Aspirin, Ibuprofen (Advil®, Motrin®), and Naproxen
sodium (Aleve®)
Aspirin, ibuprofen and naproxen sodium are grouped
together in the current guidelines. They are only considered appropriate for the pain of mild or moderate
migraine attacks. If you have a severe attack or a sensitive
stomach, you should avoid them.
Since the original guidelines were published, most of
these medications have been studied and shown to be
effective for patients with migraine. The important points
to remember about them are:
• They are all better than placebo (sugar pill) for pain
• Ibuprofen seems to be better than aspirin or
acetaminophen
Some patients say these drugs help with nausea, light
sensitivity, and returning them to work. Remember that
the safety precaution for sensitive stomachs still applies.
Since those guidelines were published, newer research
has confirmed the efficacy and relative safety of the oral
triptans.
Acetaminophen, Aspirin, Caffeine (Excedrin®)
A drug which combines aspirin and acetaminophen
with caffeine is used to relieve migraine attacks. In the
current guidelines, this combination is preferred over
aspirin or acetaminophen alone for mild or moderate
migraine attacks. However, newer studies suggest that this
guideline may change in the future. The combination of
acetaminophen, aspirin, and caffeine is not only highly
effective at relieving even the worst migraine pain, but
it also helps relieve your nausea and sensitivity to light
and sound, allowing you to return to your regular daily
activities, such as work or school. This combination drug
also appears to work better than two tablets of ibuprofen.
Two newer triptan drugs are now available. The first,
Treximet®, combines sumatriptan with naproxen sodium
to provide relief for some migraine patients. The second,
Zecuity®, is a patch that contains sumatriptan and can be
applied to the skin–similar to nicotine patches. If your
attacks or your medications sometimes make you nauseated, ask your doctor about the new sumatriptan patch.
Two migraine-specific medications that use the same
active ingredient, dihydroergotamine, are currently
recommended for moderate or severe attacks: injectable
DHE-45® and the nasal spray, Migranal®. Both of these
medications are effective for migraine, but many patients
complain of nausea after taking them.
Migraine-specific medications
Some drugs are created specifically to work on
migraine attacks. Examples of migraine-specific drugs
include the triptans and dihydroergotamine (DHE-45®).
The triptans (Table 1) are a group of drugs used for the
treatment of migraine that are available by prescription
only. In the current guidelines, doctors are told to use
triptans as the first drug for:
• Attacks that are moderate or severe
• Patients whose headaches respond poorly to
aspirin, ibuprofen, or a combination drug containing acetaminophen, aspirin, and caffeine
Opioids
Opioids are medications that relieve pain by reducing
the intensity of pain signals reaching the brain. They
also reduce pain by affecting the parts of the brain that
control emotion. Sometimes, opioids are combined with
another pain reliever, such as aspirin or acetaminophen .
Several examples of opioids are listed in Table 2.
Table 1 Examples of Triptan Medications
TRIPTANS
Chemical name Brand name
Forms Available
Sumatriptan
Imitrex®, Zecuity® Oral, nasal, injectable,
transdermal
Rizatriptan
Maxalt®
Oral
Naratriptan
Amerge®
Oral
Zolmitriptan
Zomig®
Oral, nasal
Eletriptan
Relpax®
Oral
Almotriptan
Axert®
Oral
Frovatriptan
Frova®
Oral
*May be