By: Paul Winner, DO, FAHS
When you have the right medicine available to you that can stop your headaches with full control of your symptoms within one to two hours, then you should be able to stop worrying about your next headache.
Today, this is possible for most of us.
First, how to identify the medicine that works the best for you? Generally, migraine specific medication, like one of the triptans, will turn out to be the right first choice for the first line medication (the first medication you take at the first sign of a migraine).
Second, what is the best way to take your medication, by mouth, either standard tablet or a melt tablet, nasal or subcutaneous (under the skin) so you will get the relief you need? Subcutaneous (under the skin) comes in either needle or needleless technology today. This is the quickest way to get rid of your migraine symptoms. This often proves to be an excellent choice if you wake up with a severe headache, or if you experience severe nausea or vomiting early in your headache.
Using a nasal spray can result in a similar, but often slightly slower response to the relief of your migraine symptoms then the subcutaneous route. Clearly most of us prefer taking our medication in tablet form, and this will often work very well provided your headache has a gradual onset. It will often work better if you take your pill early in the onset of your migraine (when the pain is mild and the symptoms are just beginning). The choice of the way you take your medicine can be just as important as the which specific medicine you take. Generally, if you want the fastest and most complete relief of your headache, whether you wake up with it or it occurs during the day, then use the subcutaneous injection (either needleless or with a needle). Your expectation is very important. Today, we can usually give people either complete or close to complete relief in one to two hours. All of us, myself included, who suffer from migraine would like to have meaningful relief in ten to 15 minutes or sooner—this pretty much impossible right now.
You may experience a time when the migraine specific medications do not work completely, or do not work at all. This is actually normal for most people, so you will need to have a backup or rescue medication(s). The most commonly used are non-steroidal, over-the-counter medicines like ibuprofen or naproxen, or sometimes salicylates (aspirin), may be beneficial.
Prescription non-steroidal medicines often last longer and sometimes are more powerful depending on the dosage. If you are experiencing severe nausea or already have vomited then other options have to be considered. Ideally you want to have an anti-nausea medicine available so you can take it before the nausea gets severe. There are many oral, anti-nausea medications (anti-emetics) available that you can review with your physician.
When you are able to set up this method of treatment with your doctor, then you will be able to control your migraines and your worry over the next migraine attack will either evaporate away or diminish dramatically—because you’re in control. The key is to work with your doctor, and learn how to control your migraines. Don’t let the migraines control you.
Paul Winner, DO, FAAN, FAHS
Director: Palm Beach Headache Center
Clinical Professor of Neurology
Nova Southeastern University
West Palm Beach, FL