What does a neurologist take for his migraine?
There is now a large and increasing range of medicines for treating a migraine attack.
Consider this list for which there is pretty sound scientific evidence for using these as migraine treatments:
- Aspirin
- Ibuprofen or tolfenamic acid
- Anti-emetics
- Metoclopramide
- Prochlorperazine
- Buclizine
- Triptans
- Almotriptan
- Eelitriptan
- Frovatriptan
- Naratriptan
- Rizatriptan
- Sumatriptan
- Zolmitriptan
These drugs are from a group that get called NSAIDS (Non-Steroidal Anti-Inflammatory Drugs). They are powerful anti-inflammatory drugs - as most pain is caused by the chemical process of inflammation they are usually used as painkillers.
There is probably not a whole lot to choose between these anti-migraine drugs. Some can be given as injection, nasal spray, a wafer that melts on the tongue or a tablet to swallow.
That’s a long list, so how do you choose which medicine to treat migraine? If your migraine is not that severe, you could easily get away without a triptan (and GPs often worry that these drugs are too expensive to use regularly - which is a fair comment if there are cheaper alternatives). However, there is some evidence that for more severe migraine episodes (one’s that really make you lose out on a days activity as you have had to take to bed), that triptans should be considered.
The final choice of migraine treatment will mostly be determined by any pre-existing medical conditions. For example, heart disease or pregnancy means that triptans are not suitable. Asthma may restrict use of certain NSAIDS.
My own choice (I am originally Scottish so a cheap drug is always preferable), for my own migraine - chew 3 x 300mg aspirin tablets and allow them to be absorbed from the mouth (your cheek and floor mouth can absorb aspirin rapidly). Then wash down the bitter taste with some water. The trials of aspirin suggest that a 50-60% chance of pain relief can be expected. The main reason not to take aspirin is that you have stomach or duodenal ulceration, and if heart burn develops you should stop using aspirin to treat your migraine headache.