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Abortive Headache Medications

Abortive headache medications? What are those? Well, that is any medication that you take to stop a headache. And at this point you have probably taken many.

I would like to review for you, the most commonly used abortive headache medications used for headaches and migraines. If these are taken within 60 minutes of the onset of a headache, you have a 90% chance of getting rid of the pain. This is a common mistake that many make, is delaying treatment. How often have YOU thought..."Well, if I just wait a little longer, maybe it will go away." Trust me, many people do this, in fact I used to think that way myself. Early, effective treatment is important.

  • Triptans

Triptans are one of the most commonly used abortive headache medications to treat migraines when in a neurologist's office. Most of them are in tablet form, but a few are nasal sprays and injectable. They are highly specific drugs directed at the 5HT receptor site at trigeminal nerve endings. This is where the nerve releases neurochemicals causing vasodilation and the result is pounding head pain. By blocking this, a triptan can stop a migraine.

Opioids are discussed on another page, so I will not go into them here. This includes the drug midrin which is a combination of medications.

This class contains the drugs

  • Imitrex, which is injectable, a tablet and nasal spray
  • Axert tablets
  • Relpax tablets
  • Maxalt tablets
  • Amerge tablets
  • Frova tablets
  • Zomig tablets and nasal spray
  • Treximet tablets
  • Sumavel injectable (needle free!)

So how to choose? Well, some are fast acting and are best for those severe "fast take off" headaches and migraines. Those are Imitrex, Maxalt and Zomig.

Either Imitrex or Sumavel injectable are great for those of you with cluster headaches, as they have a very fast onset and are short lived. The benefit with Sumavel is that it is needle free injectable, and some have said is has less pain when using it than Imitrex statdose which has a needle. Injectable sumatriptan (which is the medication in each) has an onset of action of 10-12 minutes and bypass the GI system. This is important with severe migraine as gastroparesis occurs which is when the gut slows down. Oral medications cannot be absorbed too well during this time and nausea occurs. This is why injectables are one of the best abortive headache medications and should be part of your treatment. Most insurance companies now allow injections and pills on a monthly basis.

The newer drug Treximet is a combination of Imitrex and naprosyn (prescribtion level Aleve) and if taken at the onset of a migraineas one of the abortive headache medications, has been shown in studies to get rid of the headache faster than either medication alone. Unfortunately, if you have severe nausea and vomiting with your migraines, this might not be best for you as naprosyn can provoke nausea. If this is the case, consider one of the injectables.

For menstrual migraines the best and most promising drug in this class is Frova because this is the only drug in this class that is truly long acting.

When fighting the effects hormones for up to a week, headache medications need to last long enough to prevent a recurring headache.

The remaining drugs are all excellent and if one does not work for your as a migraine medication, ask your doctor to try another until you get the right "brain/drug" combo that stops your headache dead in its' tracks. If your migraines don't respond to triptans, then your headaches might be so severe that you require a short course of daily medication to settle things down. You may then find that the triptans will start working again as abortive headache medications. Note: we combine Naprosyn or naproxyn with any triptan and take both at the onset of pain. The exception is Treximent which already has naprosyn in it.

NOTE: You cannot take the triptans if you have coronary artery disease, UNcontrolled high blood pressure, or are pregnant. You cannot take these if you are on an MAOI type of anti-depressant. You also can't use it within 24 hours of taking Migranol Nasal spray.

Common side effects: flushing, tingling, a mild feeling of anxiety, dizziness.

  • Ergots

Elvis Presley Migraines This is an older class of drug and one of the first used to treat active migraine attacks. One of the better abortive headache medications, it has a quick onset of action.

OK..who is old enough to remember Elvis Presley? Well he suffered from daily headaches and migraines and use extensive amounts of a drug called Cafergot.

Unfortunately, this drug has numerous side effects and if over used for a long time can cause heart problems. When Elvis it was reported in the papers (and tabloids) that he had LSD in his system. This was totally inaccurate and it is a shame that no medical professionals corrected this. When ergots pass through the liver, they produce a metabolite similar to LSD which will be found in the urine. Since he was taking Cafergot daily, this is the true answer to the LSD question.

Read about how Elvis was affected by his migraines.

However, there is good news for those of you who need another option for migraine headache medication.

Migranol Nasal Spray is a kinder, gentler form of Cafergot. Unlike Cafergot, there is no caffeine in this product and it has less side effects. It also has a fast onset as it is a nasal spray and can be an excellent drug for menstrual migraine. The medication in Migranol (dihydroergotamine) is also available as an injectable and is called DHE-45. This comes in 1.0ml vials. I have one of my nurses teach patients how to draw up the medication and inject at the onset of a migraine. The dosing is similar to triptans and Migranol, take at the onset of a migraine and maximum dose is 2 in 24 hours.

NOTE: You cannot take these medications if you have any of the following: UNcontrolled hypertension, kidney or liver disease, are pregnant, have peripheral vascular disease, are over 60 years old, have diabetes for over 10 years or are nursing.

Common side effects: leg and abdominal pain, dizziness, nasal stuffiness (with the nasal spray), sometimes a fast or a slower heart rate.

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