Migraine is much more than just a headache. For millions of people in Israel and around the world, migraine is a chronic neurological condition that can significantly impact quality of life. At Pharma Care, we understand the unique challenges migraine sufferers face, and the importance of finding the most appropriate treatment. Choosing the right migraine medication can be the difference between a life filled with pain and the ability to lead a normal routine.
In this article, we will review the variety of migraine treatment options, and help you understand how to choose the treatment that best suits your personal situation, in consultation with your treating physician.
What is a migraine and what causes it?
Migraine is a neurological disorder characterized by recurrent attacks of moderate to severe headache, usually on one side of the head. A migraine headache is often described as a throbbing or pounding sensation, and may be accompanied by other symptoms such as:
- Sensitivity to light (photophobia)
- Sensitivity to noise (phonophobia)
- Nausea and vomiting
- Blurred vision
- Dizziness
In about 251% of migraine sufferers, the attack is preceded by a phenomenon called "aura" – sensory disturbances such as spots of light, zigzag lines, or temporary loss of the field of vision.
The causes of migraine are not yet fully understood, but research suggests a combination of genetic and environmental factors. The leading theory currently focuses on changes in neural activity in the brain and the dilation and narrowing of blood vessels in the brain, as well as changes in levels of brain chemicals, such as serotonin.
Types of migraine medications
Drug treatment for migraine is divided into two main categories:
- Medications to treat an acute attack – Taken during a migraine attack to relieve pain and associated symptoms
- Preventive medications – Taken regularly to reduce the frequency and severity of attacks
Medications to treat an acute migraine attack
When a migraine attack begins, there are several treatment options:
| Type of drug | Examples | Particularly suitable for |
|---|---|---|
| Over-the-counter pain relievers | Paracetamol, Advil, Nurofen | Mild to moderate seizures |
| Nonsteroidal anti-inflammatory drugs (NSAIDs) | Aspirin, naproxen, diclofenac | Moderate seizures |
| Triptans | Sumatriptan (Imitrex), zolmitriptan (Zomig), rizatriptan (Maxalt) | Moderate to severe seizures |
| Ergotamines | Argomar, Capregot | Prolonged seizures |
| Anti-nausea medications | Metoclopramide (Permin), domperidone | Migraine accompanied by nausea and vomiting |
Migraine preventive medications
Preventive treatment is recommended for people who suffer from frequent migraine attacks (four or more per month), severe attacks, or when medications to treat an attack are not effective enough.
- Beta blockers: Propranolol (Darlin), metoprolol (Lopressor)
- Antidepressants: Amitriptyline (Altrol), venlafaxine (Effexor)
- Anticonvulsants: Topiramate (Topamax), valproate (Deflavent)
- Calcium channel blockers: Pelodipine (Dino)
- Monoclonal antibodies: Eranumab (Imagliti), Parmanezumab (Ajovi), Galcanezumab (Imagliti) – a new generation of drugs targeting calcitonin gene-related peptide (CGRP)
- Non-pharmacological treatments: Botox treatments (for chronic migraine)
How to choose the right migraine treatment?
Choosing the most appropriate treatment for migraine is a personal decision that should be made in collaboration with your doctor. Here are a few factors to consider:
1. Severity and type of migraine
The nature of your migraine attacks will significantly influence the choice of treatment:
- For mild to moderate attacks, simple painkillers or NSAIDs may be sufficient.
- For more severe migraines, triptans or combination therapies may be more effective.
- If you suffer from migraine with aura, some treatments may be more suitable than others.
2. Frequency of seizures
The frequency of migraine attacks is a decisive factor in choosing between acute treatment and preventive treatment:
- Less than 4 attacks per month: Treatment of the acute attack is usually sufficient.
- 4 or more attacks per month: consider preventive treatment
- Daily or almost daily attacks: a comprehensive, sometimes combined, therapeutic approach is required
3. Response to previous treatments
Your treatment history is essential information:
- What migraine medications have you tried in the past?
- Were they effective?
- Have you experienced any side effects?
4. Associated medical conditions
Other health conditions may affect the choice of treatment:
- Cardiovascular disease: may limit the use of triptans and ergotamines
- Depression or anxiety: Some migraine medications can also help with these conditions.
- High blood pressure: Beta blockers may be helpful for both problems
- Pregnancy or breastfeeding: limits treatment options
5. Lifestyle and personal factors
Personal factors also influence the choice of treatment:
- Work hours and schedule: affect the ability to take medication regularly
- Susceptibility to side effects: Some people are more sensitive to certain side effects
- Personal preferences: for example, preference for daily care versus as-needed care
The process of choosing the right treatment for migraine
Choosing the right treatment is a process that sometimes requires trial and error. Here are three recommended steps:
- Detailed documentation: Keep a migraine diary before your appointment with your doctor. Record frequency, duration, severity, triggers, and associated symptoms.
- Professional consultation: See a neurologist or family doctor with experience in treating migraines. Share your diary and treatment history.
- Tracking and matching: After starting a new treatment, continue to record your response. If the treatment is not effective enough or causes significant side effects, return to your doctor for treatment adjustments.
Complementary strategies for treating migraine
Alongside medication, there are additional strategies that can help reduce the frequency and severity of migraine attacks:
- Identifying and managing triggers: Avoid foods known to trigger migraines (such as aged cheeses, alcohol, processed foods with MSG)
- Regular sleep: Maintain regular sleep hours.
- Stress management: Practice relaxation techniques, meditation, or yoga
- Regular physical activity: Regular moderate aerobic activity
- hydration: Drinking enough water throughout the day
- Complementary treatments: Acupuncture, massage, biofeedback
Frequently Asked Questions
Can migraine medications cause addiction?
Some migraine medications, especially painkillers that are taken frequently, can be addictive. Furthermore, overuse of medications to treat an acute attack (more than 10-15 days a month) can cause a "rebound headache" or "medication overuse headache." It is important to use medications as directed by your doctor and to report any changes in the frequency of your headaches.
When should you consider preventive treatment for migraine?
Migraine prophylaxis is usually recommended when you experience four or more migraine days per month, when the attacks cause significant impairment in functioning, or when medications to treat an acute attack are not effective enough or cause problematic side effects. Even if you have fewer attacks but they are particularly severe, prophylaxis may be right for you.
Are the new anti-CGRP treatments better than traditional treatments?
Newer treatments based on CGRP antibodies offer significant benefits for some patients, especially those who have not responded well to traditional treatments. The benefits include fewer side effects and less frequent dosing (once a month or once a quarter by injection). However, they are more expensive and not all health plans cover them fully. The decision whether they are “better” depends on your individual circumstances, including your response to previous treatments, underlying health conditions, and insurance coverage.
Can migraine treatment affect other treatments I am receiving?
Yes, migraine medications can interact with other medications. For example, triptans can cause life-threatening serotonin syndrome when taken with certain antidepressants. Beta-blockers can make asthma worse in some people. It is important to tell your doctor about all medications, supplements, and herbs you are taking.
Are there any migraine medications that are safe to use during pregnancy?
Most migraine medications are not recommended for use during pregnancy, but there are safer options. Acetaminophen (paracetamol) is considered the safest choice for treating an acute attack. For preventive treatment, some beta-blockers (such as propranolol) are considered a reasonable choice under medical supervision. It is important to consult with a gynecologist and neurologist before taking any medication during pregnancy.
Medical Disclaimer: The information presented in this article is for general informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. You should always consult a qualified physician or other medical professional regarding any medical question or health condition. Professional medical advice should not be disregarded or delayed because of content you have read in this article. Pharma Care is not responsible for any action taken based on the information presented in this article.
Prof. Alon Green is an expert in clinical psychiatry and drug research, specializing in the development and adaptation of prescription drugs for a variety of neuropsychiatric conditions. He has over 35 years of experience in clinical and academic work, and has served as a lecturer and visiting professor at several leading universities in Israel and abroad. He has headed research and treatment units in public hospitals and advanced medical centers. His areas of expertise include attention deficit hyperactivity disorder (ADHD), anxiety and sedation disorders, clinical depression and mood disorders, as well as drug therapies that support diet and metabolic balance. He combines evidence-based approaches with pharmacological innovation, and has published dozens of professional articles in scientific journals, making a significant contribution to the understanding of the mechanisms of action of drugs and their clinical effects.
