Pain and Supportive Therapy for Migraine Sufferers
Posted: Saturday, August 13, 2011
by Krista Aman-Widgren
Gospelflier
Migraines are debilitating pain that disrupt a person’s normal function and way of life for days. An untreated migraine can put you at risk for a stroke, as the brain’s blood vessels are abnormally dilated. Why people get Migraines is still mostly unknown, but it does seem to be hereditary, triggered by a head injury, stress related, and since women get them more than men; related to the female hormonal cycle. Also once a person does get them, they seem to have many food related and environmental triggers.
So how does a person manage Migraine pain? Some people can treat it with over the counter (OTC) therapy such as Exederin Migraine which is Tylenol, aspirin, and caffeine. For people with occasional Migraines this would work.
NSAID’s: An NSAID is a non steroidal anti-inflammatory drug, such as advil or aleve (naproxen). For short term use, of less than 10 days in a row, these medications may help with migraine pain. I have found that aleve works better than advil for me. But use caution when using an NSAID, as these medications can cause stomach bleeding, especially when used for longer than recommended.
Torodol: Otherwise known as Kotorolac . Is an injectible NSAID abortive medication used for pain that in combination with Promethazine for nausea and Benadryl is known as a “headache cocktail”. My neurologist has given me a prescription so I can give myself injections once a month when I have a severe migraine, usually around the menstrual cycle. It is a 1ml 30mg dose shot. This has kept me out of the ER for pain IV’s for over two years.
Another group of medications is the Ergots: These are abortive medications. Examples include Ergomar, Wigraine, and Cafergot, which are ergotamine preparations, and dihydroergotamine preparations such as Migranal and DHE-45. These medications cause constrictions of blood vessels but also cause constrictions of the blood vessels in the heart as well. They also can cause miscarriages in pregnant women. I once used Migranal and it made me very dizzy and I saw black for 20 minutes and could not walk. It made my headache worse. It is inhaled up the nose. I would never use this therapy again.
Triptans: Such as Maxalt , Sumitriptan (Imitrex), Zomig, Naratriptan (Amerge), Almotriptan (Axert) and Frovatriptan (Frovalan. These attach to serotonin transmitters in the brain and reduce inflammation. These medications should be taken at the first sign of a migraine to prevent them from escalating into a full-blown one. They have been shown to abort 80% of Migraines within 2 hours. I have personally taken Imitrex, which quit working after five years and am now taking Maxalt, which dissolves under the tongue.
Oxycodone:In a very low dose of 5mg immediate release, this medication is used for “break-through” pain of a head-ache cycle. My neurologist gives me 10 pills every 3 months and I don’t usually use them all in that time.
Vicodin: Although some doctors prescribe high doses of narcotics for migraines, I am not a great fan of this form of therapy. The reason is, once the medication wears off in 4-6 hours, the pain always comes back. The risk for addiction is very high. You cannot function when you are on narcotics, and you cannot function when you are in pain. It becomes a vicious cycle. I tried this therapy for a couple of months until I found a good Headache doctor and was miserable the whole time.
Morphine: When I was in the ER, the doctor gave me the headache cocktail, which helped with the migraine pain. But after I told him I still was in pain, he asked me if I wanted a dose of morphine to “kick the rest of the headache out of there”. I figured “Why not?” The nurse added a dose of morphine to my IV and I felt much better. There is something about morphine that is both good and bad in my opinion. You are still in pain, but you don’t care because you are too busy riding around on fluffy pink clouds. It detaches you from the pain receptors in the brain. It always makes me a bit giddy and unsure of where or who I am. Be aware that you can’t be given this medication unless you have someone to drive you home.
Preventative Medications are just as important as abortive medications. For people with severe Migraines like myself, they would be taking abortive medications on a daily basis and still be crippled by a headache. After extensive testing to rule out seizures, brain injury, tumors, and other Neurological disorders, a Neurologist can put a Migraine sufferer on preventative medications and supportive therapy.
Preventative Medications:Depakote, Topamax, beta blockers such as propranolol, atenolol, meoprolol, nadolol and timolol, antidepressant amitriptyline, Calcium channel blockers verapamil, diltiazem, nimodipine and Ace inhibiters Lisinopril, candesartan. I have tried the Topamax , verapamil and amytriptyline. The only medication that worked for me is the Topamax. The other two I am allergic to. However, the Topamax has a lot of side effects, one is lowered ability to communicate and find words as easily. I guess it is worth the trade-off as my Migraines were so bad that I was falling all the time from the Migraines making my legs weak.
(www.emedexpert.com/classes/migraine.shtmail)
Antinausea:There are a few medications used for nausea caused by Migraines. A very common symptom. One is Promethazine (Phenergan) It is also a light sedative. There is Compozine, Zofran and another is Reglan. Out of all of these, Reglan is the poorest choice, as many people are allergic to it. It has many bad side effects. I have had the best experience with Promethazine.
Benedryl: When taken in conjunction with an abortive medication, this helps relieve the migraine faster. The slight sedative effect of the Benadryl is what helps a person sleep through a migraine, which is considered the best therapy for migraine relief.
Aspirin:When a person has a severe Migraine, it is recommended they take 81mg low dose chewable aspirin to help reduce the possibility of a stroke.
Supplements:Potassium is often prescribed with Topamax to counteract the side effect of the tingling in the hands and feet. Magnesium is often prescribed for people with Migraines as it helps with neuron function, but I couldn’t take it because it made my tongue hurt.
Oral Steroids:A very low dose of 4mg, four times a day of Dexamethasome for four days has been shown to reduce inflammation in the brain and thus break up a persistent Migraine. My neurologist has used this therapy on me twice and has worked wonders for me.
Ice: Putting an ice pack on the side where the migraine is located may help reduce inflammation and swelling, but it has not worked for me, as the cold makes the pain shoot even worse in my head. But many people say it helps them.
Acupressure: There is a pressure point in the fleshy part between your thumb and index finger, just behind the webbing of your thumb. Grab hold and gently squeeze for 10 seconds, release and repeat. The side your migraine is on will usually be the tender side. Do this a few times and stop. This pressure point helps reduce the migraine pain. It has helped me somewhat with the pain and nausea.
Alternative Medicine I tried a chiropractor and it made the migraines worse, however a massage of the neck and back did help relieve the tension in my neck and shoulder muscles. I have heard that acupuncture helps relieve migraine pain, but have not tried this therapy.
Sleep: Go to a quiet, dark room, put on a sleeping mask, ear plugs if you need to, close the door and get some rest. This is the best therapy for a migraine. I hope that you find peace.
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Top-level comments on this article: (1 total)This is a fabulously summed-up article about migraines. Really great job on describing and medicating these nasty headaches.Ty Grey Mare....:)
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