Migraines cannot be cured, although they may ease or even disappear over time. Migraine treatment aims to relieve symptoms and sometimes prevent the onset, if taken early enough. Migraine treatment can range from over-the-counter painkillers to prescription treatments depending on the symptoms and severity.
Simple painkillers such as paracetamol, ibuprofen or aspirin, can help to relieve the throbbing headache associated with a migraine attack if they are taken early enough. You should take them at the first onset of symptoms, do not wait until you are already experiencing a painful headache as it will be too late and they may be less effective. Soluble painkillers are absorbed into your system quicker and may be more effective at relieving migraine pain.
If simple painkillers do not relieve pain, stronger painkillers containing codeine, such as Solpadeine or Nurofen Plus, may be more effective.
Take care when using painkillers as overuse can be dangerous. Regular use of any painkillers can cause headaches and make migraines worse.
If you have been diagnosed with migraines by your GP and they cannot be controlled with simple painkillers, you will be prescribed a Triptan. Triptans (also known as 5-HT1 agonists), which are taken alongside painkillers, cause the blood vessels in the brain to contract. As some of the changes that occur in the brain to trigger a migraine attack are believed to involve the blood vessels widening, Triptans help to reverse this process and relieve the symptoms of migraine. They may also have some effect by stabilising some of the chemical changes that occur in the brain during a migraine attack.
Each Triptan has a very similar mode of action, however each can work differently depending on the person. Although, there are slight variations in effectiveness and side effects, it is much more important to find the right drug for you. This may mean trying a few different Triptans before you find the most effective one for you. It is recommended by The British Society for the Study of Headache (BASH) that you try each individual Triptan on three separate occasions before deciding on its effectiveness. If you feel it is not effective, you should then try a different Triptan or higher strength.
When choosing the correct triptan it is worth considering the method of administration as this can help to improve the effectiveness. Tablets are the standard form of triptan that are effective in most people, however if you experience nausea or vomiting they may be difficult to take. Tablets can also take longer to have an effect than other treatments and may not be the best option if a fast onset of action is required. Tablets need to be taken early on in a migraine attack for a maximal effect as there is some evidence that the absorption of drugs may decrease during a migraine attack.
Nasal sprays or wafer melts may be a better option in cases where tablets are not suitable due to the need for a quick onset of action or where nausea/vomiting makes swallowing impractical.
What triptans are available?
Each Triptan has a slightly different dose and administration method; you should check the individual instructions for each treatment. For maximum effectiveness, the Triptan should be taken at the onset of the migraine headache (the migraine attack phase), not during the prodromal or aura phases. It has been shown that taking triptans at this point in a migraine makes them most effective. In most cases you can repeat the dose after 2-4 hours if the treatment was effective and the headache returns.
Triptans can be taken alongside painkillers and anti-sickness medicines to help treat all symptoms that occur during a migraine attack.
Anti-sickness treatments (anti-emetics)
Anti-sickness treatments, such as Buccastem, can be taken to relieve the symptoms of nausea and vomiting that are experienced as part of a migraine attack. Like painkillers, anti-sickness treatments for migraine are best taken as early as possible in an attack if you know you usually experience nausea. The earlier they are taken in the migraine attack, the more effective they tend to be at treating the nausea and sickness.
Buccastem is the first line treatment for nausea and vomiting and is very effective at preventing symptoms. Buccastem is a buccal tablet meaning it is dissolved between the lip and gum. This means there is no need to swallow a tablet when feeling nauseous. Absorption of the drug through the gums allows it to be absorbed more quickly meaning a faster onset of action.