What Should Work, What Might: Migraine Meds Reassessed

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New Studies Re-assesses Migraine Drug Efficacies (1)

Efficacy of migraine drugs was under another new review from researchers who have examined all of the scientific literature available on the treatment as well as followed up on migraine patients and the scientists have come up with what in their view prove effective in acute cases of migraine. Besides these 2 criteria the study was also based on the depth of the published research done on the medications as well as the quantum of studies on them.

The conclusions of the new study at a glance are:

DEEMED EFFECTIVE (LEVEL A) PROBABLY EFFECTIVE (LEVEL B)
TRIPTANS – Sumatriptan, Zolmitriptan, Rizatriptan, Frovatriptan, Almotriptan, Naratriptan, Eletriptan, Avitriptan OPIOID – Codeine+Acetaminophen, Tramadaol+Acetaminophen
Dihydroergotamins
NSAID – Aspirin, Ibuprofen, Naproxen
OPIOID – Butorphanol Nasal Spray
Caffeine with NSAIDS

Findings of the study were published in the January 2015 issue of the medical journal Headache. As per Dr. Stephen Silberstein , professor of neurology and director of the Jefferson Headache Center of Thomas Jefferson University in Philadelphia, “We hope that this assessment of the efficacy of currently available migraine therapies helps patients and their physicians utilize treatments that are the most appropriate for them.” (2)

Based on the study criteria, drugs were thus rated as deemed effective (Level A), probably effective (Level B), possibly effective (Level C). For such medications where the proof was found either inadequate or gave such results which refutes the use of that medicine, was classified as Level U. For a drug to be classified as deemed effective or a Level A drug, the studies done on the drug must be supported by at least well-designed, double-blind, randomized, placebo-controlled clinical trials.  (3)

The American Headache Society will soon be translating the research findings that will aid in providing evidence-based guidelines to clinical practice. In any case, doctors treating migraine patients must consider the individuals on a case to case basis keeping in view the drug side-effects, patient history, costs and drug efficacy.

SOURCES

  1. Image credit: Pills and Capsules – Stock Photo; freedigitalphotos.net; Web February 2015; http://www.freedigitalphotos.net/images/pills-and-capsules-photo-p308698
  2. Study Rates Migraine Medications; WebMD.com; Web February 2015; http://www.webmd.com/migraines-headaches/news/20150120/study-rates-migraine-medications
  3. American Headache Society Provides Updated Assessment of Medications to Treat Acute Migraine; Newswise.com; Web February 2015; http://www.newswise.com/articles/american-headache-society-provides-updated-assessment-of-medications-to-treat-acute-migraine

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Migraine Symptoms & Some Fixes

Besides the debilitating pain, migraineurs often experience some symptoms that precede and/or last during the time the migraine episode is on. Here’s a list of some of the symptoms a migraineur may experience before or during an attack:

  • Nausea
  • Dizziness
  • Sleep disturbances
  • Visual disturbances/aura
  • Hyper-sensitivity to sound
  • Hyper sensitivity to light
  • Increased sensitivity to odours
  • Frequent yawning
  • Frequent need to urinate
  • Constipation
  • Diarrhea
  • Non-visual aura
  • Confusion
  • Fatigue

Symptoms and Some Fixes (1)

The exact reason why a migraine attack begins is not yet clear to scientists. However, based on years of data gathered from cases that report for treatment assistance to clinics and hospitals, several migraine triggers have been identified.

Despite the extreme discomfort migraines give, it is possible to obtain symptomatic relief at least some extent. Here are a few tips at what can be done should you be in the grips of a migraine attack. However, it is important to keep in mind that the priority is get a medical help and consultation at the earliest. The tips below are to serve only till you are able to see a doctor. (2)

  • Excruciating pain

Pain may be tackled with NSAID (Non-Steroidal Anti Inflammatory Drugs) brufen, naproxen, diclofenac sodium etc. It may also be managed by analgesics such as paracetamols, spirins etc. However, it is recommended that you take any one of them as per the dosage and instructions on the label after a light meal of complex carbohydrates or some non-acidic foods. It is important that painkillers be taken at the first signs of migraine. Putting an ice pack on the painful area also helps. (3)

  • Nausea

Nausea may be tackled with taking of anti-emetic along with the analgesic in the prescribed dosage. It is also important to not stay on an empty stomach for long durations. A light snack taken frequently helps in stubbing the queasiness and helps by utilising the excessive bile migraineurs release during attack episodes.

  • Visual Aura

The best way to manage a visual aura is to stop or put down what you are doing and stand until you can get to a place where you can sit or lay down. It is dangerous to operate any machinery or drive at such times. Breathing in deeply and fully and massaging of temples with a balm may aid temporarily.

  • Light and sound sensitivity

Going to a dark room or one with curtains drawn and lights turned off helps. Wearing dark glasses helps when outdoors. Noise disturbances may be managed with an earplug or by putting cotton wool in the ears to keep out or dull the surrounding noises.

  • Constipation

Constipation may be helped by taking tepid fluids such as warm milk or ginger tea or warm water etc. It is also advisable to have allergy-free natural laxatives like flaxseeds and high fiber diet including wholegrain cereals if you are gluten tolerant.

  • Diarhhea

Yet another accompanying nuisance with migraines, diarrhoea may be managed by taking stomach-binding foods and avoiding those with high fibre content.

DIET INCLUSIONS:

Holistic Health Therapist recommended the inclusion of herbs such as feverfew, St. John’s Wort and butterbur in one’s diet. Conventional physicians are of the opinion that calcium and magnesium supplements help take the edge off migraines. Tryptophan and omega 3 rich foods and B vitamins are also advised by doctors.

Complementary Alternative Medicines offer support therapy that aid in the management of migraines. Help comes from the sciences of yoga, aromatherapy, massage, reflexology, shiastu, acupuncture, sujok, biofeedback, chiropractic, cranial osteopathy, homeopathy, ayurveda, reiki, Alexander technique, autogenic training etc

MAINSTREAM MIGRAINE MEDICATION

  • Excedrin Migraine

Excedrin is a leading non-prescription drug from Novartis from the acetaminophen or paracetamol family that uses a combination of paracetamol with caffeine and aspirin designed especially to tackle migraine pain. Excedrin is available in geltab, tablet and caplet forms. Dosage and frequency of drug intake should be as per label instructions or doctor’s advice. It is important to understand and comply by the contraindications and warnings mentioned on the label of Excedrin Migraine and all other drugs.

Other ABORTIVE MEDICATIONS sometimes used by doctors are:

  • Analgesics: Aspirin, Paracetamol/Acetaminophen
  • NSAIDs: Ibuprofen, Diclofenac sodium, Fenoprofen, Ketorolac, Indomethacin, Tolmetin, Celecoxib
  • Ergotamines: Dihydroergotamine mesylate, Ergotamine tartrate
  • Corticosteroids: Methylprednisolone, decsamethasone
  • Opiods: Morphine, Codeine, Oxycodone
  • Combination: Analgesics containing barbiturates, analgesics containing opiods/narcotics
  • Triptans: sumatriptan succinate, Elitriptan hydrobromide, Almotriptan malate, Frovatriptan, Naratriptan

SECONDARY PROPHYLACTIC DRUGS (those that would keep the symptoms from getting worse) could also be recommended by the doctor to manage migraines. Examples are:

  • Anti-depresants: Phenelzine, Nortriptyline, Amitriptyline
  • Beta Blockers: Propanolol, Atenolol, Verapamil
  • Anti convulsants: Topiramate, Divalproex sodium
  • MAO inhibiters: Phenezine sulfate
  • Calcium channel blockers: Flunarazine (4)

SOURCES:

  1. Image by Michal Marcol; Freedigitalphotos.net. April 2012; http://www.freedigitalphotos.net/images/view_photog.php?photogid=371
  2. How Can We Manage The Common Symptoms At Home; Migraines For The Informed Woman (Book); April 2012; http://www.amazon.com/Migraines-Informed-Woman-Tips-Sufferer/dp/8129115174
  3. Migraine Awareness Group: A National Understanding For Migraineurs (M.A.G.N.U.M); Treatment and Management- Current Treatment Methods – General Pain Management; http://www.migraines.org/treatment/treatctm.htm; 2006
  4. MedicineNet.com; Migraine Headache; Dennis Lee, MD, Harley I. Kornblum, MD, PhD; http://www.medicinenet.com/migraine_headache/page6.htm; 2010

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