ABORTIVE MIGRAINE MEDICATION
Abortive medications include over-the-counter medications and prescriptions. Keep in mind that when experiencing a migraine, the sooner you take an abortive medication the better your chances of a positive result. The majority of time, the longer a migraine lasts, the less responsive it is to abortive medication.
Since there are so many options we've included a summary of the process for choosing the most appropriate medication:
It's also extremely important to consider that taking these medications more than twice a week greatly increases the risk of rebound headaches. Too much caffeine can also trigger rebound headaches. This is why we focus on nonpharmacologic / alternative treatments at Om.
PREVENTATIVE MIGRAINE MEDICATION
Although there are many preventative medications available, only four orally ingested preventatives have shown consistent evidence demonstrating an ability to reduce migraine frequency: topiramate, valproic acid, propranolol and amitriptyline. These must be taken daily, and that's a serious decision.
Since valproic acid, propranolol and amitriptyline have not demonstrated superior clinical results to topiramate, we've focused on the latter (and you can always email us with any questions: email@example.com).
Topiramate (brand name Topamax) for Migraines
In a 2009 study published in Headache, 306 patients with chronic migraines (more than 15 headache days per month) were randomly assigned to receive either 100 milligrams of topiramate daily or a placebo pill. When the study was over, those who had received topiramate on average had 5.8 fewer headache days per month than they were having prior to the study. However patients who received the placebo, a sugar pill, had 4.7 fewer headaches per month: so taking topiramate daily resulted in 1 fewer headache day per month as compared to a sugar pill.
In the world of migraine prevention this result is actually considered a huge success. But we at Om don't find these results to be particularly exciting, especially considering all the common side effects of topiramate, such as tingling and numbness, dizziness, nausea, loss of appetite (a major issue since skipping meals is a common migraine trigger), sleepiness, mood-swings, changes in taste, and even problems with concentration and memory.
Topiramate versus Exercise for Migraines
In a 2011 study researchers compared an exercise program with topiramate. 31 migraineurs received topiramate and 30 migraineurs who were not exercising regularly were required to work out for 40 minutes per week (15 minute warmup, 20 minutes on the bike, and a 5 minute cool down).
During the three months of the study those receiving topiramate had a reduction of 0.97 migraines per month - and those who exercised experienced a reduction of 0.93 migraines per month. So both treatments reduced migraines by just under 1 per month. Exercise, however, did not induce any adverse side-effects.
What we hear from Migraineurs
In our experience at Om - connecting with hundreds of migraineurs around the world through surveys and sharing experiences - the feedback on preventative migraine medications has been that they sometimes work initially, but over time their effectiveness tends to diminish, leaving you with the difficult decision of increasing the dosage, stopping the medication, or switching to a new medication.
We have heard from migraineurs that antidepressants can work as a preventative, which is an intriguing alternative since depression and anxiety are common migraine triggers. However, clinical trials have not demonstrated a significant positive result when comparing antidepressants with an active placebo.
Botox for Migraines
Unlike prescription medications, Botox is a preventative that is injected into the muscle of the forehead, neck and shoulders. Botox was originally developed as a therapy for neurological disorders that caused involuntary and disabling muscle spasms. In 2010 it was approved by the FDA for use in adult patients with chronic migraine, defined as having 15 or more headache days per month. Botox has not been shown to be effective for any other headache type yet (such as episodic migraine, tension-type headache, or cluster headache).
The results that BOTOX® advertises indicate that the treatment prevents up to 9 headache days a month, versus up to 7 days for the placebo.
Botox has shown to be more effective than orally ingested prescription medications and side effects tend to be less severe, although they can include problems swallowing, speaking or breathing, and the spread of toxins from the injections, which can result in loss of strength and overall muscle weakness, blurred vision, drooping eyelids, and trouble speaking. Furthermore, we have not identified any studies that address possible side effects of pro-longed Botox.
Botox has shown to be a viable treatment for patients unable to implement Alternative treatments such as dietary and lifestyle changes, or to help with severe situations as the patient eases into a dietary and Alternative treatment plan.
Why Om? Why Alternative Treatments for Migraines?
Considering the side effects that result from abortive medication (rebound headaches) and preventative medication (numbness, dizziness, cognitive impairment, etc.), we at Om recommend dietary / Alternative treatments as the core treatment option for reducing migraine frequency and severity.