Migraine Medicines and Drugs

Dihydroergotamine Mesylate (Dihydergot, DHE 45)

This can be used by the intramuscular or intravenous route. Its effect is less pronounced than ergotamine. Only a small percentage of persons respond to this drug. The adverse effects and precautions for dihydroergotamine are the same as those for ergotamine.

Triptans (Sumatriptian, Sumitrex, Migratan, 50 mg, 100 mg tablet; 60 mg/5 ml amp.)

These are newer drugs and are very effective in acute migraine. These are better tolerated than ergotamine. About three-fourths of the patients get complete relief within 2 to 3 hours. However, in some cases the pain may recur in 24 hours, due to short duration of action of the drug. Sumatriptan constricts dilated blood vessels and reduces swelling and inflammation which causes pain. Usual dose is 50 to 100 mg orally at the onset of pain and repeated after 24 hours. It can be used by subcutaneous injection (3 to 6 mg). This injection is painful.

Adverse Effects and Precautions

Tightness of head and chest, abnormal sensations (paraesthesia) in arms and legs, weakness and dizziness are common short lasting adverse effects. Serious effects are slow pulse (bradycardia) and precipitation of heart attack (acute myocardial infarction). In rare cases it may cause sudden death. Some cases of fits and drug allergy have also reported. Therefore, it should never be taken by patients suffering from heart disease (coronary artery disease), epilepsy and high blood pressure. Other contraindication are pregnancy, liver and kidney diseases. It is never combined with ergotamine.

Drugs for Prevention of Future Attacks

Preventive treatment is needed if the attacks occur more than twice or thrice a month . Before starting this kind of treatment one must try to avoid or treat the above-mentioned precipitating factors. In most cases, it occurs unpredictably or develops in relation to such provoking factors as the work situation, which cannot be avoided or modified. The drugs for the prevention of attacks of migraine are described in the order in which they might be useful for this purpose.

Beta-Adrenergic Receptor Blockers

Propranolol (Inderal, Betaspan)

This is moderately effective in preventing attacks of migraine and remains the most commonly used drug in this condition. In the beginning low doses of 20 mg are given 2 to 3 times daily; these are increased every 2 to 3 weeks until either the migraine attacks become significantly less frequent and/or dose of 160 mg/day is reached.

Adverse Effects: It may decrease the working capacity of the heart, specialiy if large doses are used. In asthmatic patients it aggravates the disease. Some patients experience a feeling of weakness or lassitude and leg pains.

Precautions

It should be used with great caution if the heart is weak.

It should not be used in patients suffering from asthma or related lung disease like bronchitis and emphysema (enlargement of the air sacs of the lungs, causing breathlessness).

Diabetes patients should get their blood sugar checked regularly while taking this drug.

It should never be stopped abruptly as it may precipitate a heart attack. Always consult a doctor if you want to stop this drug.

Do not increase the dose if a feeling of weakness or lassitude develops.

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