Migraine headache treatment

Several years ago aspirin was almost the only available treatment for migrain headache. Now there are drugs specifically designed to treat migraines.
There are two kind of migraine medications:
Pain-relieving medications. These stop pain once it has started.
Preventive medications. These reduce or prevent a migraine headache.

Choosing a preventive strategy or a pain relieving strategy depends on the frequency and severity of your headaches, the degree of disability your headaches cause and other medical conditions you may have.
You need a preventive therapy if you
- have two or more migraine headache attacks in a month
- use pain relieving medications more than twice a week
- pain-relieving medications aren't helping
- have uncommon migraines.

Some medications aren't recommended if you're pregnant or breast-feeding. Some aren't used for children. Your doctor can help find the right medication for you.

Pain-relieving medications
For best results, take pain-relieving drugs as soon as you experience signs or symptoms of a migraine headache. It may help if you rest or sleep in a dark room after taking them:
Over-the-counter medications for mild migraine:
- ibuprofen (Advil, Motrin, others)
- aspirin
- the combination of acetaminophen, aspirin and caffeine (Excedrin Migraine)

If over-the-counter medications taken too often or for long periods of time, its can lead to ulcers, gastrointestinal bleeding and rebound headaches.

Drugs for stronger migraine:
- Triptan. It mimics the action of serotonin by binding to serotonin receptors and causing blood vessels to constrict. Triptan is available in oral, nasal and injection form. Injected triptan works faster than any other migraine-specific medication — in as little as 15 minutes — and is effective in most cases. But injections may be inconvenient and painful.
Example: Sumatriptan (Imitrex), rizatriptan (Maxalt), naratriptan (Amerge), zolmitriptan (Zomig), almotriptan (Axert), frovatriptan (Frova) and eletriptan (Relpax).
Side effects of triptans include nausea, dizziness, and muscle weakness and, rarely, stroke and heart attack.
- Ergot.
Example: ergotamine (Ergomar), dihydroergotamine (D.H.E. 45), dihydroergotamine nasal spray (Migranal)These drugs may have more side effects than do triptans.

Preventive medications
- Beta blocker — which are commonly used to treat high blood pressure and coronary artery disease — can reduce the frequency and severity of migraines. Example: Calcium channel blockers,verapamil (Calan, Isoptin), antihypertensive medications lisinopril (Prinivil, Zestril) and candesartan (Atacand)
- Antidepressant. Example: tricyclic antidepressants; amitriptyline, nortriptyline (Pamelor) and protriptyline (Vivactil).
- Anti-seizure drug. Example: divalproex sodium (Depakote), valproic acid (Depakene) and topiramate (Topamax).
- Cyproheptadine. This antihistamine specifically affects serotonin activity. Doctors sometimes give it to children as a preventive measure.
- Botulinum toxin type A (Botox). Some people receiving Botox injections for their facial wrinkles have noted improvement of their headaches. However, it's unclear what effect Botox actually has on headaches. It may cause changes in your nervous system that modify your tendency to develop migraines. Additional research is necessary.