Migraine Headaches – 1st of a Series:
“Five Mís: Modern Mainstream Medication Management of Migraine Headaches Ė And Why It Fails”
Prior to the introduction of a new class of medications in the 1990’s, medical management of migraines was limited to either narcotics (which are addictive) or just not very effective. With the introduction of a class of medications called triptans, migraine headache management was revolutionized.
The more technical name for this class of medications is selective serotonin receptor agonists. Triptans are not pain medications as we traditionally think of them. Traditional pain medications don't end the pain. They simply increase our tolerance to it -- temporarily. Unless the migraine attack has run its course while a pain medication is working, the symptoms will return when the pain medication wears off.Triptans are termed abortive migraine medications. They cannot prevent migraines. They are used to abort a migraine attack in an effort to stop the attack itself and the associated symptoms.
The effect on the blood vessels is considerable in that they seem to tighten up or vasoconstrict arteries. This is consistent with observed vasodilatation or opening up of the arteries during a migraine headache attack.
The potential danger of this class of medications is that someone who has borderline blood flow to the heart or brain, for example in ischemic heart disease, is at risk for a full blown heart attack or stroke if these medications are taken. Most migraine sufferers are younger so this is generally not that great a concern for the vast majority of people with migraine headaches.
With the first medication called Imitrex®, made by Glaxo-Smith-Kline, the triptan revolution swept across migraine headache management. The initial product was an injectible medication and had a quick onset of action. Many people were relieved relatively quickly and thought it was a godsend, despite the steep price.
Imitrex® was also sold under the name Imigran®. It also became available in a tablet and nasal spray forms. Soon after Imitrex came to the market, other drug companies began rolling out their own triptan medications. Imitrex® had been followed by Maxalt®, Zomig®, Amerge®, Avert®, Frova® and Relpax®. All of the other manufacturers made their triptans into a pill form, with Maxalt® and Zomig® having a dissolvable pill.
The various routes of administration are important. For example, the injectible Imitrex® has the fastest onset of action and to this day still provides the greatest amount of relief once the headache strikes. The dissolvable forms are for those people whose nausea is so significant that they are unable to keep down a swallowed pill. The nasal spray is also an option to bypass the stomach.
Side effects to watch for include chest pain, throat pain or abdominal pain. The reason why these pains are important to look for is that they may indicate a reduction in blood supply to the heart or major organs of the body. People with angina pectoris or ischemic heart disease are advised to not take these medications.
Secondary side effects include shortness of breath, wheezing, heart palpitations, facial or eyelid swelling, skin rashes, tingling and flushing, drowsiness, dizziness, dry mouth, muscle pain, feeling tired and sick. The tingling is a particularly common observation.
The good news is that the secondary side effects are not going to kill you. Most people are willing to trade a reduction in the migraine headache attack for a little discomfort.
Another medication that is still commonly used, even though it is not part of the triptan class of medication is called ergotamine, or more precisely, dihydroergotamine (brand names Migranal®, DHE-45®). This medication works to constrict blood vessels, similar in action to the triptans. Side effects are similar with the same warnings to those people with bad hearts.
Preventive or Prophylactic Approach to Migraines
Waiting for the headache to start and subsequent rushing to take a triptan or ergotamine medication is the most common method of migraine headache management in those people who do not experience a high frequency of headaches.
For those who are plagued with frequent headaches, another major approach involving medication is through an attempt of preventive or prophylactic measure to stop the headaches from coming in the first place.
This method has shown to be very disappointing. It barely exceeds results found in placebo methods.
The most common attempt at migraine prevention is the use of beta-blockers. Propranolol (Inderal®) is the most commonly prescribed beta blocker for this purpose.
Anti-depressant medications are also extremely commonly used. The thinking here is that there is some relationship with serotonin levels, which anti-depressants do have some type of effect on. I have never seen anyone with migraine headaches benefit from anti-depressants.
The medical profession, as a rule, is generally pretty quick to prescribe anti-depressants for virtually any condition which they don’t understand. Doctors particularly like to prescribe anti-depressants for women.
Calcium channel blockers like verapimil are occasionally prescribed as a preventative. Verapimil is used primarily to treat high blood pressure and is also used to treat irregular heart rhythms.
If a migraine sufferer also has high blood pressure or an irregular heart rhythm, many doctors will prescribe verapimil to treat all of these conditions at the same time. One drug treats multiple conditions. Otherwise, calcium channels do not tend to be used for migraine treatment.
Rarely, the drug methysergide will be prescribed. There are some pretty scary side effects associated with this drug, and it is nowhere near the top of the list in being prescribed any more.
Finally, in the traditional prevention class, a whole new set of medications that had been used to treat seizure disorders has been tried. Depakote®, Neurontin® and Topamax® are the top three anti-seizure medications now being used for migraine headache prophylaxis.
All three of those medications have potentially significant side effects and are frequently not tolerated by people long-term. Some people do benefit significantly, however.
General Pain Management
Finally, there is the general pain management approach to migraine headaches. This approach is not specific to migraines, but to pain in general.
There are basically two types of pain medications: Non-narcotic and narcotic pain medication.
Non-narcotic pain medications consist of anti-inflammatory medications called NSAIDS. These are the aspirin-like compounds found in prescription strength and over the counter at a local pharmacy. The public is well versed with the brand names like Motrin®, Nuprin® and Aleve®. I will not go into any further detail here. Another major non-narcotic medication, but is technically not an NSAID, is Tylenol®. Again, the public is knowledgeable about this drug.
The narcotic pain medications are the other pain management method to migraine headaches. Vicodin® and Lorcet® are perhaps the most familiar first-line narcotic pain medications. There are tighter prescription controls on doctors for other narcotics like Percodan®, Darvon®, Equigesic®, and Oxycontin®, just to name a few. There are many, many narcotic medications available.
Narcotics are almost never advisable unless there is an emergency room situation whereby this is the initial presentation of a migraine headache or a dramatic worsening compared to past headaches. Some unfortunate sufferers of cluster headaches require narcotics. Many have committed suicide.
Once you go down the road of requiring narcotic pain medications for a medical condition that does not resolve, addiction and tolerance is a near certainly. There are numerous political and legal implications for both the doctor and the patient when this occurs.
Virtually all 50 state boards of medicine that regulate doctors and grant their licenses to practice medicine are taking a strong look at narcotic-prescribing habits of doctors. This is why doctors are extremely reluctant to prescribe narcotics almost under any situation. As a result, many people who require these medications cannot obtain them.
In summary, traditional medical management of migraine headaches is frankly ineffective and burdensome. Only with the advent of triptan medication class just 15 years ago have there been some strides made in this regard.
Unfortunately, the triptans, which are indeed helpful, are only taken AFTER a migraine headache has started. Frequently they don’t help to completely eliminate migraine attack symptoms. It is not unusual for these medications to get “tolerated” and lose their effectiveness in the same person over time.
Switching brands of triptans in order to find the brand that proves to be the most effective one is the rule. Even though they do help, this is still a fairly miserable lifestyle. The waiting for the next migraine headache is always lurking, particularly when noone knows if this next migraine headache is going to respond to the latest triptan drug.
None of the other “traditional” approaches to migraine headache management are effective. Unfortunately, there is essentially no good mainstream preventative drug out there that works. Traditional pain medications with narcotics or NSAIDS are simply ineffective and just not the right way to treat this condition.
Something is clearly missing in this picture. What is needed is a CURE, not a band-aid. If someone can nail down the actual reason why migraine headaches are contracted in the first place and find something to eliminate that condition, then we won’t have to worry about all the other techniques that are aimed at combating the outbreaks.
Sure enough, if we found something that simply eliminates the cause of migraine headaches to begin with then we should definitely apply that knowledge. Almost quite by accident, I have discovered in my practice an association between migraine headaches and the relative deficiencies of certain sex hormones.
Replacing the deficient hormones and satisfying the deficit has led to a complete resolution and cure of the migraine headaches in patient after patient. Admittedly, we don’t necessarily understand the exact biochemical mechanism as to why and how exactly do migraines result from a hormone deficiency.
But achieving complete cure in 80% of the times, my patients don’t seem to mind the fact that we don’t have all of the answers. They are pain-free and completely cured and are quite happy in that knowledge. What this information offers is a path to complete cure to your migraine headaches and even cluster headaches. It is simple, natural, safe and very inexpensive with zero side effects.
The information contained is known to all doctors, because they learned it in their first year of medical school – and most have since forgotten it. Doctors (and I was part of that mindset for many years) are trained to prescribe drugs. That is what they do and all they know. Thanks to the US patent laws, these drugs are never natural or bio-identical. They are all chemical compounds, foreign to the body and fraught with side effects.
A Better Method
There is another option – a migraine cure. Cure the migraine and put your expensive and dangerous prescriptions away and get on the road to the new life – free of pain, suffering and missed time and opportunities! Read the articles or just order my e-book today and get a new lease on life – free of migraines! You will be glad you did.
Recent reports indicate migraine headaches can indeed be totally abolished – as a number of elite medical clinics catering to women have testified. Under their treatment protocols, migraines are completely eliminated in 80% of their patients.
These successes are limited to women only, as addressing a women’s hormones is the basis of the cure. Some clinics have published their treatment protocols and even made them available to the public.
The Women’s Health Institute of Texas believes that a migraine cure certainly eliminates the migraine auras altogether - and concern over the ensuing migraine headache may no longer be necessary – at least in women.
About the Author: Dr. Andrew P. Jones, M.D. is the Medical Director for the Women’s Health Institute of Texas. He is Board Certified by the American Board of Internal Medicine and by the American Academy of Biologically Identical Hormone Therapy.
His medical experience primarily revolves around the relationship of women’s health issues and bio-identical hormone management of PMS, menopause and migraine headaches.
Find out more about Dr. Jones and the cure for migraine headaches
• migraine headaches
• migraine headache
• migraine headache relief
• migraine relief
• headache treatment cure
• women's health
• birth control pills
• oral contraceptives
• Dr. Andrew Jones
• Andrew Jones M.D.
• Andrew Jones
• Women's Health Institute of Texas
• Women's Health Institute
View next migraine headache article to understand more... Article No. 2