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Migraine headaches are some of the most disabling diseases in the world. In fact, according to the American Migraine Foundation, about 35 million Americans suffer from migraines. This includes 43% of all women and 18% of all American men. The prevalence of migraines in women is believed to be a result of unique hormonal changes.
Migraine Symptoms and Causes
Migraines affecting adults, adolescents, and children often go through four stages: prodrome, aura, attack, and post-drome. However, not everyone who experiences migraines goes through the four stages.
This stage occurs a day or two before the actual migraine. Some of the subtle hints that you’re about to have a migraine headache include:
- Mood swings.
- Food cravings.
- Neck stiffening.
- Frequent yawning.
- Fluid retention.
Auras are reversible disturbances in the nervous system. They can occur before or during the migraine headache. Most of the time, they cause visual disturbances. Other symptoms of migraine auras include:
- Vision loss.
- Visual phenomena such as hallucinations.
- Pins and needles sensations on extremities.
- Difficulty speaking.
Migraine attacks can last a few hours and up to three days if untreated. Their frequency also differs from person to person. One patient can have a migraine attack once in a while, while the next has several episodes in a month.
Here are the most common migraine symptoms:
- Severe headaches.
- Pain that pulses or throbs.
- Pain, typically on one side of the head, but sometimes on both.
- Nausea and vomiting.
After a migraine attack, you might feel exhausted or confused for up to a day. Some say they feel elated, while others report pain on slight head movement.
The causes of migraines are not fully understood, but genetics and environmental factors have been found to play a role. For instance, if several members of your family experience migraines, you’re at an increased risk of experiencing them. As a result, a health professional will diagnose you through family history and prescribe preventive medication.
Relationship Between Hormones and Migraines
As noted earlier, women are more likely to experience migraines than men due to their hormonal predisposition. In particular, women have a drop in estrogen during their monthly periods. This causes menstrual cramps and, sometimes, menstrual migraine.
Treatment of Acute Migraine Headaches
There are two primary types of migraine headache: acute and chronic migraine. Acute treatment of migraines involves treating pain and other symptoms, while chronic migraines require preventive medications.
Drugs for acute migraine attacks are taken on the onset of auras or migraine symptoms to relieve the headache. However, taking acute medications for too long can lead to headache recurrence. Therefore, you should seek an expert opinion if you use acute migraine drugs more than nine times a month.
Some over-the-counter drugs are used to treat acute severe migraine headache, although most of them are available in prescription strength. Apart from acetaminophen, which only reduces the pain, most of these pain relief medications are Nonsteroidal Anti Inflammatory Drugs (NSAIDs), which also reduce inflammation. These include:
- Diclofenac (Cataflam.)
- Naproxen (Aleve.)
Some over-the-counter drugs specifically marketed for migraine treatment combine one or more of the drugs above with small amounts of caffeine which increases their effectiveness, especially on mild headaches or migraines.
However, prolonged use of Nonsteroidal Anti Inflammatory Drugs can have side effects such as:
- Heart attack.
- Stomach ulcers.
- Kidney damage.
If common migraine medications are ineffective, you might want to talk to a health expert. In addition to painkillers, they recommend using anti-sickness drugs or triptans.
Triptans are a new class of drugs that increases serotonin levels in your brain, effectively ending the migraine. They are available as injections, pills, nasal sprays, and pills that dissolve under your tongue.
Common triptans include:
- sumatriptan (Imitrex.)
- Almotriptan( Axert.)
- Frovatriptan (Frova.)
- Rizatriptan (Maxalt-MLT, Maxalt.)
- Sumatriptan and Naproxen (Treximet.)
- Zolmitriptan (Zomig.)
It is important to note that triptans are not recommended for people with cardiovascular risk factors. They could also cause the deadly serotonin syndrome when taken with other drugs that increase the chemical, such as anti-seizure drugs.
If your migraine pain does not respond to regular painkillers and you can’t take triptans, doctors might recommend opioids. These are just extremely powerful painkillers that should be taken on a strict prescription. They include:
- Meperidine (Demerol.)
- Oxycodone (Oxycontin.)
Opioids are pretty addictive, so it’s essential to follow a guided prescription when using them.
Preventive Treatment of Migraine Headaches
If you experience frequent migraines, most doctors will prescribe preventive migraine medications. These will prevent migraines or lessen their frequency.
These drugs are taken regularly, usually daily, and can be prescribed alone or with other treatments. It may also take them a few weeks or months to be effective.
The drugs are also used to treat other conditions despite being effective for migraines.
Calcium Channel Blockers
Calcium channel blockers are blood pressure drugs that dilate or constrict blood vessels. Since the level of dilation plays a role in migraine pain, moderating it can help in migraine prevention.
A few examples of calcium channel blockers are:
- Nimodipine (Nimotop.)
- Dilitiazem (Cartia XT, Cardizem, Dilacor, Tiazac.)
However, these drugs can have a few side effects, including weight gain, dizziness, low blood pressure, and constipation.
Beta-blockers are prescription drugs used to treat high blood pressure. They decrease the effects of stress hormones on your blood vessels and heart. This also helps to treat migraines or reduce their frequency.
- Metropol (Tropol XL.)
- Atenolol (Tenormin.)
- Propranolol (Inderal.)
- Nadolol (Corgard.)
These drugs moderate the levels of various chemicals in the brain, including serotonin. Antidepressants, especially selective serotonin reuptake inhibitors, can reduce inflammation in the brain’s blood vessels, which helps in the treatment of migraine headaches.
Some examples are:
- Fluoxetine (Sarafem, Elavil.)
- Amitriptyline (Endep, Elavil.)
- Nortriptyline (Pamelor, Aventyl.)
- Imipramine (Tofranil.)
- Paroxetine (Paxil, Pexeva.)
- Venlafaxine (Effexor.)
Compound Medications for Migraine Treatment
Even with the treatment options above, some patients have little success relieving migraines. In fact, randomized controlled trials show that inadequate response to acute migraine treatment occurs in at least 56% of patients treated. This necessitates an alternative to common migraine drugs.
Compound medications are customized treatments based on your medical history, unique symptoms, and risk factors. They are especially useful for patients with recurring headaches who have to use chronic migraine medications.
Currently, there’s no definitive cure for migraines, and since they are multifactoral, a combination of drugs aimed at different mechanisms is more likely to be successful than monotherapy. This makes compound medications perfect for patients who are unresponsive to other migraine medications.
Opportunities in Compounding Treatments
Fort Worth Pharmacy provides individualized compound treatments for patients suffering from chronic and acute migraines. Our pharmacists can compound a combination of active pharmaceutical ingredients into a nasal spray, transdermal cream, or a sublingual dosage form. There are countless treatment options, and our prescribers can offer them depending on the patient’s case.
We can also convert your prescription tablets into liquid if you have trouble swallowing pills.
To Sum It Up
Migraines cost upwards of $20 billion annually in lost productivity and medical expenses. While there’s a wide variety of medications to alleviate migraine symptoms, there’s no specific treatment. As a result, it’s important to find a solution that works for you.
Compound medications are the surest way to get individualized treatment for chronic or acute migraine headache. Contact us to talk to our expert pharmacists and learn more about compound medications.