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DRUG THERAPY FOR MIGRAINE
DR.MIRZA AZKAR AHMED BAIG,
M.D., MRIPHH(UK)
P.I.M.S, HOSPITAL COMPLEX, ISLAMABAD

There are many migraine drugs available, and it is important that therapy be individualized just for you. Your physician will work with you to determine which drugs are best for you. Some migraine medications are also used as treatments for other medical conditions. For example, beta-blockers are prescribed for hypertension and tricyclic antidepressants for depression. The benefits of these therapies in migraine are not necessarily related to the treatment of these other conditions. The dosages of these drugs
when used for migraine are generally different from the dosages used in these other conditions.
You may receive treatment to stop an attack when it occurs or to treat its symptoms. For individuals who experience frequent attacks, a prophylactic or "preventive" treatment can be taken regularly so that migraines will strike less often and last for a shorter time. Be sure to continue taking your
preventive medications while treating yourself for an acute attack.
Many drugs that treat acute migraine attacks work best when taken as soon as you feel a migraine coming on. Do not to take these medications more often or in higher doses than your physician recommends. Pain
relievers such as aspirin, acetaminophen, and ibuprofen are frequently recommended as initial treatments. However, if they do not relieve the pain,
your physician may prescribe other drugs or drug combinations.
Nonspecific (analgesic) drugs used to relieve the painof migraine attacks include Nonprescription (over-the-counter) medications, such as aspirin or acetaminophen, alone or in combination with antihistamines, decongestants, or caffeine. Prescription analgesics, including narcotics,
nonnarcotics, or both. These drugs are often combined with sedatives or medications to relieve anxiety. Nonsteroidal anti-inflammatory drugs, ie, to relieve both pain and inflammation. Many different anti-inflammatory drugs are effective in treating migraine.
Specific drugs used to stop migraine attacks include Ergot alkaloids, such as ergotamine and dihydroergotamine.  Serotonin agonists such as naratriptan, sumatriptan, rizatriptan, and zolmitriptan Drugs used in hospital emergency rooms include Narcotics, anti-emetics (anti-nausea drugs), and
corticosteroids. Drugs used to stop migraine attacks If your migraine occurs several times a month and produces severe impairment, or treatments for acute attacks do not offer adequate relief, your physician
may recommend prophylactic or 'preventive' therapy. While these drugs may not prevent all migraines, they often can reduce the frequency, intensity and duration of attacks. Once your migraines are under control,
your physician may advise you to gradually reduce the preventive medication. This is particularly true when you have established successful lifestyle modifications and adequate treatment of acute attacks.
Specific drugs used to prevent migraine include Antidepressants (also used to treat depression) such as amitriptyline, nortriptyline, and doxepin. These
drugs represent a class of antidepressants called tricyclic antidepressants.
Beta-blockers (also used to treat hypertension and angina) such as propranolol, metoprolol, timolol, nadolol, or atenolol Calcium channel blockers, such as verapamil or nifedipine Serotonin antagonists, especially methysergide Antiseizure medications, specifically divalproex sodium
Drugs used to prevent migraine in children All of the above are used in children with the following additions or cautions:
Antihistamines, especially cyproheptadine Divalproex sodium, an antiseizure medication, is not used in children under the age of 10, but is used in adolescents.