Chronic Migraine Relief Meds: Your Options

For chronic migraine, your doctor may prescribe you a daily medication. CGRP inhibitors came along in 2018 and have shown extremely promising results. They work by sending antibodies to target a specific kind of protein (CGRP) that’s known to cause migraines.

There are two types of CGRPs— monoclonal antibodies and CGRP receptor antagonists. Monoclonal antibodies treatment options include:

• erenumab (Aimovig)
• eptinezumab-jjmr (Vyepti)
• fremanezumab-vfrm (Ajovy)
• galcanezumab (Emgality)

Vyepti is administered through an IV by a medical professional at a treatment facility. The other drugs are injectables you can administer by yourself, or with the help of a loved one. All of these treatments are taken once a month.

Typically, the side effects are mild and include irritation from the injection site and constipation.

For CGRP receptor antagonist, your doctor has these options:

• ubrogepant (Ubrelvy)
• rimegepant sulfate (Nurtec ODT)

These antagonists are taken orally to reduce pain from an acute migraine. They help prevent attacks from worsening and can also help manage painful symptoms when they do. These medications might increase your risk of liver damage and the dose may be adjusted if you have liver or kidney disease.

These migraine medications are groundbreaking and show a great deal of promise, but they don’t work for everyone. Migraine (and chronic pain in general) affects every person differently. Science has yet to find one surefire way to stop the pain.

Still, there are other options. Before CGRP medication came around, a range of antidepressants, beta-blockers, and anticonvulsants were used to treat migraine.

A daily dose of tricyclic antidepressants are found to be most effective in preventing migraines. This is most likely due to the higher levels of serotonin the pills help promote.

But these antidepressants can come with a range of side effects like weight gain, confusion, seizure, painful urination, pounding heartbeats, lightheadedness, and severe constipation. While used commonly for migraines they are not FDA approved at this time.

Beta-blockers are medicines used to help lower blood pressure and for heart disease. When taken for chronic migraine, they help to reduce the frequency and severity of attacks by relaxing your blood vessels and reducing stress on your heart.

Propranolol, a beta-blocker for migraine taken daily, was shown to reduce chronic migraine by 50 percent in controlled studies. Unfortunately, side effects can include sexual performance issues, nausea, and insomnia.

Anticonvulsants are medicines used to treat epilepsy and other conditions. For people with migraine, they help reduce the frequency and severity of attacks by literally calming your nerves.

Valproate and topiramate target multiple molecular sites in the brain and decrease abnormal brain activity, thereby reducing the chance of migraine. Side effects include fatigue, dizziness, hair loss, tremors, weight gain, nausea, and in rare cases liver failure.

Doctors have been prescribing Botox to treat migraines since 2010. A 2013 study concluded that this type of treatment for migraine can reducemonthly attacks by50 percent. However, this type of therapy might cause some adverse side effects.

A shot once every three months into the head and neck muscles can reduce migraine frequency.

If your doctor doesn’t think you need to take a preventive medication, they might prescribe an acute treatment to dull the pain after it starts. Triptans are acommon drugs for migraine pain.

Taken at the first symptom of a migraine, triptans stimulate serotonin and stop the pain. The side effects are usually mild, but if you have a high risk of stroke, heart disease, liver issues, or high blood pressure, triptans may not be an option.

If you’re looking for something to help alleviate migraine pain in addition to preventive treatment, you might want to consider cognitive behavioral therapy (CBT) or biofeedback. Both therapies help you learn your stress triggers and how to control your response.

Since stress is such a big factor in migraines, learning to control you react to stress might help you avoid future migraine attacks

CBT and Biofeedback and similar exercises are great for people who don’t respond to medications (or experience severe side effects). Plus, it’s a helpful technique to lower your general stress and anxiety.

Even with preventative medication, you might still get a migraine. So, what do you do once the pain starts?

At the first symptom, a plain old ibuprofen (or any NSAID) can help the pain, especially if the migraine is mild. After you take your medication, try to lay down in a cool, quiet, and dark room. You may need to lie down for 30 minutes to a few hours, depending on the pain level and how effective over-the-counter treatments are for you.

A cold compress may help relieve pain and a hot towel could help relax the muscles in the head and neck. The cold of a compress acts as a light pain killer. Gently place the compress on your forehead and keep it there until the pain is gone or it’s no longer cold.

Conversely, a hot towel helps the muscles relax which can increase blood flow and relieve pain. Place the towel where you feel the most tension, either on the neck, shoulder, jaw, or all three! You may feel some relaxation right away but give yourself at least 15 minutes to let the muscles release.

A migraine is not a time to bust through your to-do list. Take the time to try to relax, breathe, and remember that the pain won’t last forever.

Migraine is a chronic condition, but medication can help prevent future attacks and manage pain when those stubborn headaches do start.

There are many available migraine treatments these days. If you’re unhappy with your current medication, make an appointment with your doctor or a migraine specialist. They’ll help you find the treatment that works for you.