% of children may experience migraines but that the disorder is underdiagnosed in children. An interesting study reported that when children drew pictures in response to their doctors' questions about their migraines, the doctors were able to tell the difference between migraine and non-migraine headaches in the majority of cases. Symptoms in Children. The standard diagnostic criteria for migraine in adults may apply to only about two-thirds of migraines in children and adolescents. For example, the following differences have been observed:
Outlook in Children. Migraine in children is disabling, as it is in adults, and they tend to lose more school days than other children. Children with frequent headaches may also be at higher risk for headaches in adulthood and also for other physical and psychiatric problems. Treatments in Children. For most children with migraines, mild pain relievers and home remedies (such as ginger tea) may be sufficient. The American Academy of Neurology’s 2004 practice guidelines for children and adolescents recommend the following drug treatments:
Preventive Measures in Children. Non-medication methods, including biofeedback and muscle relaxation techniques may be helpful. In one study of children with migraines and poor sleep habits, instructions in improving sleep without using medications reduced migraine attacks significantly. If these methods fail, then preventive drugs may be used, although evidence is weak on the effectiveness of standard migraine preventive drugs in children. Flunarizine (Sibelium), an anti-seizure drug that also blocks calcium channels, has been effective for children in trials but is not yet approved in the U.S. |
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