Pharmacological Approaches to... Video Transcript

Participants

, Alexander Mauskop MD, FAAN, Mark W. Green MD, Julia Samton MD

Summary

There are two basic types of medications used to treat migraines: drugs to prevent migraines from occurring and drugs to treat the headache once it develops.

Webcast Transcript

ANNOUNCER: There are two basic types of medications used to treat migraines: drugs to prevent the headache from occurring and drugs to treat the headache once it develops.

JULIA SAMTON, MD: The choice to give somebody a preventative medication is based on if they're getting a number of headaches during the month or that their headaches are severe enough that, even if there are just one or two, they might really interfere with somebody's quality of life. So even just one or two migraines a month might really be enough criteria for preventative medication.

MARK W. GREEN, MD: When we put someone on prevention, the idea is that they take this agent every single day to reduce the number of headaches. When you talk about acute therapy, they only use those agents when the headache comes on.

ALEXANDER MAUSKOP, MD: Every patient requires a different approach depending on their type of migraines or type of headaches, the triggers, the associated symptoms and other conditions that they may have. So it's a very individualized approach.

ANNOUNCER: The three classes of drugs most often used for the prevention of migraines are antihypertensives, antidepressants and anticonvulsants.

ALEXANDER MAUSKOP, MD: The first group is blood pressure medications, and you do not have to have high blood pressure to take them, and they are very effective for some patients with specifically migraine headaches. And we have beta-blockers, we have calcium channel blockers, ACE receptor inhibitors. There are several categories within that category.

The second category is antidepressants. Although antidepressants are not FDA-approved for migraine treatment, they're widely used and they're very effective in prevention of headaches.

And the third category is epilepsy drugs, anticonvulsants. They were accidentally discovered to be very effective for migraines. Again, you do not have to suffer from epilepsy to take an epilepsy drug.

ANNOUNCER: Other agents may also be effective for some people in the prevention of migraine attacks.

ALEXANDER MAUSKOP, MD: One of the things we recommend routinely is magnesium supplementation. Another supplement is feverfew; vitamin B-2; riboflavin. I would say magnesium is probably the most effective; feverfew is the second-most effective supplement. Coenzyme Q10, 300 mg, has shown to prevent migraines. A German product, butterbur extract, has been shown to prevent migraines as well.

ANNOUNCER: Although not FDA-approved for migraine treatment, botulinum toxin, known as Botox, has also been shown to be effective.

ALEXANDER MAUSKOP, MD: I've been using Botox off-label for the past ten years and many of my patients who've failed to respond to many drugs have a very good response to Botox, and Botox is injected once every three months.

ANNOUNCER: To treat sufferers for the relief of migraine symptoms attack-aborting drugs are used.

MARK W. GREEN, MD: When we talk about acute treatment, in other words treatment given at the time of an attack, the idea is to stop the attack in its tracks. Now, there are a whole variety of classes. The most commonly used these days are the triptans, which really revolutionized migraine therapy, but we still occasionally use the older ergots. We do use nonsteroidal anti-inflammatories and an assortment of other agents from time to time.

These agents, the principles are the same. You have to use a fairly decent dose, and you have to treat early. The most important principle in treating a migraine is to treat early and recognize the attack, because our real goal of treatment is to have the attack completely go away.