Migraines are severe, debilitating headaches that are usually characterized by an intense throbbing or pulsing in one area of your head. They can include sensitivity to light, sound, and smell, create visual disturbances such as auras, and can even cause nausea or vomiting. They are more than a headache and can affect your everyday life.

1. Overview
Migraines aresevere, debilitatingheadaches thatareusually characterized by an intense throbbingor pulsingin
one area of your head. They can includesensitivity to light,sound,and smell,create visual disturbancessuch as
auras,and can even causenausea or vomiting. They are more than a headache and can affect your everyday life.
Migraines arecommonly treated with medication.There aretwo categories of drugs used to treat migraines:acute
treatment, for pain and other symptoms duringa migraineheadache, and preventive treatment, to reduce the
frequency and severity of headaches.
What is migraine?
Migraineis a neurological condition thatcan causemultiplesymptoms. It’s frequently characterized by intense,
debilitatingheadaches.Symptoms may includenausea,vomiting, difficulty speaking,numbness or tingling,and
sensitivity to lightand sound. Migraines often run in families and affectall ages.
The diagnosisof migraineheadaches is determined based on clinical history,reported symptoms, and by rulingout
other causes.The most common categories of migraineheadache arethose without aura (previously known as
common migraines) and those with aura (previously known as classic migraines).
Migraines can begin in childhood or may not occur until early adulthood.Women are more likely than men to have
migraines.Family history isoneof the most common risk factors for havingmigraines.
Migraines aredifferent from other headaches.
Migraine symptoms
Migrainesymptoms may begin one to two days before the headache itself.This is known as the prodrome stage.
Symptoms duringthis stage can include:
 food cravings
 depression
 fatigue or lowenergy
 frequent yawning
 hyperactivity
 irritability
 neck stiffness
In migrainewith aura,the aura occurs after the prodrome stage. Duringan aura,you may have problems with your
vision,sensation,movement, and speech. Examples of these problems include:
 difficulty speakingclearly
 feeling a pricklingor tinglingsensation in your face,arms,or legs
 seeing shapes,lightflashes,or brightspots
 temporarily losingyour vision
The next phaseis known as the attack phase.This is the most acute or severe of the phases when the actual
migrainepain occurs.In some people, this can overlap or occur duringan aura .Attack phasesymptoms can last

2. anywhere from hours to days.Symptoms of a migrainecan vary from person to person. Some symptoms may
include:
 increased sensitivity to lightand sound
 nausea
 dizziness or feelingfaint
 pain on one sideof your head, either on the left side, rightside,front, or back,or in your temples
 pulsingand throbbinghead pain
 vomiting
After the attack phase, a person will often experience the postdrome phase. Duringthis phase, there are usually
changes in mood and feelings. These can range from feeling euphoric and extremely happy, to feeling very
fatigued and apathetic. A mild,dull headachemay persist.
The length and intensity of these phases can occur to different degrees in different people. Sometimes, a phaseis
skipped and it’s possiblethata migraineattack occurs without causinga headache.
Migraine pain
People describemigrainepain as:
 pulsating
 throbbing
 perforating
 pounding
 debilitating
It can also feel likea severe dull,steady ache. The pain may startout as mild, but without treatment will become
moderate to severe.
Migrainepain mostcommonly affects the forehead area.It’s usually on one sideof the head, but it can occur on
both sides,or shift.
Most migraines lastabout4 hours.If they’re not treated or don’t respond to treatment, they can lastfor as longas
72 hours to a week. In migraines with aura,pain may overlap with an aura or may never occur at all.
What are Antimigraine agents?
Antimigraineagents are used to treat migraineheadaches.Migraines aredi fferent from other headaches because
they occur with symptoms such as nausea,vomiting,or sensitivity to light.Some people who get migraines have
warningsymptoms, called an aura,before the actual headachebegins.Pain relievingdrugs can be taken as soon as
the pain begins and includeagents in the drug classes such as ergots,triptans and NSAID's.
Drugs for acute treatment
These drugs are taken at the onset of migrainesymptoms or auras to relieve a headache or reduce its severity.

3. Takingany of these drugs too often can lead to a rebound headache, headaches that arisefromoveruse of
medication,which then necessitateadditional medication.If you need to use acute migrainedrugs more than nine
times per month, talk to your doctor about possiblepreventivetreatments.
Painkillers
Some over-the-counter painkillers arecommonly used for migraine,but many are only availablein prescription
strength. Aside from acetaminophen, an analgesic thatonly relieves pain,these drugs are nonsteroidal anti -
inflammatory drugs (NSAIDs), which relievepain and reduce inflammation:
 acetaminophen (Excedrin, Tylenol)
 aspirin
 diclofenac (Cataflam)
 ibuprofen (Advil,Motrin)
 ketorolac (Toradol)
 naproxen (Aleve)
Many over-the-counter drugs marketed specifically for migraine or headaches in general combine one or more of
the drugs above with a small amountof caffeine, which can make them work more quickly and effectively,
especially for mild migraineheadaches.
Possible side effects of long-term NSAID use include:
 heart attack
 stroke
 kidney damage
 stomach ulcers
Ergotamines
Ergotamines were the firstclass of drugs used specifically for migraines.They causeblood vessels around your
brain to contractand can relieve a migrainewithin a few minutes. Ergotamines areavailablea s pills,tablets that
dissolveunder your tongue, nasal sprays,suppositories,and injections.They are generally taken at the firstsign of
headache symptoms, and some have the option to take additional doses every 30 minutes if the headache
continues.Some ergotamines are:
 dihydroergotamine (DHE-45, Migranal)
 ergotamine (Ergomar)
 ergotamine and caffeine (Cafatine,Cafergot, Cafetrate, Ercaf, Migergot, Wigraine)
 methysergide (Sansert)
 methylergonovine (Methergine)
Ergotamines can have dangerous sideeffects. They can causebirth defects and heart problems, and are toxic in
high doses. If you are pregnant or breast-feeding or have heart disease,you should not take ergotamines.
Ergotamines can also interactnegatively with other drugs,includingantifungal and antibiotic medications.
Triptans

4. Triptans area newer classof drug that increases serotonin levels in your brain,reducinginflammation and
constrictingblood vessels,effectively endinga migraine.Triptans areavailableas pills,nasal sprays,injections,and
tablets that dissolveunder your tongue, and work quickly to stop a migraine.Some triptans are:
 almotriptan (Axert)
 eletriptan (Relpax)
 frovatriptan (Frova)
 naratriptan (Amerge)
 rizatriptan (Maxalt,Maxalt-MLT)
 sumatriptan (Imitrex)
 sumatriptan and naproxen (Treximet)
 zolmitriptan (Zomig)
Possible side effects of triptans include:
 tinglingor numbness in your toes
 drowsiness
 dizziness
 nausea
 tightness or discomfortin your chest or throat
People with heart problems or who are at risk for stroke should avoid triptans.Triptanscan also causethe
potentially fatal serotonin syndrome,if taken with other drugs that increases serotonin,such as antidepressants.
Antinausea Drugs
These drugs reduce nausea and vomitingthat can accompany severe migraines .They are usually taken alongwith
a painkiller,as they do not reduce pain:
 dimenhydrinate (Gravol)
 metoclopramide (Reglan)
 prochlorperazine(Compazine)
 promethazine (Phenergan)
 trimethobenzamide (Tigan)
These drugs may make you drowsy, less alert,or dizzy, and have other possiblesideeffects.
Opioids
If migrainepain does not respond to other painkillersand you can’t take ergotamines or triptans,your doctor may
prescribeopioids,much more powerful painkillers.Many migrainedrugs area combination of opioids and
painkillers.Some opiods are:
 codeine
 meperidine (Demerol)
 morphine
 oxycodone (OxyContin)

5. General dosage advice
Always take antimigrainedrugs exactly as directed.Never take larger or more frequent doses,and do not take the
drug for longer than directed.
If possible,liedown and relax in a dark,quiet room for a few hours after takingthe medicine.
Precautions
These drugs should be used only to treat the type of headache for which they were prescribed.Patients should not
use them for other headaches, such as thosecaused by stress or too much alcohol,unless directed to do so by a
physician.
Anyone whose headache is unlikeany previous headacheshould check with a physician beforetakingthese drugs.
If the headacheis far worse than any other, emergency medical treatment should be sought immediately.
Takingtoo much of the antimigrainedrugergotamine (Cafergot), can lead to ergot poisoning.Symptoms include
headache, musclepain,numbness, coldness,and unusually palefingers and toes. If not treated, the condition can
lead to gangrene (tissuedeath).
Sumatriptan (Imitrex), naratriptan (Amerge), rizatriptan (Maxalt) and zolmitriptan (Zomig) may interactwith
ergotamine. These drugs should not be taken within 24 hours of taking any drug containingergotamine.
Some antimigrainedrugs work by tightening blood vessels in the brain.Because these drugs also affectblood
vessels in other parts of the body, people with coronary heartdisease,circulatory problems,or high blood
pressureshould not take these medicines unless directed to do so by their physicians.
About 40% of all migraineattacks do not respond to treatment with triptans or any other medication.If the
headache lasts longer than 72 hours—a condition known as status migrainosus—thepatientmay be given narcotic
medications to bringon sleep and stop the attack.Patients with status migrainosusareoften hospitalized because
they are likely to be dehydrated from severe nausea and vomiting.
Side effects
The most common sideeffects are fluid retention, flushing;high blood pressure;unusually fastor slowheart rate;
numbness; tingling;itching;nausea; vomiting; weakness; neck or jawpain and stiffness;feelings of tightness,
heaviness,warmth, or coldness;sorethroat; and discomfort of the mouth and tongue.
More serious sideeffects are not common, but they may occur.If any of the followingsideeffects occur,call a
physician immediately:
 Tightness in the chest
 Bluish tingeto the skin
 Cold arms and legs
 Signs of gangrene, such as coldness,dryness,and a shriveled or black appearanceof a body part
 Dizziness
 Drowsiness
 Shortness of breath or wheezing
 Skin rash

6.  Swellingof the eyelids or face.
Possiblesideeffects with anticonvulsants includedizziness,drowsiness,emotional upset, skin rash,temporary hair
loss,nausea,and irregular menstrual periods.
Other sideeffects may occur with any antimigrainedrug.Anyone who has unusual symptoms after takingthis
medicine should get in touch with his or her physician.
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