Migraine is a very common, serious and debilitating condition, the cause of which is not yet very clear.
What is migraine?
Migraine is an attack consisting of initial visual disturbance (the aura) which may be absent too, severe thrombing unilateral(one sided) pulsatile headache often with photophobia, nausea and vomiting.
Main reason is inflammation and dilatation of blood vessels in brain. Latest theory states that migraine is caused due to release of calcitonin gene related peptide (CGRP) where Calcitonin is an hormone released from thyroid gland.
Medicines for Acute(sudden) attack of migraine
1. Mild attack of migraine
If the headache is not too severe, you can take paracetamol (acetaminophen).
2. Moderate attack
For moderate acute attack of migraine, NSAIDs( Non steroidal anti inflammatory drugs) are used. They provide symptomatic relief but should not be taken on a long term basis, e.g. Aspirin, ibuprofen, diclofenac, etc.
Anti emetic drugs : They are used to treat vomiting associated with the attack. It includes metoclopramide, promerhazine, etc.
Severe Attack of Migraine
The medicine of choice for severe attack of migraine are Triptans.
Triptans are serotonin receptors stimulators, they causes vasoconstriction of blood vessels and inhibit CGRP release that inhibit inflammation.
Medicines included are Sumatriptan, Naratriptan, Rizatriptan, Eletriptan, Zolmitriptan, Frovatriptan.
These medicines also decrease vomiting associated with migraine.
Another class of medicines are Ergotamines. They are also serotonin receptors stimulators. But they increase the vomiting.
Never give Ergotamines and Triptans together because they can cause coronary artery spasm.
Prophylaxis of Migraine
Prophylactic treatment may be required if migraine headache occurs two or more times in a month or if there is significant functional impairment during the attack.
Medicines used are
1. Anti Depressants - Imipramine, Amitriptyline
2. Anti Epileptics - Valproate, Topiramate
3. Beta blockers - Propanolol, Timolol, Metoprolol
4. Calcium channel blockers - Veramapil, Flunarizine, etc.
New Drugs for treatment of Migraine
Lasmiditan : For acute attack of migraine
Olcegepant, Rimegepant : For acute attack of migraine
Erenumab, Galcanezumab : For prophylaxis of Migraine.
P.S. : Please consult a medical professional before taking any medication.
Thank You.