Abortive medicines (also known as acute medicines) can help alleviate pain once a migraine sufferer experiences the onset of an attack. Unlike preventive medicines, abortive treatments are not taken every day, rather the patient takes them as soon as they feel a migraine coming on.
Abortive medicines vary in nature and primarily work by relieving inflammation, blocking the release of neurotransmitters such as serotonin, and causing selective arterial vasospasm. Let’s take a deeper look into the specific abortive treatments available, how they work, and whether they’re the right option for you.
Once a migraine condition is diagnosed I encourage my patients to treat the pain early and aggressively in order to try to “abort” or stop the cascade of chemical and electrical events that cause all of the debilitating symptoms of migraine.
NSAIDs can be an effective abortive treatment option after the pain from the migraine attack has spread throughout the head and even into the neck and shoulders. When the pain spreads like this it is called central sensitization, and can also be associated with the sensitivity to light, noise, touch, and movement which come at the peak of a migraine.
They work by blocking inflammation in the brain that contributes towards the pain of a migraine attack. Anyone who has had a heart attack will need to discuss NSAID use with their doctor, as some clinical trials have shown an increased risk of heart attack and stroke.
With my patients, I have found that NSAIDs are often the best choice when the migraine has fully developed, as other abortive medication may not be as effective taken after that point. They can also be used to increase the effect of migraine-specific medications and possibly lower the chance of a migraine recurring.
NSAIDs are not habit-forming and can be highly effective. They can be administered in pill form, by injection, dissolved in water, or through a nasal spray. NSAIDs that I prescribe regularly include Ibuprofen, Naproxen, Nabumetone, Diclofenac, and Ketoprofen.
Triptans are another medication that can offer migraine sufferers fast relief once they feel the onslaught of an attack. They work by binding to serotonin receptors in the brain to reduce the swelling of blood vessels, and can be used effectively together with NSAIDs. Triptans also help to relieve other symptoms such as nausea, vomiting, and sensitivity to light and sound.
Triptans come in the form of pills, injections, and a nasal spray. There are several variations of triptan treatment, so it’s important to consult with your doctor which is best for you. For example, if a patient of mine suffers from nausea or vomiting during attacks, I would prescribe an injection over orally-administered treatment. If you feel a triptan is not working, you can consult with your doctor and try another one.
They can however cause side effects, such as dizziness, dry mouth, drowsiness, tightness in your throat, feeling heavy in your face and body, and muscle weakness, amongst others. Triptans may also not be appropriate for people with a history of cardiac conditions or coronary artery disease, so a doctor’s evaluation is important if this is the case.
Fioricet is a combination medication made of acetaminophen (Tylenol’s main ingredient), caffeine, and butalbital (a relaxant), and can be used as an abortive treatment for moderate migraine. It usually comes in capsule form to be taken orally.
A combination of acetaminophen to relieve pain, caffeine to squeeze down blood vessels, and butalbital to cause relaxation and sleepiness, are believed to ease migraine symptoms.
The most common side effects from Fioricet include drowsiness, nausea, vomiting, depression, lightheadedness, and confusion. It is also important to note that it can be a habit-forming treatment, meaning I am less inclined to prescribe it initially to my patients. Additionally, some
Ergotamine works best taken as soon as the patient feels the onset of migraine symptoms, and works by tightening the blood vessels in the brain. It is not considered one of the more effective abortive migraine treatments, as it is not a pain reliever on its own and can come with persistent side effects, including irregular heartbeat, high blood pressure, nausea, and vomiting. There have also been reports of serious side effects that have occured when Ergotamine has been taken with certain medications, including protease inhibitors and macrolide antibiotics.
Ergotamine comes as a tablet that dissolves under the tongue and should be taken at the first sign of a migraine.
Muscle relaxants are sometimes used when migraine headaches persist. The exact mechanism of action of these medications is not understood, but they may be used as an adjunctive treatment to help when patients have migraines.
In my practice I also use prescription anti-nausea medications such as Metoclopramide, Promethazine, and Ondansetron. These medications can help with the severe nausea and vomiting that is associated with migraine. Metoclopramide in particular can help the stomach’s natural movements to begin again.
I always remind patients to keep track of their headaches. Once headaches become more frequent than 4-6 times a month, preventive medicines may be necessary to help acute medicines work better and to stop a pain cycle and rebound headache from starting.
The above blog is for informational purposes only and patients should remain under a doctor’s supervision while trying out different medication options.
For more information on abortive medicines for migraine, book an online consultation with me, Dr. Risa Ravitz, here.