As anyone who suffers from migraines will know, a migraine is not just a headache. As well as severe pain, migraines can cause nausea, vomiting and extreme sensitivity to light and sound. There’s not one thing that causes migraines, and different people will have different triggers. These often include tiredness, stress, menstruation and certain types of food and drink. If you suffer from the excruciating pain of migraines, we're here to help you find the right treatments to manage your migraines and and stop the crippling pain in its tracks.
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Migraine medication: what works?
Many of us who get migraines regularly come to know when an episode is beginning. While there is no cure, there are various types of medication that can offer relief. If you experience migraines regularly, it’s worth seeking professional advice to see if there’s an underlying cause.
Migraine tablets vary in price, especially if you buy them over the counter. The Independent Pharmacy – a regulated UK online pharmacy – makes ordering your migraine medication quick and easy, with professional service and fast delivery. Be safe and always follow the guidelines that come with any form of medicine.
Migraine is a very common condition that involves a severe headache that can also include other symptoms such as nausea, vomiting and sensitivity to light or sound. Migraines normally begin in early adulthood and are more common in women. It is thought they affect around 1 in 5 women and only around 1 in 15 men. Migraines normally gradually improve as people get older, although in some cases they can get worse.
Migraines are very individual with different people experiencing different symptoms with varying impacts on their lifestyle. At the most extreme end, migraines can occur several times a week and involve severe pain, sickness and sensitivity to light and/or sound, lasting days at a time. At the other end of the spectrum, migraines may only occur occasionally with months, or even years, between attacks that can be fairly mild and short-lived.
As you can see, migraines can have a massive impact on your quality of life and in some cases can stop you from working. It is important that you treat migraines effectively and follow preventative measures to reduce their frequency.
Migraines are thought to be caused by abnormal brain activity that affects nerve signals, chemical transmitters and blood vessels within the brain. Although it is not clear what the exact cause of the abnormal activity is, it is thought that your genes may make you more likely to experience a migraine following exposure to a specific trigger factor.
Trigger factors are stimuli that cause the changes in the brain that start a migraine. There are many proposed triggers and each migraine sufferer will have a specific trigger(s) that they are aware of that will bring on a migraine.
Migraine trigger factors can include:
Stages of a migraine
To understand the symptoms of a migraine, it is also important to understand the phases of a migraine. They will normally have four distinct phases, although some people may not experience all of them. The four distinct phases of a migraine are:
For some people the first sign that a migraine is about to occur will be the aura phase, which occurs in around one third of sufferers. This visual ‘warning’ stage usually lasts for between 5 minutes and 1 hour and can involve the following symptoms:
The main symptom of a migraine (during the migraine attack) is a severe headache that occurs on one side or across the front of the head. It can, however, occur across the whole head and even affect the face or neck in some people. The headache experienced with a migraine is normally an intense throbbing that gets worse with movement.
Additional symptoms that may be experienced with a migraine include:
Not everyone will experience all of these symptoms and they may vary with each migraine attack. It is possible to experience these additional symptoms without the typical migraine headache on some occasions.
You should seek urgent medical attention at the hospital if you have any of the following migraine symptoms:
There is no specific way/test to diagnose migraines. A diagnosis is normally made by your GP; it is based on the pattern and severity of headaches along with the occurrence of other associated symptoms as well as your response to migraine treatments. This can take time depending on the frequency, severity and associated symptoms of your migraines.
To aid your diagnosis it is helpful to keep a migraine diary to keep an accurate record of your condition. Your migraine diary should include:
Based on the contents of your migraine diary, the symptoms that you experience and your response to any painkillers or migraine treatments, an accurate diagnosis can be made.
Migraines cannot be cured, although they may ease or even disappear over time. Migraine treatment aims to relieve symptoms and sometimes prevent the onset, if taken early enough. Migraine treatment can range from over-the-counter painkillers to prescription treatments depending on the symptoms and severity.
Painkillers
Simple painkillers such as paracetamol, ibuprofen or aspirin, can help to relieve the throbbing headache associated with a migraine attack if they are taken early enough. You should take them at the first onset of symptoms, do not wait until you are already experiencing a painful headache as it will be too late and they may be less effective. Soluble painkillers are absorbed into your system quicker and may be more effective at relieving migraine pain.
If simple painkillers do not relieve pain, stronger painkillers containing codeine, such as Solpadeine or Nurofen Plus, may be more effective.
Take care when using painkillers as overuse can be dangerous. Regular use of any painkillers can cause headaches and make migraines worse.
Triptans
If you have been diagnosed with migraines by your GP and they cannot be controlled with simple painkillers, you will be prescribed a Triptan. Triptans (also known as 5-HT1 agonists), which are taken alongside painkillers, cause the blood vessels in the brain to contract. As some of the changes that occur in the brain to trigger a migraine attack are believed to involve the blood vessels widening, Triptans help to reverse this process and relieve the symptoms of migraine. They may also have some effect by stabilising some of the chemical changes that occur in the brain during a migraine attack.
Each Triptan has a very similar mode of action, however each can work differently depending on the person. Although, there are slight variations in effectiveness and side effects, it is much more important to find the right drug for you. This may mean trying a few different Triptans before you find the most effective one for you. It is recommended by The British Society for the Study of Headache (BASH) that you try each individual Triptan on three separate occasions before deciding on its effectiveness. If you feel it is not effective, you should then try a different Triptan or higher strength.
When choosing the correct triptan it is worth considering the method of administration as this can help to improve the effectiveness. Tablets are the standard form of triptan that are effective in most people, however if you experience nausea or vomiting they may be difficult to take. Tablets can also take longer to have an effect than other treatments and may not be the best option if a fast onset of action is required. Tablets need to be taken early on in a migraine attack for a maximal effect as there is some evidence that the absorption of drugs may decrease during a migraine attack.
Nasal sprays or wafer melts may be a better option in cases where tablets are not suitable due to the need for a quick onset of action or where nausea/vomiting makes swallowing impractical.
What triptans are available?
Tablets
Nasal Sprays
Wafer Melts
Each Triptan has a slightly different dose and administration method; you should check the individual instructions for each treatment. For maximum effectiveness, the Triptan should be taken at the onset of the migraine headache (the migraine attack phase), not during the prodromal or aura phases. It has been shown that taking triptans at this point in a migraine makes them most effective. In most cases you can repeat the dose after 2-4 hours if the treatment was effective and the headache returns.
Triptans can be taken alongside painkillers and anti-sickness medicines to help treat all symptoms that occur during a migraine attack.
Anti-sickness treatments (anti-emetics)
Anti-sickness treatments, such as Buccastem, can be taken to relieve the symptoms of nausea and vomiting that are experienced as part of a migraine attack. Like painkillers, anti-sickness treatments for migraine are best taken as early as possible in an attack if you know you usually experience nausea. The earlier they are taken in the migraine attack, the more effective they tend to be at treating the nausea and sickness.
Buccastem is the first line treatment for nausea and vomiting and is very effective at preventing symptoms. Buccastem is a buccal tablet meaning it is dissolved between the lip and gum. This means there is no need to swallow a tablet when feeling nauseous. Absorption of the drug through the gums allows it to be absorbed more quickly meaning a faster onset of action.
The most important method of migraine prevention is to identify and avoid triggers. By keeping a migraine diary as detailed above in ‘Diagnosis’ you can start to identify triggers and then learn to avoid any triggers that bring on a migraine. Common migraine triggers are listed above in ‘Causes’. This list is only the most common triggers, you may find that there are other factors that you are sensitive to; migraine triggers are different from one individual to another.
If you experience more than 5 days of migraines in a month, you may benefit from preventative treatment from your GP. There are many medical treatments for the prevention of migraines, such as topiramate, propranolol and gabapentin, which may be effective if you have frequent, severe migraines. If you think you fall into this category you should book an appointment to discuss preventative migraine treatment with your GP and take a comprehensive migraine diary to aid diagnosis.
Alternative OTC (over the counter) Medication
There are some over the counter medications that can be used initially to try and combat migraine pain and nausea. Some of the products include;
If you suffer from sensitivity of light you should try and stay in a dimly lit room until these symptoms ease.
Triptans are the newest and most popular type of migraine treatment. They include almotriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan, and are available as various different branded and generic migraine treatments from our Online Pharmacy.
Triptans work by constricting the widened (dilated) blood vessels in the brain that are thought to occur during a migraine. They may also stabilise the changes in activity of some brain chemicals that occur during a migraine attack. Triptans are an 'as required' migraine treatment; they are only taken when necessary to treat a migraine attack. Triptans can help to to halt the onset of migraine symptoms if it is taken at the correct time, at the beginning of the headache phase.
There is no best migraine treatment that suits everyone. All Triptans would probably work well in most people with migraine. However, there is some evidence to suggest that some are slightly more effective than others; but also, that side effects may vary between each different Triptan and each can have different levels of effectiveness in separate individuals.
Therefore, if the first Triptan you try does not work as well as desired, or causes side effects, after three separate attempts it is definitely worth trying a different Triptan that may be more suited to you.
You should take your triptan as you start to feel a slight headache develop and not before. Triptans are effective at treating a migraine in its early stages and can prevent a full-blown attack, however they are not preventatives and should not be taken before a migraine occurs. Triptans are designed to work rapidly - within an hour or so, to treat migraines quickly.
When migraine symptoms begin:
There are no objective tests for migraine; the diagnosis is on the basis of the history and pattern of symptoms over time as well as response to any drug treatments tried. This is why keeping a migraine diary can be helpful.
Things that should be covered in a migraine diary are:
Migraines are most common in females; 75% of migraine sufferers are women. There is no known cause for the difference in migraine occurrence between the sexes.
Nausea causes poor absorption of tablets into your body and many people find it hard to take tablet treatments when they are experiencing nausea.
Prochlorperazine (Buccastem) is an effective and fast-acting anti-sickness treatment. It comes in a buccal tablet form; it dissolves between the gum and cheek, without the need to swallow. This can be useful if you feel sick and do not wish to swallow a tablet. Anti-sickness medicines work best if you take them as soon as possible after symptoms begin.
If you take painkillers, they may remain in your stomach if you are experiencing nausea and vomiting. This means they will not be absorbed well and you may even bring the tablets back up. If this is the case, use soluble (dissolvable) painkillers. These are absorbed more quickly from your stomach and are likely to work better. You can take anti-sickness treatment in addition to painkillers.
Taking painkillers or Triptans too often for tension-type headaches or migraine attacks can cause a condition known as medication-induced headache. It is also known as a medication-overuse headache.
It is a common cause of headaches that occur daily, or on most days. About 1 in 50 people develop this problem at some time in their life. If you find that you are getting headaches on most days and you are regularly taking Triptans or painkillers then you should discuss this with your doctor.
Changing blood sugar levels can be a trigger for migraines. To keep blood sugar levels stable try to ensure you:
It is a well-known myth that if you avoid chocolate, cheese and red wine, you won't get migraine. Although these can all be triggers for migraines, there are many different triggers and what may affect one person does not necessarily affect another.
For most people it is not just one trigger but a combination of factors which can trigger a migraine attack. Read the ‘Causes’ section above for more information on common trigger factors.
There may be a hereditary predisposition to migraines, as it does tend to run in families although not everyone in the family will suffer with them. There are many factors involved in the occurrence of migraines, not all of which are understood. There will usually be a number of factors influencing whether you develop migraines, not just your family history.
Alcohol can be a migraine trigger for certain people. For this reason, migraine sufferers tend to consume alcohol less often than most. Red wine is thought to be a particular culprit, although studies show that other alcoholic drinks are equally likely (sometimes more so) to be the cause. A bad hangover also has the potential to cause a migraine in those who are prone to the affliction.
Obesity does not directly cause migraines, however, it is a risk factor and may mean that it’s more likely – depending on how overweight the person is. Certain research shows that as we gain weight, migraine symptoms can also become more severe.
Living a healthy lifestyle, getting enough exercise and getting plenty of sleep can all help with this. If you are overweight, then weight loss will not necessarily lead to curing your migraines, but they may become more bearable and less frequent.
The NHS may soon start using Botox injections to treat chronic migraines. While the muscle-paralysing injections are popular as a cosmetic ‘anti-wrinkle’ treatment, the nerve-blocking effects may also help to alleviate some of the painful symptoms of associated with the condition.
Precision tinted lenses are thought to help reduce the discomfort experienced when a migraine attack occurs. They do this by normalising excessive brain activity, which can sometimes act as a trigger. Available from Amazon and other outlets, those who suffer from migraines frequently may wish to try tinted migraine glasses as a preventative measure.
Some research shows that taking magnesium tablets (usually magnesium oxide) once a day can help to prevent menstrual-related migraines. The recommended dosage, if you tend to get migraines around your period, is 400 to 500 milligrams a day.
Authored by
Andy is a co-founder and the Superintendent Pharmacist and Director at The Independent Pharmacy.
Reviewed by
Dan is an experienced pharmacist having spent time working in both primary and secondary care. He currently supports our clinical team by providing robust clinical governance review of our internal processes and information.
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