How to choose medication during an acute migraine attack?

This is the 3213th article of Da Yi Xiao Hu

In order to avoid headaches, some people take painkillers before they feel a headache is coming, even if they don’t have one. Some people start taking painkillers as soon as they have a slight headache. Some people are afraid that long-term medication will lead to addiction, so they are unwilling to take medication even when they have a headache. So how should painkillers be taken to be effective? Let’s talk about the drug treatment of migraine today.

Migraines are prone to recurring and have a high disability rate. Patients are more likely to suffer from anxiety, depressive disorders, coronary heart disease and other diseases than the general population. Therefore, it is very important to choose the right medicine in a timely and correct manner. The purpose of migraine drug treatment is to stop the headache attack and relieve the associated symptoms as soon as possible, reduce or avoid adverse reactions, prevent recurrence and resume normal life functions as soon as possible. Drug treatment is divided into preventive medication and therapeutic medication. This article mainly introduces the acute symptomatic medication during the migraine attack period.

1. What is successful drug treatment for migraine attacks?

At least three of the following four items should be achieved for drug treatment to be successful:

1. Medication is effective for most attacks;

2. The headache disappears within 2 hours;

3. Ability to resume normal life functions within 2 hours;

4. The medication enables the patient to feel satisfied with the ease with which he or she can arrange his or her daily activities.

If the effect of the medication is less than 3, you should consider changing the medication.

2. What are the acute symptomatic medications for migraine attacks?

1. Nonspecific analgesics

The most common ones are non-steroidal anti-inflammatory drugs such as ibuprofen, diclofenac, indomethacin, aspirin, acetaminophen, headache powder, painkillers, etc. The ingredients of the painkillers that everyone is familiar with mainly include acetaminophen, aminopyrine, caffeine, phenobarbital, etc.

2. Specific analgesics

There are two main classes of drugs, triptans and ergot alkaloids.

(1) Common triptans include sumatriptan, zolmitriptan, rizatriptan, naratriptan, eletriptan, frovatriptan, and almotriptan.

(2) Ergot alkaloid drugs include ergotamine tartrate, dihydroergotamine, etc.

3. Medication selection

Nonsteroidal anti-inflammatory drugs can be used for a maximum of 14 days per month, and triptans and ergotamine compound analgesics can be used for a maximum of 9 days per month. If both drugs are used together, the total number of days per month for both drugs should not exceed 9. When headaches occur frequently, behavioral therapy and preventive medication should be used.

Principles of drug selection during migraine attacks

1. Principle of individualized treatment

Some patients need to try multiple medications before they find the treatment that's right for them.

2. Principle of early medication

Medication should be used early in the course of a headache when it is mild, but should be started after the headache begins, not during the aura phase.

3. Layered Principle

First, assess the degree of disability caused by the headache. If the ability to live daily life is lost by more than 50% for ≥ 10 days in the past 3 months, it is considered moderate to severe headache and should be treated with specific medication.

4. Ladder Principle

When the headache is mild according to the above standards, step-by-step treatment is given, that is, non-specific analgesics are given first, and then specific analgesics are given if they are ineffective.

5. Duration of medication

No more than 10 days per month to avoid drug dependence, which is what ordinary people call addiction, or turning to medication overuse headaches and chronic migraines.

6. Timing of medication

Specific analgesics may be tried a few hours later if nonspecific analgesics are ineffective for a single attack or may be given if nonspecific analgesics are ineffective for several attacks.

By understanding the drug treatment for acute migraine attacks, you can know how to perform initial treatment at home. Of course, it is best to go to a neurology headache clinic to get professional solutions.

Author: Department of Neurology, Second Hospital of Jilin University

Man YuhongDeputy Chief Physician