A Primer On Headache Medicine

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QUESTION: “I get migraines routinely and I’ve taken Amerge, Imitrex and a new one, Frova. Can you discuss these and tell me which is best?”
–G.N., Gastonia, N.C.

Answer: There isn’t one that is “best.” All of the meds you mention belong to a class of drugs called triptans, which help reduce inflammation and swelling of vessels around the brain. They also increase the transmission of nerve signals. The net effect is less pain. While the mechanism of action may be similar among triptans, each one has different properties, such as the time it takes to begin working, the adverse reactions it causes or its maximum daily dose.

Axert, Relpax, Imitrex, Maxalt and Zomig usually begin working in half an hour to an hour. Frova works for a long time, whereas older triptans (like Imitrex) may only work for a few hours before you need more medicine. Of course, if you are not shy of needles, you could opt for Imitrex injection, which begins working within a few minutes. Bear in mind, these are generalizations and you may react differently.

The side effects for triptans are similar, but the newer ones behave selectively in the brain and therefore spark fewer problems. People who take triptans may experience a variety of side effects, such as nausea, tingling or prickly sensations in the skin (paresthesia), dizziness, drowsiness and a sensation of chest pressure or pain. These drugs can affect the heart and should be avoided, or used with caution, by people with heart conditions.

Triptan dosages vary. For example, 5 mg of Amerge is the maximum daily dose, according to the makers. But for a different chemical entity such as Relpax, that upper limit is 80 mg. Does that mean Amerge is more potent and therefore works faster? Not necessarily. In fact, some people who take Relpax can actually get back to their day in two hours. Medications are potent substances and should never be misused. This is especially true for headache medications. Don’t exceed the maximum dose and don’t combine with alcohol.

Over the years, I have seen many people, obviously suffering incomprehensible pain, refill triptan prescriptions like candy. If this sounds like you, please explore other methods of relief, such as acupuncture, chiropractic or massage. Test for food allergies and hormonal imbalances and consider dietary supplements for migraines. Also, if you experience headaches of a “different” nature — strange neurological or visual disturbances, or other serious symptoms — see your doctor for a complete workup and read my two other articles posted at this website. One of them is called “Mystery Headaches” and the other one is called “Trigeminal Neuralgia.