The Migraine Triad

Migraine is a neurological disorder of brain function whose roots are genetic. This disorder is easily diagnosed but is complicated and sometimes tedious to manage.There are plenty of medications to treat Migraine and there are more being developed and tested specifically for the acute treatment of Migraine. This page aims to explain how I was taught to approach the medication management of Migraine.

Treatment Triad Navigator

Preventative Therapies

Migraine Preventative Therapies are typically prescribed after a patient has had 4 or more attacks in a month. Depending one the therapy the dose could be administered as infrequently a once a month or as frequently twice daily. Some examples of Preventative Therapies include:

Type of MedicationsMedication ClassGeneric NameSide Effects
Calcitonin Gene-Related Peptide (CGRP) Receptor InhibitorErenumabInjection site reaction
constapation
Serotonin antagonistsMethysergide
Methylergonovine
Blood vessel spasm
Abdominal scarring (very rare)
Blood pressure medicationsBeta-BlockersAtenolol
Metoprolol
Nadolol
Propranolol
Timolol
Fatigue
Depression
Nausea
Insomnia
Dizziness
Calcium channel blockersVerapamil
Diltiazem
Nimodipine
Weight gain
Constipation
Dizziness
Low blood pressure
AntidepressantsTricyclic antidepressantsAmitriptyline
Nortriptyline
Imipramine
Weight gain
Dry mouth
Sedation
Decreased libido (sex drive)
Selective Serotonin Reuptake Inhibitors (SSRI/SSNRI)Fluoxetine
Paroxetine
Sertraline
Weight gain or loss
Decreased libido
AnticonvulsantsDivalproex sodium
Gabapentin
Topiramate
Weight gain or loss
Sedation
Skin rash
Serotonin antagonistsMethysergide
Methylergonovine
Blood vessel spasm
Abdominal scarring (very rare)

Abortive Therapies

Abortive therapies for migraine are typically prescribed after a patient has tried Over The Counter rememdies for the headache. The treatment is uaully administered at the onset of an attack. Dependent on different health factors the doctor may write the prescription such the patient can repeat a dosage some given amount of time after the first.

Type of MedicationsMedication ClassGeneric NameSide Effects
TriptanAlatriptan
Avitriptan
Donitriptan
Eletriptan
Frovatriptan
Naratriptan
Sumatriptan
Zulmatriptan
Tingling of the skin

Burning or prickly feeling
Numbness
Dizziness
Dry mouth
Headache
Nausea
Sleepiness

Rescue Therapies

Abortive therapies for migraine are typically prescribed after a patient has tried Over The Counter rememdies for the headache. The treatment is uaully administered at the onset of an attack. Dependent on different health factors the doctor may write the prescription such the patient can repeat a dosage some given amount of time after the first.

Type of MedicationsMedication ClassGeneric NameSide Effects
Non Steroidal Anti-Inflamatory Drugs (NSAID)Asprin
Ibuprofen
Ketorolac
Naproxen
Nausea
Vommiting
Diarrhea
Constipation
Decreased Appetite
Rash
Dizziness
Headache*
Drowsiness
Antiemetics/Anti-NauseaBismuth subsalicylate
Dimenhydrinate
Emetrol
Meclizine hydrochloride
Ondansetron
Arrhythmia

* “Regular intake of one or more non-steroidal anti-inflammatory drugs (NSAIDs)1 (other than acetylsalicylic acid) on ≥15 days/month for >3 months” (ICHD-3, 8.2.3.2)

What is the Treatment Triad

Your doctor may prescribe some combination of drugs from each of these groups but at minimum there may be one of each. An example of a therapy plan would be a beta blocker as preventative, triptan as an abortive, and an NSAID as a rescue.

It is common to have abortive medications and rescue medications to be considered the same. This isn’t the case, the recuse medication group are meant to augment the prescribed abortive.

Your doctor may prescribe some combination of drugs from each of these groups but at minimum there may be one of each. An example of a therapy plan would be a beta blocker as preventative, triptan as an abortive, and an NSAID as a rescue.

It is common to have abortive medications and rescue medications to be considered the same. This isn’t the case, the recuse medication group are meant to augment the prescribed abortive.

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