Medication For Migraine Chart: Table 1: Acute Treatment when the attack begins Page a Analgesics (painkillers) Non-steroidal antiinflammatory drugs (NSAIDs) Prescription required Brand Name Formulation type Aspirin No There are many different preparations of analgesics so the brand names are too numerous to mention. enteric coated tablets Ibuprofen No, modified release tablets, suspension, Several combination Diclofenac preparations are available. The most commonly used contain aspirin or paracetamol combined Naproxen with codeine, caffeine and/or an antiemetic. granules, modified release tablets, dispersible tablets, injection, suppositories, enteric coated tablets Tolfenamic acid Clotam rapid tablets Combinations specifically Flurbiprofen licensed for migraine, modified release include: tablets, suppositories Other Paracetamol No Migraleve - OTC, soluble tablets, Pink tablets codeine, capsules, suppositories, paracetamol & suspension Codeine phosphate Depends on formulation (may buclizine, injection, syrup be OTC when combined with Yellow tablets - aspirin or paracetamol codeine & paracetamol Paramax - POM Paracetamol & metoclopramide, dispersible tablets, suppositories, Combinations also available as dispersible tablets, tablets, capsules, sachets Analgesic drugs relieve pain and reduce stiffness associated with migraine. The NSAIDs also reduce inflammation by inhibiting the production of certain chemicals in the body. Analgesics tend to be more effective when taken as soluble, effervescent or liquid formulations because they are absorbed quicker (not all drugs are available in these forms). Enteric coated preparations are less suitable for treating migraine attacks because they are absorbed more slowly and therefore may take longer to work Codeine is an analgesic which blocks pain signals in the spinal cord and brain Caffeine is a weak stimulant that is often combined in small amounts with analgesics to enhance their effect. However, there is evidence that caffeine can provoke headache and may result in headaches following its withdrawal after long term treatment POM Prescription only medication OTC- over the counter - registered. Enteric coated - tablets can be coated with a substance that enables them to pass through the stomach and into the intestine unchanged
Table 1: Acute continued Page b Antiemetics (Antisickness) Domperidone Some preparations are OTC Generic form Motilium OTC Metoclopramide Generic form Maxolon Maxolon SR Paramax Metoclopramide combined with paracetamol MigraMax Metoclopramide combined with aspirin Prochlorperazine Generic, suppositories, suspension, Solution, injection, Syrup, injection Capsules ; Sachets containing effervescent powder Sachets containing powder Anti-emetics relieve the nausea associated with migraine attacks. Metoclopramide and domperidone also promote normal activity of the gut and can accelerate the absorption of analgesics Anti-emetics should be taken before or at the same time as analgesics Metoclopramide is associated with serious side effects (resulting in symptoms very like Parkinson s disease) and should be avoided in children and young adults Phenothiazines Buccastem Stemetil Buccal tablets (dissolve in the mouth), syrup, effervescent granules, injection, suppositories
Table 1: Acute continued Page c Serotonin (5-HT 1 ) agonists or Triptans Generic Name [the name of the basic active Sumatriptan Prescription required (POM), tablets available on prescription and OTC after assessment by pharmacist Brand Name Formulation type Imigran, injection, nasal spray Selective 5-HT 1 agonists relieve pain by narrowing blood vessels Almotriptan Almogran Eletriptan Relpax Frovatriptan Migard Naratriptan Naramig Rizatriptan Maxalt, Maxalt Melt, wafers Zolmitriptan Zomig Zomig rapimelt Ergot Alkaloids Ergotamine tartrate Cafergot Ergotamine and caffeine Migril Ergotamine, cyclizine and caffeine, nasal spray Wafers (Medihaler discontinued) in the head and blocking the transmission of pain in sensory nerves supplying the skin and structures of the face. Sumatriptan has been available for the longest period of time and is often compared to the newer triptans in trials. If one triptan doesn t work for you then it is worth trying a different one. The BNF states: the value of ergotamine for migraine is limited by difficulties in absorption and by its side effects particularly nausea, vomiting, abdominal pain and muscle cramps. It is best avoided. Recommended doses of ergotamine preparations should NOT be exceeded and treatment should not be repeated at intervals of less than 4 days. To avoid tolerance, the frequency should be limited to no more than twice a month. Patients should be warned to stop treatment if numbness or tingling of the extremities develops. It is most effective if taken at the onset of a migraine attack. BNF British National Formulary is the joint publication published by the British Medical Association and the Royal Pharmaceutical Society which is distributed to NHS doctors by the Department of Health.
Table 1: Acute continued Page d Other Isometheptene mucate - also OTC packs of 15 and under may be sold under the supervision of the pharmacist Midrid Isometheptene with paracetamol Capsules Acts by constricting blood vessels in the head and the rest of the body. The BNF state that as more effective preparations are now available it is not widely used. Table 2: Prophylactic treatment to prevent an attack Beta-blockers Propranolol Generic form and several brands available Anti-serotonergic (Anti 5- HT) drugs Metoprolol Generic form Betaloc Lopressor Atenolol Generic form Tenormin, capsules, solution (Modified release available) (Modified release also available) Nadolol Corgard Timolol Betim Pizotifen Generic form Sanomigran, Elixir Methysergide Deseril This is a semi synthetic ergot alkaloid. It should only be administered under hospital supervision because of the side effects (retroperitoneal fibrosis and fibrosis of heart values and pleura). These drugs have several actions: They block or prevent the dilation (widening) of arterial blood vessels in the body They reduce activity of the brain cells involved in migraine Serotonin (5-HT) is a chemical occurring in the body, which is thought to play a key role in migraine. These drugs block 5-HT 2 receptors to stop the effects of 5-HT. Pizotifen also has antihistamine properties and is related to the Tricyclic antidepressants.
Table 2: Prophylactic continued Page e Tricyclic antidepressants (TCAs) Anti-convulsants Amitriptyline Dosulepin (Dothiepin) Generic form Generic form Prothiaden, oral solution Capsules, tablets Capsules, tablets These drugs are primarily used for depression, however, they are also effective at preventing Nortriptyline Allegron migraine Serotonin (5-HT) is a chemical occurring in the body, which is thought to play a key role in migraine. TCAs are thought to: Block the re-uptake of 5- HT May block 5-HT 2 receptors The products shown are most commonly used for the prevention of migraine. Sodium valproate Topiramate Generic form Epilim Epilim chrono Topamax, solution, syrup, liquid Gabapentin Neurotonin, capsules NSAIDs Naproxen Generic form Naprosyn Synflex, enteric coated Mode of action in migraine is unclear. They may reduce the capacity of the nerves to transmit pain signals in the brain. See above BNF British National Formulary is the joint publication published by the British Medical Association and the Royal Pharmaceutical Society which is distributed to NHS doctors by the Department of Health.
Table 2: Prophylactic continued Page f Calcium channel blockers (calcium channel antagonists) Anti-histamines Centrally acting antihypertensive drug Flunarizine This is not widely available in the UK and is usually only prescribed by a specialist. Cyproheptadine hydrochloride Sibelium Reduces calcium entry into neurons making them less excitable. Blocks dopamine receptors in the brain No Periactin Anti-histamine with 5-HT antagonist and calcium channel blocking activity. Mode of action is unclear Clonidine Dixarit Licensed for hypertension but has been used for migraine. Controlled trials show it is not effective for migraine. The BNF states that this drug is not recommended and may aggravate depression or produce insomnia. Caution: For a small percentage of people with headache, frequent use of drugs particularly ergotamine, triptans, codeine, paracetamol, NSAIDs and caffeine have been implicated in chronic daily headache and rebound headache. If you are experiencing 4 or more migraine attacks per month you should consider the use of preventative treatment to avoid attacks. The information in this fact sheet has been read and checked for accuracy and relevance by headache professionals and people living with migraine. Date reviewed January 2012.