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Migraine Treatment Tablets & Nasal Sprays

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Almogran Tablets 12.5 mg
Pack Size: 3 tablets
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  • Before you start this treatment, read the manufacturer's printed information leaflet from inside your pack. The leaflet will give you more information about almotriptan and a full list of the unwanted side-effects which you may experience from taking it.
  • Take almotriptan exactly as your doctor tells you to. It is usual to take one tablet as soon as you start to feel a migraine headache develop. If your migraine at first improves but then comes back again, you may take another tablet, providing it is at least two hours after you took the first one. Do not take more than two tablets in 24 hours. If your migraine is not eased after taking the first tablet, a further dose is unlikely to work and so do not take a second tablet.
  • Swallow the tablets with a drink of water. You can take almotriptan before or after meals.
  • Almotriptan is meant to be used during a migraine attack, not to stop one from coming on. There is some evidence that taking it too early in a migraine attack may make the treatment less effective. You should wait until you feel mild discomfort (usually, the beginning of the migraine headache) rather than taking it at the aura stage or when you feel that a migraine may be developing.

Almotriptan is used to treat migraine headaches.

Take one tablet as soon as you start to feel a migraine headache develop. Do not take it before the headache begins (for example, during the 'aura phase'), as it may be less effective.

Your chest may feel tight or 'heavy' after taking almotriptan. These sensations do not usually last for long, but if they continue or become intense, do not take any more almotriptan tablets, and let your doctor know as soon as possible.

Almotriptan can make you feel sleepy. If this happens, do not drive or use tools or machines.

It is not clear what causes migraine. It is thought that some chemicals in the brain increase in activity, and as a result parts of the brain then send out confused signals which result in the symptoms of migraine.

It is also not clear why people with migraine should develop these chemical changes. Many migraine attacks occur for no apparent reason, but in some people there may be things which trigger an attack, like certain foods or drinks.

Almotriptan is effective in relieving migraine attacks once an attack has started but it does not help prevent headaches or migraine attacks from starting. It works by stimulating the receptors of a chemical in the brain, called serotonin (or 5HT). This eases the symptoms of a migraine. 

 Other tretament ideas

 

  • It may help to keep a migraine diary. Note down when and where each migraine attack started, what you were doing, and what you had eaten that day. A pattern may emerge, and it may be possible to avoid one or more things that trigger your migraine attacks.
  • Almotriptan is used to treat a migraine once it has started, but there are other medicines that are available that may help to prevent you having migraines. If you have migraines frequently, discuss this with your doctor.
  • Do not take other migraine treatments, such as other triptans or ergotamine, as well as almotriptan. However, some people may benefit from taking a non-steroidal anti-inflammatory painkiller (such as naproxen) as well as almotriptan. Your doctor will advise you about this if it is needed.
  • If you find that almotriptan does not relieve your migraine, make an appointment to discuss this with your doctor, as an alternative preparation may be more effective for you.
  • If you buy any 'over-the-counter' medicines, check with your pharmacist which medicines are safe for you to take.
  • Some people who get frequent migraine attacks are in fact getting medication-induced headache. Medication-induced headache (also called medication-overuse headache) is caused by taking painkillers or triptans too often. If you use almotriptan or painkillers on more than two days per week on a regular basis, you may be at risk. You should talk to your doctor if you suspect this.
Feeling tired, sleepy or dizzy If this happens, do not drive or use tools or machines
Feeling or being sick Stick to simple foods
Occasionally, some people feel intense tightness or pain in their chest If this happens, do not take any further tablets and speak with your doctor about it

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking almotriptan it is important that your doctor or pharmacist knows:

  • If you are aged over 65 years or under 18 years old.
  • If you are pregnant or breast-feeding.
  • If you have heart problems or angina, or if you have recently had a heart attack.
  • If you have high blood pressure.
  • If you have circulation problems.
  • If you have problems with your liver or kidneys.
  • If you have ever had a stroke or a transient ischaemic attack (also referred to as a TIA or 'mini-stroke').
  • If you have ever had an allergic reaction to a medicine. It is particularly important that you tell your doctor if you have had a bad reaction to a sulfonamide medicine used to treat an infection.
  • If you are taking or using any other medicines. This includes any medicines you are taking which are available to buy without a prescription, such as herbal and complementary medicines.
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Arlevert Tablets 20/40mg
Pack Size: 100 tablets
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Arlevert tablets contain two active ingredients, cinnarizine and dimenhydrinate, both of which are antihistamine medicines. Arlevert tablets are used to treat symptoms of various types of vertigo.

Vertigo is described as a spinning or swaying sensation whilst standing still. It is commonly caused by a problem with the vestibular apparatus in the middle ear. The vestibular apparatus provides continual feedback to the brain about our body position. When something disturbs it, nerve signals are sent from the vestibular apparatus to the vomiting centre in the brain. This can cause sensations such as nausea, dizziness or spinning sensations (vertigo) and the reflex of vomiting.

This medicine works by blocking histamine and muscarinic receptors in the vomiting centre in the brain. This prevents the vomiting centre from receiving the nerve messages from the vestibular apparatus in the middle ear. In turn, this prevents disturbances in the middle ear from activating the vomiting centre and causing vertigo, nausea and vomiting.

Arlevert tablets are usually taken for a maximum of four weeks.




  • This medicine may cause drowsiness. If affected do not drive or operate machinery. Alcohol should be avoided.
  • This medicine can upset your stomach: taking it with or after food may help to reduce the indigestion.
  • If you are due to have any skin prick tests to diagnose allergies you should stop taking this medicine at least 48 hours before the tests. This is because antihistamines can prevent or lessen the skin reactions that indicate an allergy, and so can make the test results unreliable.

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

Common (affect between 1 in 10 and 1 in 100 people)

  • Drowsiness.
  • Headache.
  • Dry mouth.
  • Abdominal pain.

There will be increased drowsiness and sedation if this medicine is taken in combination with any of the following (which can also cause drowsiness):

  • alcohol
  • antipsychotics, eg haloperidol
  • barbiturates, eg phenobarbital, amobarbital
  • benzodiazepines, eg diazepam, temazepam
  • MAOI antidepressants, eg phenelzine, isocarboxazid or tranylcypromine
  • other sedating antihistamines, eg chlorphenamine, hydroxyzine
  • sleeping tablets, eg zopiclone
  • strong opioid painkillers, eg codeine, dihydrocodeine, morphine
  • tricyclic antidepressants, eg amitriptyline.
  • People with mild to moderately decreased kidney function.
  • People with mild to moderately decreased liver function.
  • Parkinson's disease.
  • Enlarged prostate gland (prostatic hypertrophy).
  • People with a blockage of the area where the stomach joins the intestines (pyloroduodenal obstruction).
  • People with high or low blood pressure.
  • Severe disease involving the heart and blood vessels (cardiovascular disease).
  • Overactive thyroid gland (hyperthyroidism).
  • People with raised pressure in the eye, eg open angle glaucoma.
  • Rare hereditary blood disorders called porphyrias.

Not to be used in

  • People with severely decreased kidney function.
  • People with severely decreased liver function.
  • Closed angle glaucoma.
  • People with increased pressure in the brain (raised intracranial pressure).
  • People who are intoxicated with alcohol (acute alcoholism).
  • Convulsions, eg epilepsy.
  • People with difficulty passing urine (urinary retention), due to prostate problems.
  • Pregnancy.
  • Breastfeeding.




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Imigran Nasal Spray 10mg
Pack Size: 2 sprays
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Imigran Nasal Spray should be used to treat a migraine attack, not to prevent one. You should use ONE spray of Imigran 10mg Nasal Spray into ONE nostril as soon as possible at the onset of migraines. Do not use another dose for at least 2 hours. Do not use more than 2 sprays of Imigran Nasal Spray in 24 hours.

You should not use any other 'triptan' migraine treatment whilst you are using Imigran Nasal Spray, this includes sumatriptan, naratriptan and favotriptan. You can use painkillers and antisickness medicines with Imigran Nasal Spray. 

How to use an Imigran Nasal Spray 

Imigran Nasal Sprays come in indivudual blister packs. Do not open a blister until you are ready to use the spray. Blow your nose before use if it feels blocked.

  1. Hold the spray with your index and middle fingers each side on the nozzle and your thumb resting on the blue plunger.
  2. Insert the nozzle into one nostril (about 1cm or 1/2 inch in) and block the other using a finger by pressing firmly on hte side of your nose. 
  3. Start to breathe in gently through your nose and out through your mouth.
  4. As you breath in, press the blue plunger firmly with your thumb, keep breathing in whilst it is spraying.
  5. Remove the spray and unblock your other nostril.
  6. Keep breathing in gently through your nose and out through your mouth for 10 seconds. Your nose may feel wet and you may detect a slight taste after using the spray - this is normal.
  7. Discard the used spray.

Sumtriptan (the active ingredient in Imigran Nasal Spray) causes 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 (such as Sumatriptan) 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. Imigran Nasal Spray usually starts to work after 30 minutes, therefore it important to use it as soon as possible into a migraine attack. Imigran Nasal Spray may not work for everyone, where it does not work alternative 'triptans', such as almotriptan (Almogran) and favotriptan (Migard) are worth trying.

Imigran 10mg Nasal Spray can be used with painkillers such as paracetamol, ibuprofen or codeine or with antisickness medicines such as Buccastem, to help treat any additional symptoms associated with your migraines. You should not take any other migraine treatments containing 'triptans' whilst you are taking Imigran Nasal Spray.

Imigran Nasal Spray is appropriate for use in people who cannot take tablets, those who suffer with nausea and sickness as part of their migraine symptoms, and those who get migraines that come on very rapidly.  It offers and easy alternative when taking tablets is not possible or appropriate and offers a fast onset for quick relief of symptoms.

Imigran 10mg Nasal Spray is suitable as the starting dose for those new to sumatriptan or Imigran Nasal Spray. If this is found to be ineffective, you can increase the strength of your treatment to Imigran Nasal Spray 20mg.

The side effects of Imigran 10mg Nasal Spray can include pain, heaviness, pressure or tightness in the chest, throat or other parts of the body, or unusual sensations, including numbness, tingling and warmth or cold. These effects may be intense but generally pass quickly. Please read the Patient Information Leaflet enclosed with your medicines for a full list of side effects.

Other common side effects include:

  • Feeling sick (nausea) or being sick (vomiting), although this may be due to the migraine itself
  • Tiredness or drowsiness
  • Dizziness, feeling weak, or getting hot flushes
  • Temporary increase in blood pressure
  • Shortness of breath
If you feel pain or tightness in your chest after you use sumatriptan, do not panic, the symptoms may be intense but they usually pass quickly. If they do not pass quickly or they become severe, get medical help immediately. 

Imigran (Sumatriptan) has been widely used for many years and is generally considered a safe drug.

Imigran can cause a temporary narrowing of blood vessels. People who have had strokes or mini-strokes, have problems with poor circulation, or a history of angina (heart pain on exertion) or a have had heart attacks should not use Imigran Nasal Spray.

Even in people who have never had circulation problems sumatriptan can in rare situations trigger serious heart problems. The following groups should check with their GP before using Imigran Nasal Spray:

  • Heavy smokers
  • Men over 40
  • Women after the menopause

In some rare serious cases migraine headaches are associated with paralysis, loss of vision and loss of speech. Imigran is not to be used in these cases.

  • Before self medicating for headaches it is best to see a GP for a diagnosis
  • When headaches start for the first time over the age of 40
  • When headaches are getting more frequent and lasting longer
  • When headaches are different from before or there are new symptoms

You should not use Imigran Nasal Spray if:

  • You are allergic to sumatriptan or any of the ingredients
  • You have high blood pressure
  • You have severely reduced liver function
  • You use, or have recently used, ergotamine or similar medicines (e.g. methsergide maleate) or MAO inhibitors (e.g. moclobemide or selegiline).
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Imigran Nasal Spray 20mg
Pack Size: 2 sprays
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Imigran Nasal Spray should be used to treat a migraine attack, not to prevent one. You should use ONE spray of Imigran 20mg Nasal Spray into ONE nostril as soon as possible at the onset of migraines. Do not use another dose for at least 2 hours. Do not use more than 2 sprays of Imigran Nasal Spray in 24 hours.

You should not use any other 'triptan' migraine treatment whilst you are using Imigran Nasal Spray, this includes sumatriptan, naratriptan and favotriptan. You can use painkillers and antisickness medicines with Imigran Nasal Spray. 

How to use an Imigran Nasal Spray 

Imigran Nasal Sprays come in indivudual blister packs. Do not open a blister until you are ready to use the spray. Blow your nose before use if it feels blocked.

  1. Hold the spray with your index and middle fingers each side on the nozzle and your thumb resting on the blue plunger.
  2. Insert the nozzle into one nostril (about 1cm or 1/2 inch in) and block the other using a finger by pressing firmly on hte side of your nose. 
  3. Start to breathe in gently through your nose and out through your mouth.
  4. As you breath in, press the blue plunger firmly with your thumb, keep breathing in whilst it is spraying.
  5. Remove the spray and unblock your other nostril.
  6. Keep breathing in gently through your nose and out through your mouth for 10 seconds. Your nose may feel wet and you may detect a slight taste after using the spray - this is normal.
  7. Discard the used spray.

Sumtriptan (the active ingredient in Imigran Nasal Spray) causes 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 (such as Sumatriptan) 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. Imigran Nasal Spray usually starts to work after 30 minutes, therefore it important to use it as soon as possible into a migraine attack. Imigran Nasal Spray may not work for everyone, where it does not work alternative 'triptans', such as almotriptan (Almogran) and favotriptan (Migard) are worth trying.

Imigran 20mg Nasal Spray can be used with painkillers such as paracetamol, ibuprofen or codeine or with antisickness medicines such as Buccastem, to help treat any additional symptoms associated with your migraines. You should not take any other migraine treatments containing 'triptans' whilst you are taking Imigran Nasal Spray.

Imigran Nasal Spray is appropriate for use in people who cannot take tablets, those who suffer with nausea and sickness as part of their migraine symptoms, and those who get migraines that come on very rapidly.  It offers and easy alternative when taking tablets is not possible or appropriate and offers a fast onset for quick relief of symptoms.

The side effects of Imigran Nasal Spray can include pain, heaviness, pressure or tightness in the chest, throat or other parts of the body, or unusual sensations, including numbness, tingling and warmth or cold. These effects may be intense but generally pass quickly. Please read the Patient Information Leaflet enclosed with your medicines for a full list of side effects.

Other common side effects include:

  • Feeling sick (nausea) or being sick (vomiting), although this may be due to the migraine itself
  • Tiredness or drowsiness
  • Dizziness, feeling weak, or getting hot flushes
  • Temporary increase in blood pressure
  • Shortness of breath
If you feel pain or tightness in your chest after you use sumatriptan, do not panic, the symptoms may be intense but they usually pass quickly. If they do not pass quickly or they become severe, get medical help immediately. 

If you find that your medicine is effective but you get mild unwanted side effects, you may wish to lower the strength of your treatment to Imigran Nasal Spray 10mg to see if it is still effective without the side effects. 

Imigran (Sumatriptan) has been widely used for many years and is generally considered a safe drug.

Imigran can cause a temporary narrowing of blood vessels. People who have had strokes or mini-strokes, have problems with poor circulation, or a history of angina (heart pain on exertion) or a have had heart attacks should not use Imigran Nasal Spray.

Even in people who have never had circulation problems sumatriptan can in rare situations trigger serious heart problems. The following groups should check with their GP before using Imigran Nasal Spray:

  • Heavy smokers
  • Men over 40
  • Women after the menopause

In some rare serious cases migraine headaches are associated with paralysis, loss of vision and loss of speech. Imigran is not to be used in these cases.

  • Before self medicating for headaches it is best to see a GP for a diagnosis
  • When headaches start for the first time over the age of 40
  • When headaches are getting more frequent and lasting longer
  • When headaches are different from before or there are new symptoms

You should not use Imigran Nasal Spray if:

  • You are allergic to sumatriptan or any of the ingredients
  • You have high blood pressure
  • You have severely reduced liver function
  • You use, or have recently used, ergotamine or similar medicines (e.g. methsergide maleate) or MAO inhibitors (e.g. moclobemide or selegiline).
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Maxalt Melt Wafers 10mg
Pack Size: 3 wafers
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  • Before you start this treatment, read the manufacturer's printed information leaflet from inside your pack. The manufacturer's leaflet will give you more information about rizatriptan and a full list of the side-effects which you may experience from taking it.
  • Take rizatriptan exactly as your doctor tells you to. It is usual to take one tablet as soon as you start to feel a migraine headache develop.
  • If you are taking a Maxalt® tablet, swallow the tablet with a drink of water. If you are taking a Maxalt® Melt wafer, this has been made so that you can place it on your tongue and allow it to dissolve in your mouth. Maxalt® Melt wafers are particularly helpful if drinking water to take a tablet would make you feel sick.
  • If you have recently had a meal, rizatriptan may take a little longer before it starts to work than if you had not eaten. This is because the food in your stomach can delay the absorption of the medicine. Although rizatriptan is better taken when your stomach is empty, you can still take it if you have had a meal.
  • If your migraine at first improves but then comes back again, you may take another tablet/wafer, providing it is at least two hours after you took the first one. If your migraine is not eased after taking the first dose, a further dose is unlikely to work, so do not take a second tablet/wafer.
  • Do not take more than two 10 mg tablets in 24 hours.

It is not clear what causes migraine. It is thought that some chemicals in the brain increase in activity, and as a result parts of the brain then send out confused signals which result in the symptoms of migraine. Why people with migraine should develop these chemical changes is also not clear. Many migraine attacks occur for no apparent reason, but for some people there may be things which trigger an attack, like certain foods or drinks.

Rizatriptan belongs to a class of medicines known as 5HT1-receptor agonists. They are also known simply as triptans. Triptans work by stimulating the receptors of a natural substance in the brain called serotonin (or 5HT). This eases the symptoms of migraine.

Rizatriptan is effective in relieving migraine attacks once the headache phase has started. It does not help prevent migraine headaches from developing.

 

  • Rizatriptan is meant to be used to treat headache pain during a migraine attack, not to stop the pain from coming on. You should wait until the pain is just beginning to develop, rather than taking it at the aura stage or when you feel that a migraine may be developing. Taking it earlier in a migraine attack will not stop the headache from developing.
  • You should not take other migraine treatments such as other triptans or ergotamine at the same time as rizatriptan.
  • Some people may benefit from taking a non-steroidal anti-inflammatory painkiller (such as naproxen) in addition to rizatriptan. Your doctor will advise you about this if it is recommended for you.
  • If you find that rizatriptan does not relieve your migraine, make an appointment to discuss this with your doctor, as an alternative medicine may be more effective for you.
  • If you buy any 'over-the-counter' medicines, check with your pharmacist which medicines are safe for you to take.
  • It may help to keep a migraine diary. Note down when and where each migraine attack started, what you were doing, and what you had eaten that day. A pattern may emerge, and it may be possible to avoid one or more things that trigger your migraine attacks.
  • Rizatriptan is used to treat migraine attacks, but there are other medicines that are available that may help to prevent you from having migraines. If you have migraines frequently, discuss this with your doctor.
  • Some people who get frequent migraine attacks are in fact getting medication-induced headache. Medication-induced headache (also called medication-overuse headache) is caused by taking painkillers or triptans too often. If you use rizatriptan or painkillers on more than two days a week on a regular basis, you may be at risk of this. You should talk to your doctor if you suspect it.

Feeling tired, dizzy or sleepy

Common rizatriptan side-effects (these affect less than 1 in 10 people)
What can I do if I experience this?
Feeling tired, dizzy or sleepy If this happens, do not drive or use tools or machines
Feeling sick, indigestion, diarrhoea Stick to simple foods
Sore throat, feeling shaky, tingling feelings, feeling hot and flushed, palpitations, dry mouth If troublesome, speak with your doctor
Some people feel tightness or pain in their throat or chest If the pain is intense, do not take any further tablets and speak with your doctor about it

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking rizatriptan it is important that your doctor or pharmacist knows:

  • If you are aged over 65 years or under 18 years.
  • If you are pregnant or breast-feeding.
  • If you have heart problems such as angina, or if you have had a heart attack.
  • If you have high blood pressure.
  • If you have circulation problems.
  • If you have any problems with the way your liver works or with the way your kidneys work.
  • If you have ever had a stroke or a transient ischaemic attack (this is also referred to as a TIA, or 'mini-stroke').
  • If you have ever had an allergic reaction to a medicine.
  • If you are taking or using any other medicines. This includes any medicines you are taking which are available to buy without a prescription, such as herbal and complementary medicines.
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Migard Tablets 2.5mg
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  1. Always take Migard 2.5 mg tablets exactly as your doctor has told you.You should check with your doctor if you are not sure.
    Take Migard 2.5 mg tablets as early as possible after the onset of the migraine headache. Swallow one tablet whole with water.

    If the first dose does not give you any relief, do not take a second dose during the same attack. You can use Migard 2.5 mg tablet for any following attacks.
    If you obtain relief after the first dose, but later on suffer from the re-appearance of a headache within 24 hours, you can take a second dose provided that at least 2 hours have elapsed between the 2 doses.

    Do not exceed the maximum dose of 5 mg (two tablets) in 24 hours.

    Excessive use (repeated use over several consecutive days) of Migard 2.5 mg tablets constitutes incorrect use of this medicine and may cause an increase in side effects and lead to chronic daily headaches requiring the temporary discontinuation of treatment. Consult your doctor if you start having too frequent or daily headaches as you may be suffering from medication overuse headache.

    Migard should not be used in patients under 18 years of age.
    As there is little experience in patients over 65 years, the use of Migard is not recommended in patients in this age group.

    If you take more Migard than you should

    If you accidentally take an overdose of this medicine, tell your doctor or pharmacist immediately or go to the emergency department of your nearest hospital. Please remember to take the remaining tablets or this leaflet with you.

    If you stop taking Migard

    No special precautions are necessary when stopping the drug. 

Migard tablets contain the active ingredient frovatriptan, which is a type of medicine called a serotonin (or 5HT) agonist. This type of medicine is also commonly known as a 'triptan'. It is a painkiller specifically used to relieve migraine attacks.

Although the cause of migraine attacks is not fully understood, it is thought that widening of blood vessels in the brain causes the throbbing pain of migraine headaches. Frovatriptan relieves this pain by causing the blood vessels in the brain to narrow.

Frovatriptan works by stimulating receptors called serotonin (or 5HT) receptors that are found in the brain. A natural substance called serotonin normally acts on these receptors, causing blood vessels in the brain to narrow. Frovatriptan mimics this action of serotonin by directly stimulating the serotonin receptors in the brain. This narrows the blood vessels and so relieves the pain of migraine headaches.

The dose of frovatriptan should be taken as early as possible after the migraine headache has started, though it is also effective if taken at a later stage during the migraine attack. It should not be taken during the aura, or warning phase that can occur before a migraine headache, as the safety and effectiveness of the medicine have not been established during this period, and the medicine will not prevent the headache.




Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.

  • Dizziness.
  • Fatigue.
  • Headache.
  • Flushing.
  • Changes in sensation, for example pins and needles, tingling or numb sensations.
  • Sleepiness (somnolence).
  • Dry mouth.
  • Chest pain.
  • Awareness of your heartbeat (palpitations).
  • Feeling of tightness in the throat.
  • Increased sweating.
  • Visual disturbances.
  • Disturbances of the gut such as nausea, indigestion, diarrhoea, constipation, flatulence or abdominal pain.
  • Anxiety or agitation.
  • Confusion or concentration difficulties.
  • Mood changes.
  • Abnormal thinking.
  • Difficulty sleeping (insomnia).
  • Feeling weak.
  • Increase in blood pressure.



  • This medicine should not be used to prevent migraines.
  • This medicine should only be used by people with a clear diagnosis of migraine from their doctor.
  • If the first dose of this medicine doesn't relieve your migraine headache then you should NOT take another dose for the same attack, as trials have shown that this is not effective. (You can still take Migard for your next attack.) If the first dose does initially relieve your migraine, but the headache then comes back, you can take a second dose. However, if you need a second dose because your migraine has returned, you should NOT take it within two hours of your first dose. Do not exceed the recommended dose.
  • Using any painkillers for headaches too often or for too long can actually make the headaches worse. If you find you need to use this medicine frequently you should consult your doctor for advice.
  • This medicine can cause feelings of warmth, heaviness, pressure, tightness, tingling or pain in certain parts of the body, including the chest or throat. Although sometimes very strong, these feelings usually only last a few minutes. If they continue or are particularly severe (especially chest pain), you should not take any more tablets and consult your doctor immediately.
  • This medicine may cause drowsiness. If affected do not drive or operate machinery.




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  • f you have been supplied the 3 mg buccal tablets (Buccastem® brand) - the tablets are designed to stick to the inside of your mouth and to dissolve there. Place the tablet in your mouth, high up between your top gum and upper lip. Leave it in place - the tablet will dissolve slowly over the next hour or so.
  • If you forget to take a dose, take it as soon as you remember unless it is nearly time for your next dose, in which case leave out the missed dose. Do not take two doses together to make up for a missed dose.
  • Buccastem M buccal tablets should not be swallowed like normal tablets.
  • The tablet should be placed high up along the top gum, under the upper lip on either side of your mouth. The tablet will soften and stick to your gum, taking between one and two hours to dissolve completely. The medicine is absorbed into your bloodstream through the rich supply of blood vessels in this area.
  • If you wear dentures, the tablet may be placed in any comfortable position between your lip and gum.
  • Don't move the tablet about the mouth with your tongue as this will cause it to dissolve more quickly.
  • Don't eat while the tablet is in your mouth.
  • The usual dose of Buccastem M tablets is one or two tablets twice a day. Do not exceed this dose.
  • Do not take this medicine for longer than two days. If your symptoms persist after this time consult a doctor.


Buccastem M buccal tablets contain the active ingredient prochlorperazine, which is a type of medicine called a phenothiazine. Prochlorperazine has two quite different uses. In higher doses it is used in the treatment of psychiatric illnesses. In lower doses it is used in the management of nausea and vomiting.

The Buccastem M brand of prochlorperazine can be bought from pharmacies. It contains a low dose of prochlorperazine to treat nausea and vomiting associated with migraine. The prochlorperazine works by blocking dopamine receptors in an area of the brain that controls nausea and vomiting.

Vomiting is controlled by an area of the brain called the vomiting centre. The vomiting centre is responsible for causing feelings of sickness (nausea) and for the vomiting reflex. It is activated when it receives nerve messages from another area of the brain called the chemoreceptor trigger zone (CTZ) and when it receives nerve messages from the gut.

Prochlorperazine controls nausea and vomiting by blocking dopamine receptors found in the CTZ. This stops the CTZ from sending the messages to the vomiting centre that would otherwise cause nausea and vomiting.




Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

  • Drowsiness.
  • Dizziness.
  • Dry mouth.
  • Difficulty sleeping.
  • Agitation.
  • A drop in blood pressure that occurs when going from lying down to sitting or standing, which results in dizziness and lightheadedness (postural hypotension).
  • Irritation to the gum or mouth where the tablet has been placed.
  • Skin rashes.
  • High temperature combined with falling levels of consciousness, paleness, sweating and a fast heart beat (neuroleptic malignant syndrome). This is rare but requires stopping the medicine and immediate medical treatment - see warning section above.
  • Blood clots in the veins especially in the legs (symptoms include swelling, pain and redness in the leg), which may travel through blood vessels to the lungs causing chest pain and difficulty in breathing. If you notice any of these symptoms seek medical advice immediately.
  • Keep your regular doctor's appointments so your progress can be checked. If you are taking prochlorperazine for a long-term condition, you may need to have some blood tests from time to time.
  • If you have been given prochlorperazine to relieve nausea, dizziness or agitation, it will be given to you for a short time until your symptoms have eased. If you have been prescribed prochlorperazine for schizophrenia, treatment is usually long-term. Keep taking prochlorperazine until your doctor tells you otherwise, as your doctor may want you to reduce your dose gradually if a change in your treatment becomes necessary.
  • Prochlorperazine may cause your skin to become more sensitive to sunlight than normal. Use a sunscreen that protects against UVA light and has a sun protection factor (SPF) of at least 15, especially in strong sunlight or until you know how your skin reacts. Do not use sunbeds.
  • If you are having an operation or any dental treatment, tell the person carrying out the treatment which medicines you are taking. This is important because prochlorperazine may interfere with any anaesthetic you receive.
  • If you buy or take any 'over-the-counter' medicines, check with a pharmacist that they are suitable to take with prochlorperazine. Antacid remedies should not be taken at the same time, as they reduce the amount of prochlorperazine absorbed by your body.
  • If you drink alcohol, ask your doctor for advice about drinking while you are on prochlorperazine. Alcohol will increase the chance that you experience side-effects and is unlikely to be recommended for you.
  • If you have diabetes check your blood glucose levels regularly, as prochlorperazine may affect the levels of sugar in your blood.
  • You should only take this medicine if you have previously been diagnosed by a doctor as suffering from migraines.
  • This medicine may cause drowsiness. If affected do not drive or operate machinery.
  • Avoid drinking alcohol because it can make drowsiness worse.
  • This medicine can occasionally cause your blood pressure to drop when you move from a lying down or sitting position to sitting or standing. This may make you feel dizzy or unsteady. To avoid this try getting up slowly. If you do feel dizzy, sit or lie down until the symptoms pass.
  • This medicine may make your skin more sensitive to sunlight than it usually is, so you should avoid exposing your skin to direct sunlight or sunlamps until you know how your skin reacts.
  • This medicine may rarely cause a decrease in the normal amounts of white blood cells in the blood. For this reason, you should consult your doctor immediately if you experience any of the following symptoms while taking this medicine, as they may indicate a problem with your blood cells: unexplained sore throat, mouth ulcers, infections, high temperature (fever) or general illness.
  • Stop taking this medicine and consult your doctor immediately if you experience the following symptoms, as they may be caused by a rare but serious side effect of this type of medicine, called the neuroleptic malignant syndrome: high temperature (fever), pale complexion, sweating, muscle stiffness, fast heartbeat and decreased consciousness.



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Use propranolol sustained-release capsules as directed by your doctor. Check the label on the medicine for exact dosing instructions.

  • Take propranolol sustained-release capsules by mouth with or without food.
  • Swallow propranolol sustained-release capsules whole. Do not break, crush, or chew before swallowing.
  • If you are taking an antacid with aluminium in it, take it at least 2 hours after you take propranolol sustained-release capsules.
  • Take propranolol sustained-release capsules on a regular schedule to get the most benefit from it. Taking propranolol sustained-release capsules at the same time each day will help you remember to take it.
  • Continue to use propranolol sustained-release capsules even if you feel well. Do not miss any doses.
  • Do not suddenly stop taking propranolol sustained-release capsules. You may have an increased risk of side effects. If you need to stop propranolol sustained-release capsules, your doctor will gradually lower your dose.
  • If you miss a dose of propranolol sustained-release capsules, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use propranolol sustained-release capsules.

Propranolol sustained-release capsules is a beta-blocker. It works by slowing down the heart and decreasing the amount of blood it pumps out. This decreases blood pressure, helps the heart pump more efficiently, and reduces the workload on the heart. Exactly how propranolol sustained-release capsules works to treat migraines is not known.

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Constipation; diarrhea; dizziness; drowsiness; fatigue; light-headedness; nausea; stomach upset or cramping; trouble sleeping; vomiting; weakness.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); chest pain; confusion; fainting; fever with aching and sore throat; hallucinations; irregular heartbeat; memory loss; mental or mood changes (eg, depression); numbness or tingling of the hands; red, swollen, blistered, or peeling skin; severe or persistent dizziness or light-headedness; shortness of breath or wheezing; sudden, unusual weight gain; swelling of the hands, ankles, or feet; unusual bruising or bleeding; unusually slow heartbeat; very cold or blue fingers or toes; vision changes.

Do NOT use propranolol sustained-release capsules if:

  • you are allergic to any ingredient in propranolol sustained-release capsules
  • you have moderate to severe heart block, sick sinus syndrome, or a very slow heartbeat and you do not have a permanent pacemaker
  • you have uncontrolled heart failure or shock caused by serious heart problems
  • you have asthma
  • the patient is a child with diabetes or heart failure
  • you are taking mibefradil

Contact your doctor or health care  provider right away if any of these apply to you.

Before using propranolol sustained-release capsules:

Some medical conditions may interact with propranolol sustained-release capsules. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

  • if you are pregnant, planning to become pregnant, or are breast-feeding
  • if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
  • if you have allergies to medicines, foods, or other substances
  • if you have a history of other heart problems (eg, angina, congestive heart failure, slow heartbeat)
  • if you have a history of liver or kidney problems, blood vessel disease, lung or breathing problems (eg, chronic bronchitis, chronic obstructive pulmonary disease [COPD], emphysema), diabetes, low blood sugar, overactive thyroid, or glaucoma
  • if you have Wolff-Parkinson-White syndrome, Down syndrome, Raynaud syndrome, or an adrenal gland tumor (pheochromocytoma)
  • if you smoke or drink alcohol
  • if you are scheduled to have surgery or receive anesthesia

Some MEDICINES MAY INTERACT with propranolol sustained-release capsules. Tellyour health care provider if you are taking any other medicines, especially any of the following:

  • Mibefradil because the risk of serious heart side effects may be increased
  • Diphenhydramine because it may increase the risk of propranolol sustained-release capsules's side effects. Before you start any new medicine, including over-the-counter medicines, check the label to see if it contains diphenhydramine. If it does or you are not sure, check with your doctor or pharmacist
  • Many prescription and nonprescription medicines (eg, used for infections, inflammation, aches and pains, high blood pressure, heart problems, irregular heartbeat, diabetes, prostate problems, blood thinning, thyroid problems, depression, mental or mood problems, immune system suppression, allergic reactions, asthma or other lung or breathing problems, high cholesterol, seizures, multiple sclerosis [MS]), multivitamin products, and herbal or dietary supplements (eg, herbal teas, coenzyme Q10, garlic, ginseng, ginkgo, St. John's wort) may interact with propranolol sustained-release capsules, increasing
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Propranolol Tablets 10mg
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  • Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack. It will give you more information about propranolol and will provide you with a full list of the side-effects which you may experience from taking it.
  • Your doctor will tell you what dose is right for you, and this information will be printed on the label of the pack to remind you. Take propranolol exactly as your doctor tells you to. Propranolol tablets are usually prescribed to be taken in divided doses - so you may be prescribed two, three or four doses to take each day. Propranolol capsules have a more prolonged action and are prescribed to be taken once daily. Swallow the capsule whole with a drink of water - do not chew or open the capsules.
  • Propranolol tablets and capsules are available in several different strengths. Each time you collect a fresh supply, it's a good idea to check the strength on the packet to make sure they are the strength you are expecting.
  • Try to take your doses at the same times of day each day, as this will help you to remember to take them regularly.
  • If you do forget to take a dose, take it as soon as you remember unless your next dose is due. If your next dose is due, then take the tablet/capsule which is due but leave out the forgotten one. Do not take two doses together to make up for missing one.

Propranolol belongs to the group of medicines known as beta-blockers. It is a medicine which is used to treat several different medical conditions. It works on the heart and blood vessels.

Propranolol is also prescribed to help ease the physical symptoms of anxiety, such as a fast heartbeat and trembling. Similar symptoms to these are also experienced by people with an overactive thyroid gland. Propranolol quickly relieves these types of symptoms. It is also the beta-blocker which is commonly prescribed to help prevent migraines. It can be helpful for people who find other treatments for migraine unsuitable.

  • are allergic (hypersensitive) to propranolol hydrochloride or any of the other ingredients of this medicine

  • have a history of wheezing or asthma

  • suffer from poor circulation

  • suffer from Prinzmetal’s angina (angina due

    to coronary artery spasm)

  • have a slow heart rate

  • suffer from other heart problems such as

    heart failure, cardiogenic shock, heart block

    or sick sinus syndrome

  • suffer from uncontrolled heart failure

  • have low blood pressure

  • have an adrenal tumour (phaeochromocytoma)

    resulting in high blood pressure, flushing,

    and diarrhoea

  • suffer from metabolic acidosis (an imbalance

    of the body’s acid-base balance)

  • undertake or have recently undertaken

    prolonged periods of fasting.

    Take special care with Propranolol
    Tell your doctor before you start to take this medicine if you:
    • suffer from liver or kidney problems
    • are undergoing treatment for diabetes
    • have thyroid problems.

    If you are to have surgery, propranolol should be withdrawn 24 hours before as it may interfere with response to stress.
    Propranolol may increase reactions to a number of allergens.

    Taking other medicines
    Talk to your doctor if you are taking any of the following:
    • sympathomimetic drugs such as adrenaline • ergotamine (for migraine)
    • prostaglandin synthetase inhibitors used to

    treat inflammatory conditions
    • other drugs for other heart conditions such

    as flecainide, diltiazem, nifedipine or digoxin • cimetidine, hydralazine or chlorpromazine
    • quinidine, propafenone, rifampicin,

    theophylline, warfarin, thioridazine or

    dihydropyridine
    • calcium channel blockers e.g. nifedipine,

    nisoldipine, nicardipine, isradipine or lacidipin 

    ithout a prescription.

    Important information about some of the ingredients of Propranolol
    • Patients who are intolerant to lactose should

    note that Propranolol tablets contain a small amount of lactose. If your doctor has told you that you have an intolerance to some sugars, contact your doctor before taking this medicine.

    Taking Propranolol with food and drink

    • DO NOT take alcohol whilst taking these tablets, as it may interfere with the action of Propranolol.

    Pregnancy and breast-feeding

    • Propranolol is not recommended if you are pregnant, planning to become pregnant or are breast-feeding.

    Ask your doctor or pharmacist for advice before taking any medicine. 

    Propranolol may cause drowsiness and dizziness. If affected, DO NOT drive or operate machinery. 

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Take 100mg (ONE tablet) at onset of symptoms, dose may be repeated after at least 2 hours if migraine symptoms return. Maximum dose is 300mg in 24 hours (three 100mg tablets).

Sumatriptan (Imigran) usually starts to work after 30 minutes. It does not work for everyone. Where it does not work alternative 'triptans' are worth trying.

Sumatriptan should not be taken with other 'triptans' or with medication containing ergotamine.

Sumtriptan (generic Imigran) causes 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 (such as Sumatriptan) 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. Sumatriptan (Imigran) usually starts to work after 30 minutes, therefore it important to take it as soon as possible into a migraine attack. Sumatriptan may not work for everyone, where it does not work alternative 'triptans', such as almotriptan (Almogran) and favotriptan (Migard) are worth trying.

Sumtriptan is the drug contained in the branded Imigran tablets. Imigran Recovery tablets are available to buy in the pharmacy and contain sumatriptan 50mg, whereas The Independent Pharmacy Online Doctor is able to prescribe generic Sumatriptan 100mg, a stronger prescription-only migraine treatment for more severe migraines.

Sumtriptan tablets should be taken as soon as possible after the onset of a migraine to help reduce symptoms as soon as possible. You can repeat the dose of 100mg after 2 hours if your migraine has not been relieved.

Sumatriptan 100mg tablets can be taken with painkillers such as paracetamol, ibuprofen or codeine or with antisickness medicines such as Buccastem, to help treat any additional symptoms associated with your migraines.You should not take any other migraine treatments containing 'triptans' whilst you are taking Sumatriptan.

The side effects of sumatriptan can include pain, heaviness, pressure or tightness in the chest, throat or other parts of the body, or unusual sensations, including numbness, tingling and warmth or cold. These effects may be intense but generally pass quickly. Please read the Patient Information Leaflet enclosed with your medicines for a full list of side effects.

Other common side effects include:

  • Feeling sick (nausea) or being sick (vomiting), although this may be due to the migraine itself
  • Tiredness or drowsiness
  • Dizziness, feeling weak, or getting hot flushes
  • Temporary increase in blood pressure
  • Shortness of breath
If you feel pain or tightness in your chest after you use sumatriptan, do not panic, the symptoms may be intense but they usually pass quickly. If they do not pass quickly or they become severe, get medical help immediately. 

If you find that your medicine is effective but you get mild unwanted side effects, you may wish to lower the strength of your treatment to Sumatriptan 50mg tablets to see if they are still effective without the side effects. 

Sumatriptan has been widely used for many years and is generally considered a safe drug.

Sumatriptan (Imigran) can cause a temporary narrowing of blood vessels. People who have had strokes or mini-strokes, have problems with poor circulation, or a history of angina (heart pain on exertion) or a have had heart attacks should not take sumatriptan.

Even in people who have never had circulation problems sumatriptan can in rare situations trigger serious heart problems. The following groups should check with their GP before taking sumatriptan:

  • Heavy smokers
  • Men over 40
  • Women after the menopause

In some rare serious cases migraine headaches are associated with paralysis, loss of vision and loss of speech. Sumatriptan is not to be used in these cases.

  • Before self medicating for headaches it is best to see a GP for a diagnosis
  • When headaches start for the first time over the age of 40
  • When headaches are getting more frequent and lasting longer
  • When headaches are different from before or there are new symptoms

You should not use sumatriptan tablets if:

  • You are allergic to sumatriptan or any of the ingredients
  • You have high blood pressure
  • You have severely reduced liver function
  • You use, or have recently used, ergotamine or similar medicines (e.g. methsergide maleate) or MAO inhibitors (e.g. moclobemide or selegiline).
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Take 50mg (ONE tablet) at onset of symptoms, dose may be repeated after at least 2 hours if migraine symptoms return. Maximum dose is 300mg in 24 hours (six 50mg tablets).

Sumatriptan (Imigran) usually starts to work after 30 minutes. It does not work for everyone. Where it does not work alternative 'triptans' are worth trying.

Sumatriptan should not be taken with other 'triptans' or with medication containing ergotamine.

Sumtriptan (generic Imigran) causes 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 (such as Sumatriptan) 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. Sumatriptan (Imigran) usually starts to work after 30 minutes, therefore it important to take it as soon as possible into a migraine attack. Sumatriptan may not work for everyone, where it does not work alternative 'triptans', such as almotriptan (Almogran) and favotriptan (Migard) are worth trying.

Sumtriptan is the drug contained in the branded Imigran tablets. They are available as the medically equivalent generic Sumatriptan tablets at a significant saving compared to branded Imigran. Sumtriptan 50mg tablets are a prescription-only medicine (POM) that are available to buy from The Independent Pharmacy Online Doctor following a short, free online consultation to ensure they are safe and appropriate for you.

Sumtriptan tablets should be taken as soon as possible after the onset of a migraine to help reduce symptoms as soon as possible. You can repeat the dose of 50mg after 2 hours if your migraine has not been relieved.

Sumatriptan 50mg tablets can be taken with painkillers such as paracetamol, ibuprofen or codeine or with antisickness medicines such as Buccastem, to help treat any additional symptoms associated with your migraines.

The side effects of sumatriptan can include pain, heaviness, pressure or tightness in the chest, throat or other parts of the body, or unusual sensations, including numbness, tingling and warmth or cold. These effects may be intense but generally pass quickly. Please read the Patient Information Leaflet enclosed with your medicines for a full list of side effects.

Other common side effects include:

  • Feeling sick (nausea) or being sick (vomiting), although this may be due to the migraine itself
  • Tiredness or drowsiness
  • Dizziness, feeling weak, or getting hot flushes
  • Temporary increase in blood pressure
  • Shortness of breath
If you feel pain or tightness in your chest after you use sumatriptan, do not panic, the symptoms may be intense but they usually pass quickly. If they do not pass quickly or they become severe, get medical help immediately.

Sumatriptan has been widely used for many years and is generally considered a safe drug.

Sumatriptan (Imigran) can cause a temporary narrowing of blood vessels. People who have had strokes or mini-strokes, have problems with poor circulation, or a history of angina (heart pain on exertion) or a have had heart attacks should not take sumatriptan.

Even in people who have never had circulation problems sumatriptan can in rare situations trigger serious heart problems. The following groups should check with their GP before taking sumatriptan:

  • Heavy smokers
  • Men over 40
  • Women after the menopause

In some rare serious cases migraine headaches are associated with paralysis, loss of vision and loss of speech. Sumatriptan is not to be used in these cases.

  • Before self medicating for headaches it is best to see a GP for a diagnosis
  • When headaches start for the first time over the age of 40
  • When headaches are getting more frequent and lasting longer
  • When headaches are different from before or there are new symptoms

You should not use sumatriptan tablets if:

  • You are allergic to sumatriptan or any of the ingredients
  • You have high blood pressure
  • You have severely reduced liver function
  • You use, or have recently used, ergotamine or similar medicines (e.g. methsergide maleate) or MAO inhibitors (e.g. moclobemide or selegiline).

About Migraine

Migraine Background

The Independent Pharmacy Online Doctor service allows those suffering with migraines to have a private consultation with a doctor and have access to the treatment they need in a safe and convenient manner.

Many people do not have time in their busy lives to see their GP with demanding work, family and social lives. Using The Independent Pharmacy Online Doctor service allows you to get the treatment you require without seeing a doctor in person.

Migraine is a very common condition that involves a severe headache that can also include other symptoms such as nausea, vomiting and sensitivity to light or sound. Migraines normally begin in early adulthood and are more common in women. It is thought they affect around 1 in 5 women and only around 1 in 15 men. Migraines normally gradually improve as people get older, although in some cases they can get worse.

Migraines are very individual with different people experiencing different symptoms with varying impacts on their lifestyle. At the most extreme end migraines can occur several times a week, involve severe pain, sickness and sensitivity to light and/or sound, lasting days at a time. At the other end of the spectrum, migraines may only occur occasionally with months, or even years, between attacks that can be fairly mild and short-lived.

As you can see, migraines can have a massive impact on your quality of life and in some cases can stop you working. It is important that you treat migraines effectively and follow preventative measures to reduce their frequency.

Migraine Causes

Migraines are thought to be caused by abnormal brain activity that affects nerve signals, chemical transmitters and blood vessels within the brain. Although it is not clear what the exact cause of the abnormal activity is, it is thought that your genes may make you more likely to experience a migraine following exposure to a specific trigger factor.

Trigger factors are stimuli that cause the changes in the brain that start a migraine. There are many proposed triggers and each migraine sufferer will have a specific trigger(s) that they are aware of that will bring on a migraine.

Migraine trigger factors can include:

Emotional Triggers: stress, anxiety, tension, shock, depression, and excitement.

Physical Triggers: tiredness, shift work, poor posture, neck or shoulder tension, jet lag, low blood sugar, strenuous exercise.

Dietary Triggers: missed or irregular meals, dehydration, alcohol, tyramine (food additive), caffeine, specific foods such as cheese, chocolate or citrus fruits.

Environmental Triggers: bright lights, flickering lights or screens, smoking, loud noises, changes in humidity or temperature, strong smells, a stuffy atmosphere.

Medicinal Triggers: some sleeping tablets, some oral contraceptive pills, some HRT (hormone replacement therapy).

Hormonal Triggers: some women find that they experience migraines around the time of their period, this is possibly die to low levels of oestrogen around this time.

Migraine Symptoms

Stages of a migraine

To understand the symptoms of a migraine, it is also important to understand the phases of a migraine. They will normally have 4 distinct phases, although some people may not experience all of them. The four distinct phases of a migraine are:

  1. Prodromal phase: generally involves changes in mood, behaviour, energy levels or appetite that occur from a few hours to days before a migraine attack.
  2. Aura phase: the visual stage that occurs closer to the migraine attack, normally 5 minutes to 1 hour before. It usually involves flashes of light or blind spots in the vision.
  3. Headache phase (Migraine attack): the phase that involves the typical migraine symptoms including throbbing headache, sensitivity to light and sound, as well as nausea and vomiting. This can last for anything from a couple of hours to 3 days depending on the severity of symptoms and the treatment used.
  4. Resolution stage: as the symptoms of the headache phase leave you may be left feeling drained or tired for a number of days afterwards.

For some people the first sign that a migraine is about to occur will be the aura phase, which occurs in around one third of sufferers. This visual ‘warning’ stage usually lasts for between 5 minutes and 1 hour and can involve the following symptoms:

  • Flashing lights or patterns
  • Blind spots
  • Tingling and numbness starting in the hand, moving up the arm to the face
  • Dizziness
  • Difficulty speaking

The main symptom of a migraine (during the migraine attack) is a severe headache that occurs on one side or across the front of the head. It can, however, occur across the whole head and even affect the face or neck in some people. The headache experienced with a migraine is normally an intense throbbing that gets worse with movement.

Additional symptoms that may be experienced with a migraine include:

  • Nausea
  • Vomiting
  • Sensitivity to light and sound
  • Sweating
  • Poor concentration
  • Feeling very hot/cold
  • Diarrhoea
  • Stomach pain

Not everyone will experience all of these symptoms and they may vary with each migraine attack. It is possible to experience these additional symptoms without the typical migraine headache on some occasions.

You should seek urgent medical attention if you have any of the following migraine symptoms:

  • Paralysis/weakness of one or both arms or the face
  • Slurred speech
  • A sudden onset headache with agonising pain
  • Fever, stiff neck, confusion, seizures, double vision, and a rash.

Migraine Diagnosis

There is no specific way/test to diagnose migraines. A diagnosis is normally made by your GP; it is based on the pattern and severity of headaches along with occurrence of other associated symptoms. This can take time depending on the frequency, severity and associated symptoms of your migraines.

To aid your diagnosis it is helpful to keep a migraine diary to keep an accurate record of your condition. Your migraine diary should include:

  • Time and date of the migraine attack
  • What you were doing at the time
  • If there were any obvious or potential trigger factors
  • Which migraine stages you experienced
  • What symptoms you experienced
  • Whether you took any medication and if it was effective

Based on the contents of your migraine diary and the symptoms that you experience an accurate diagnosis can be made.

Migraine Treatment

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.

Painkillers

Simple painkillers such as paracetamol, ibuprofen or aspirin, if taken early enough, can help to relieve the throbbing headache associated with a migraine attack. 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.

Take care when using painkillers. Regular use of any painkillers can cause headaches and make migraines worse.

Triptans

If you have been diagnosed with migraines by your GP because they cannot be controlled with simple painkillers, they will prescribe a triptan. Triptans (also known as 5HT1 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 the same 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 it is ineffective and trying another.

When finding 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 there is 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. Nasal sprays or wafer melts may be a better option in cases where tablets are not suitable.

What triptans are available?

Tablets

  • Imigran (sumatriptan) 50mg & 100mg
  • Sumatriptan 50mg & 100mg
  • Almogran (almotriptan) 12.5mg
  • Migard (frovatriptan) 2.5mg

Nasal Sprays

  • Imigran (sumatriptan) 10mg & 20mg

Wafer Melts

  • Maxalt Melt (rizatriptan) 10mg

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 and allow allows it to be absorbed quicker meaning a faster onset of action.

Migraine Prevention

The most important method of migraine prevention is to identify and avoid triggers. By keeping a migraine diary as detailed above in ‘Diagnosis’ you can start to identify triggers and then learn to avoid any that bring on a migraine. Common migraine triggers are listed above in ‘Background’. This list is only the most common triggers, you may find that there are other factors that you are sensitive to; migraine triggers are different from one individual to another.

If you experience more than 5 days of migraines in a month, you may benefit from preventative treatment from your GP. There are many medical treatments for the prevention of migraines, such as topirimate, propranolol and gabapentin, which may be effective if you have frequent, severe migraines. If you think you fall into this category you should book an appointment to discuss preventative migraine treatment with your GP and take a comprehensive migraine diary to aid diagnosis.

*RRP is based on the highest price found for a comparable online service found on 04/09/14.

Migraine Treatment FAQ's

What is the difference between a migraine and a tension headache?

  • A migraine headache is usually an intense, throbbing pain on one, or sometimes both, sides of the head.
  • Most people with a migraine headache feel the pain in the temples or behind one eye or ear, although any part of the head can be involved.
  • Besides pain, migraine also can cause a number of other symptoms. Nausea and vomiting and sensitivity to light and sound can all occur. Some people also may see spots or flashing lights or have a temporary loss of vision
  • Migraine can occur any time of the day, though it often starts in the morning.
  • The pain can last a few hours or up to 72 hours. Some people get migraines once or twice a week whereas others may only suffer once or twice a year. 

A tension headache is usually a mild to moderate pain, it's distracting but not debilitating. It affects both sides of the head and rarely causes sensitivity to light.

 

What are triptans?

Triptans are the newest type of migraine treatment and have been widely available since the early 1990's. They include almotriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan, and are available as various different branded and generic migraine treatments from our Online Doctor.

They work by constricting the widened (dilated) blood vessels in the brain that are thought to occur during a migraine. They may also stabilise the change in activity of some brain chemicals that occurs during a migraine attack.

 

I didn’t get on with my first migraine treatment. Is one triptan better than another?

There is no best migraine treatment that suits everyone. All triptans would probably work well in most people with migraine. However, there is some evidence to suggest that some are slightly more effective than others; but also, that side effects may vary between each different triptan. 

Therefore, if the first triptan you try does not work as well as desired, or causes side effects, it is definitely worth trying a different triptan that may be more suited to you.

 

Can I use a triptan to prevent a migraine attack?

You should take your triptan as you start to feel a slight headache develop and not before this. Triptans are effective at treating a migraine in its early stages and can prevent a full-blown attack, however they are not preventatives and should not be taken before a migraine occurs. Triptans are designed to work rapidly - within an hour or so, to treat migraines quickly.

 

If my migraine treatment doesn’t work, should I just try another treatment?

If your first triptan does not work so well, or causes side effects, it is worth trying a different type. In some people, finding the right triptan may mean trying a few different ones.

The British Association for the Study of Headache (BASH) recommends that you try a triptan for three separate migraine attacks before deciding if a change to a different one is needed.

 

What should I do when I feel a migraine starting?

When symptoms begin:

  • If you have a triptan, take it right away.
  • Take painkillers if necessary.
  • Drink fluids, if you don't have nausea during your migraine.
  • Lie down and rest in a dark, quiet room (if that is practical).

 

How is migraine diagnosed?

There are no objective tests for migraine; the diagnosis is on the basis of the history and pattern of symptoms over time. This is why keeping a migraine diary can be helpful.

Things that should be covered in a migraine diary are:

  • How often you have headaches.
  • Where the pain occurs.
  • How long the headaches last.
  • When the headaches happen (such as during your period).
  • Other symptoms that occur (such as nausea or blind spots).
  • Any family history of migraine.
  • Any medicines you are taking, even the over-the-counter medicines & supplements.
  • Any medicines you have taken to treat your symptoms and how effective they were.

 

Is migraine more common in women or men?

Yes, 75% of migraine sufferers are women. There is no known cause for the difference in migraine occurrence between the sexes.
 

I get migraines right before my period. Could they be related to my menstrual cycle? 

Over 50% of migraines in women occur right before, during, or after a woman has her period. This is called “menstrual migraine.” However, only a small percentage of women who have migraine around their period suffer with migraines at this solely at this time of month.

It is still unclear how the menstrual cycle and migraine are linked. It is known that just before the cycle begins, levels of the female hormones, oestrogen and progesterone, go down sharply. This drop in hormones may trigger a migraine, because oestrogen controls chemicals in the brain that affect a woman’s pain sensation.

 

What is the best treatment for nausea and vomiting when you get a migraine?

Nausea causes poor absorption of tablets into your body and many people find it hard to take tablets when they are experiencing nausea.

Prochlorperazine (Buccastem) is an effective and fast-acting anti-sickness treatment. It comes in a buccal tablet form; it dissolves between the gum and cheek, without the need to swallow. This can be useful if you feel sick and do not wish to swallow a tablet. Anti-sickness medicines work best if you take them as soon as possible after symptoms begin.

If you take painkillers, they may remain in your stomach and not work well if you feel sick. You may even bring the tablets back up. Use soluble (dissolvable) painkillers. These are absorbed more quickly from your stomach and are likely to work better. You can take anti-sickness treatment in addition to painkillers. 

 

What is a medicine-induced headache?

Taking painkillers or triptans too often for tension-type headaches or migraine attacks can cause a condition known as medication-induced headache. It is also known as a medication-overuse headache.

It is a common cause of headaches that occur daily, or on most days. About 1 in 50 people develop this problem at some time in their life. If you find that you are getting headaches on most days then you should discuss this with your doctor.  

  

Can changes in blood sugar levels be a trigger for migraines?

Changing blood sugar levels can be a trigger for migraines. To keep blood sugar levels stable try to ensure you:

  • Always eat breakfast - even if it is just a piece of fruit and an oatcake.
  • Aim to eat little (but well balanced) meals often, rather than one or two large meals a day. If you need to eat between meals, snack on healthy foods with low sugar content (nuts and dried fruit, oatcakes and hummus or plain bio yoghurt with nuts and seeds).
  • Mix carbohydrate with protein and/or fat to increase the slow release energy (e.g. wholemeal toast and peanut butter is better than white bread and jam).
  • If you feel like chocolate or biscuits, try a piece of fruit or a handful of nuts and raisins instead.

 

I've heard that if I stop eating chocolate I should be able to control my migraines?

It is a well-known myth that if you avoid chocolate, cheese and red wine, you won't get migraine.  Although these can all be triggers for migraines, there are many different triggers and what may affect one person does not necessarily affect another. 

For most people it is not just one trigger but a combination of factors which can trigger an attack. Read the ‘Migraine Background’ section above for more information on common trigger factors.

 

If I have a parent who suffers with migraines does that mean I will too?

There may be a genetic predisposition to migraine, as it does tend to run in families although not everyone in the family will suffer with them. There are many factors involved in the occurrence of migraines, not all of which are understood. There will usually be a number of factors influencing whether you develop migraines, not just your family history.

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The Independent Pharmacy is an online pharmacy and online doctor service is owned and operated by ABSM Healthcare Ltd (Company Reg. 08515600) and Red Label Medical Ltd (Company Reg. 08676338). All information that appears on this website is intended for information purposes only and should be used to supplement, not replace, your relationship with your local healthcare professionals. You should consult your doctor if you think you may have a health problem or before you start taking a new medicine. Please ensure you always read the information leaflets supplied with any medicinal products.For more information see our policies and terms and conditions at the bottom of every page. © 2014 ABSM Healthcare Ltd. All rights reserved.
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