What is a migraine? Why migraine happens. Who gets migraines? Treating migraines.

Stop it in its Tracks

There are two major categories of migraine medication: pain-relieving and preventive. If you have two or more disabling migraine attacks every month, use pain relievers more than twice a week, find that pain killers are losing their effectiveness, have prolonged aura states, and/or experience one-sided numbness or one-sided partial paralysis with migraines, you may be a candidate for preventive therapy. When taken on a regular basis, these medications serve to reduce the severity, frequency, and length of migraine attacks.

Another Benefit

Preventive medications have another benefit: they can increase the effectiveness of drugs that ease the symptoms of migraines. Your doctor may decide you should take preventive medicine every day, or he may decide that you should take them in response to a predictable trigger, for example, at the approach of menstruation. Taking these medications is no guarantee against migraines or a complete reduction of the accompanying pain and some have serious side effects. Always follow your doctor's instructions to the letter when taking these medicines.

Cardiovascular drugs-Beta blockers are drugs that are known more for their use as treatments for high blood pressure and coronary artery disease, but they can also reduce the incidence and severity of migraine attacks. While these medications are often the first choice for preventive migraine treatment, calcium channel blockers, also a class of cardiovascular medication may be useful, in particular verapamil (Calan, Isoptin). Antihypertension medications such as candesartan (Atacand) and lisinopril (Prinivil, Zestril) work well to prevent migraines. The exact mechanism of cardiovascular medications in preventing migraines is not known. Common side effects include dizziness, drowsiness, or lightheadedness.

Antidepressants-Some antidepressants prevent headaches of all kinds, including migraines. The most effective of these drugs are those that are tricyclic, such as amitriptyline, nortriptyline (Pamelor), and protriptyline (Vivactil). These medications stave off migraines by stabilizing levels of serotonin and other brain chemicals, making these antidepressants a choice line of treatment. They may be taken in the absence of depression.

Anti-seizure drugs-While doctors haven't pinned down the exact mechanism, some anti-seizure drugs, for instance divalproex sodium (Depakote) and topiramate (Topamax) help to prevent migraine. These are drugs with a common association for the treatment of epilepsy and bipolar disease.  Another anti-seizure medication, gabapentin (Neurontin), comes in at second place. When taken in high doses, anti-seizure drugs have some nasty side effects, including, cramping, diarrhea, dizziness, hair loss, nausea and vomiting.

Cyproheptadine-This drug is an antihistamine that reduces the production of serotonin and doctors sometimes use it as a preventive measure for pediatric migraine.

Stop Frowning

Botulinum toxin type A (Botox)-There has been a striking phenomenon in which patients treated with Botox injections for their frown lines find their headaches disappear.  It appears the drug may alter the nervous system so as to reduce the incidence of migraine attacks.  Botox is just coming into common use as a preventive treatment for migraine headaches.