VIDEO
Diagnosis of Migraine; Indication of Nocturnal Parafunction
Acute treatment
There are lots of different headaches and there are lots of different ways of treating those headaches. The important thing is to find the right treatment for the right headache. If you use the wrong treatment, it is not likely to work well and will lead to a sense of frustration, and can often make the headache worse rather than better.
Different treatments work differently for different people at different times. Finding the right treatment takes time, motivation, and patience. Sometimes drugs can work best when taken alone, and sometimes they work best when used together with other drugs.
There is no easy way of getting it right. If one treatment does not work, you could seek advice from your local pharmacist, ask your practice nurse, or go back to your doctor. The important thing is to keep trying. It may be that you will need to contact your specialist nurse, who may be able to offer advice or talk to the headache specialist.
I’ve been taking ergotamine for years, as it’s the only thing that really stops my migraine headache. I feel really dopey afterwards, though. Is there anything else I could try?
Ergotamine is a drug that is associated with a lot of side effects. It can be very effective but can build up in the system if you take it too often. There are lots of other options. Choosing the right one is not always easy and rather depends on what you have tried before. You need to find a drug that works quickly, makes the headache go away and stay away, and causes few, if any, side effects. Any simple painkiller taken with an anti-nausea drug might help. If that isn’t any good, a triptan might work better. Talk to your doctor about the possibilities and which ones you could try out.
My friend says that Nurofen (ibuprofen) works well for her migraine, but I don’t find it helps me. Why doesn’t it work so well for me?
There are several possible reasons for this. First and foremost, any given drug can work differently in different people. It is impossible to predict how one person will respond to a particular drug. All you can do is see how you respond – which in your case with ibuprofen is not very effectively.
You might do better if you take the ibuprofen a little sooner in the attack or perhaps try a higher dose, starting at the usual 400 mg and sometimes going as high as 800 mg. It might be that you need something like metoclopramide or domperidone to help the stomach empty and so absorb the ibuprofen better, especially if you feel sick early in your migraine.
I feel sick within a few hours of my migraine starting and I vomit back any tablets I take. Is there anything I can do?
Tablets used for nausea and vomiting can work if you get them in quickly enough. Timing and speed are the crucial factors! If it takes a few hours for the nausea to kick in, the tablets should work OK. There are two drugs that are designed to help the stomach empty and so help any painkiller you take be absorbed: metoclopramide and domperidone. If you feel nauseated within 30 minutes, you might want to think about a suppository, provided you don’t get any diarrhoea. Domperidone comes as a suppository as well as a tablet and can work as quickly as an injection.
What’s the difference between Paramax and MigraMax?
The ‘max’ bit in both is from a drug called metoclopramide (brand name Maxolon), which is used to prevent nausea and vomiting. The ‘
Is Nurofen different from Nurofen Migraine or is it just the same?
There is a difference between Nurofen and Nurofen Migraine. It is a biochemical one that means that Nurofen Migraine is absorbed into the system more quickly, which is really important in treating migraine. The basic painkiller in both, though, is ibuprofen.
I always start yawning and feel really tired for a few hours before my migraine starts. Is there anything that I can take that might stop my headache starting?
The yawning and tiredness are part of your premonitory, or warning, phase at the start of your migraine. If you can take something such as aspirin or ibuprofen, at a high enough dose (with domperidone or metoclopramide), as soon as you become aware of your symptoms, you stand a fair chance of preventing the headache from starting. If the headache does start, it might be less severe and settle with a second dose of medication.
I find that Nurofen Migraine seems to work quite well but the headache always comes back. Is there anything I can do?
When treating migraine, the headache can come back in up to 30–50% of attacks. This is more likely to happen if you delay treatment for any reason. One of the things you could do is take the treatment as soon as possible after the attack starts, which may be in the aura or the premonitory phase or when the headache itself starts. If you already do that, the alternative would be to repeat Nurofen Migraine after four to six hours, which could stop the headache coming back. Alternatively, you could take something such as domperidone or metoclopramide to improve the way the Nurofen is absorbed. It may be that you need to try something different such as a different anti-inflammatory, ibuprofen being one of many, or a triptan, which is a different way of treating migraine.
How many Nurofen (ibuprofen) can I take to get rid of my migraine?
I can’t tell you how many, as that rather depends on the strength of the tablet. In an adult the standard dose is 400 mg but you might do better with 600 mg or 800 mg as your initial dose. The tablets come as 200 mg or 400 mg if you buy them ‘over the counter’ (i.e. without a prescription) from your local pharmacist. Your doctor can prescribe 600-mg-strength tablets. There are also 800-mg-strength tablets but these are slow release and not suitable for migraine treatment.
I don’t get an aura so I can’t anticipate or predict a migraine. My doctor prescribed an anti-inflammatory and dihydrocodeine for when the pain has already started. Is this the best thing to take?
They seem very strong and really knock me out. Migraine is an inflammatory process, so the anti-inflammatory is a good idea. The stomach also stops working so you need to take
a ‘gastric-emptying anti-emetic’ (anti-nausea) to help things along. The dihydrocodeine is a very strong painkiller but has no anti-inflammatory activity and can make you very sleepy. It is good for other causes of pain but not really for migraine on its own.
Can I take paracetamol as well as ibuprofen to treat my migraine?
Yes, you can, if it helps you. There are times when both drugs taken together can work better than one or the other on its own.
Migraine is a process associated with inflammation, so anti-inflammatory drugs such as ibuprofen should work better than paracetamol, which does not have an anti-inflammatory action.
My migraine always comes back, even when it goes completely with my treatment. Why is that?
The recurrence of headache symptoms happens for a variety of reasons. Migraine is a complex process in which symptoms can persist for up to three days. If you treat it early enough, you are more likely to completely suppress the process than if you delay treatment. Preventing the headache from coming back at any time in the next 36 hours is about taking an acute treatment that is absorbed quickly and stays around long enough to suppress the progress of the migraine.
My treatment seems to work well for my migraine but the headache always comes back the next day. What can I do to stop that?
You could make sure that you take your treatment early enough, repeat the dose regularly through the first 24 hours, try a different drug, or add in an anti-nausea drug if you don’t already take one. If you are using a triptan, you could try a different triptan or a higher dose of the triptan you are already taking, or try a different formulation or delivery option. You could try a nasal spray or wafer instead of a tablet, or an injection instead of a nasal spray.
How can I stop my headache from coming back? I have tried a variety of treatments but they just don’t make it go away. I feel as if I have some of the symptoms for three days, even though the headache is not so bad.
This rather depends on what you have tried already. The best way is to take an anti-inflammatory such as ibuprofen with domperidone as soon as your aura or warning phase starts, if you have one, and follow it up with a triptan as soon as the headache starts. If you do not have an aura or warning phase, take all three as soon as the headache begins. The earlier you start the treatment, the quicker it works and the more likely you are to get a sustained pain-free response. If this does not work, repeating the dose of ibuprofen every six to eight hours through the first 24 hours usually puts a stop to it.
I have been to a headache clinic and they have said that I should try several different painkillers until I find which one works. How can I decide which is best?
The best is what you want it to be. It may be the one that works quickest, that lasts the longest and keeps the headache away or gets rid of all the symptoms. It may be that you can cope with some side effects because the medication relieves enough of the symptoms to allow you to function at some level. If you try several different ones, you can make that decision for yourself.
I want a painkiller that works quickly for my migraine. Can you suggest any?
The speed with which the painkiller relieves your migraine depends on how quickly it is absorbed. The earlier you take your treatment, the quicker it will work. Using a soluble form will help it to be absorbed more quickly. If you take your painkiller with a drug that helps empty your stomach (domperidone or metoclopramide), the painkiller gets into the bloodstream more quickly so it can do its job more effectively. Some patients tell me that they can’t stand soluble tablets; they take an ordinary tablet with a fizzy drink and that works for them.
What’s the best time to take my painkiller to make sure the migraine gets better?
The simple answer is: as early as you can. Always have your treatment with you, so that you can take it as soon as you feel your symptoms starting. The more you delay, the longer it takes to be absorbed and the less likely it is to completely relieve your symptoms.
My doctor has said that an anti-inflammatory is better than paracetamol to treat migraine. Why is that?
Research has shown that inflammation is part of the changes that happen in the brain during a migraine attack. Logic and research suggest that an anti-inflammatory is more likely to help migraine in more of the people more of the time than a painkiller such as paracetamol.
Can I take more than one dose of painkiller for my migraine headache?
If you get a migraine every now and again and it works well, then yes, you can. If you get migraine every week, though, how many painkillers you take becomes an important factor. If you take too many painkillers that do not work well, there is a risk that you could develop a medication overuse headache. Taking a multiple dose of acute treatment, if it reduces the total number of headache days, is good news provided you do not need to use them too often. ‘Too often’ is taking them on three or four days in a week.
How can I decide if my new treatment is better than my old one?
If you think it is better, then it is! In order to discriminate further you will need to ask yourself a series of questions:
• Does it work more quickly or have fewer side effects than the treatment you are taking currently?
• Is it easier to take than your current option?
• Does it do what you want it to do?
These are questions only you can answer. You are the best person to decide which treatment is better, which is how it should be.
The treatment I have been using for years does not seem to work as well any more. What can I do?
This is a difficult question to answer because there are potentially many variables that you need to think about. Below are some factors for you to think about and see if they apply to you. Discuss them with your doctor, headache specialist, or specialist headache nurse. If you are using simple painkillers such as aspirin, paracetamol or ibuprofen (which is also an anti-inflammatory) to treat your migraine, they can become less effective as time passes. You may get a better effect using a different combination or even a different drug altogether.
If some of your attacks occur around the start of your menstrual period, you may need to consider a higher dose of the drug that you are using for these particular attacks to get the same effect as with attacks that occur at other times of your cycle. This will depend on which drug you are using. If there are times when the pattern of your symptoms changes and you start to feel sick or vomit earlier in the attack, your treatment may well be less effective. You might need to add in something such as domperidone to ease those symptoms or to speed up absorption of your painkiller.
My treatment seems to work better for some attacks and not so well for others. Is there anything I can do to make it more consistent?
Getting the timing right is crucial when it comes to treating your migraine. Using the right drug or drug combination at the right time makes a real difference to its effectiveness. You can help yourself by understanding the different phases of the migraine attack and then being able to recognize where you are during the attack so that you can time your treatment well.
Simple painkillers should be taken as early as possible in the premonitory or warning phase of the attack or aura. They can be taken later but will work better when taken as early as this. Some people find they work only when taken this early. Triptans are designed to be taken when the headache itself starts, not during the premonitory or aura phases. They can work at any time during the headache phase but are most effective when taken as early as possible in that phase.
You will need to keep your treatment with you at all times so that you can use it as early as possible. You should then find that the response becomes more consistent. I find that
Migraleve works well for me but my doctor has suggested I try a triptan. Why?
Migraleve is a compound painkiller that contains several active ingredients, including paracetamol, buclizine (for the nausea and vomiting) and codeine in the pink tablet to be taken as the attack starts, and just paracetamol and codeine, in the yellow tablet, if the medication needs to be repeated. A triptan is a migraine-specific drug that has been developed to target receptors in the brain and brainstem that are involved in the migraine attack. Your doctor probably feels that a triptan will be more effective than your current treatment in resolving your migraine. If you are not so sure, go back and talk to your doctor about it so you fully understand why he has suggested that you change drugs. In the meantime, consider the following questions about how well Migraleve works for you.
• Are you headache-free after using Migraleve or does it just ease your headache?
• Are you headache-free within 2 hours of taking the Migraleve?
• Does the Migraleve relieve all of your symptoms?
• Does the attack come back in the next 24 to 48 hours?
If your answers indicate that the results could be better, it would certainly be worth trying a triptan.
My cousin has been put on something called a triptan for his migraines. What is it?
Atriptan is a migraine-specific drug treatment. It works by targeting specific receptor sites in the brain and brainstem. It is designed to be taken as the headache starts and can relieve all the symptoms of the attack. It can have an effect when taken at any stage of the attack but is most effective when it is taken early.
