Acute treatment - what should I chose?
Primary choice - over the counter medicine
What should I be aware of if I take OTC?
Specific migraine medicine, triptanes
What should I be aware of if taking triptans?
List of fillers, colours and tasts in triptanes
London treatment
Ergotamine
Medicineinduced migraine
Acupuncture, biofeedback, botox and other treatments
Primary choice is OTC
Many migraineurs begin treatment with pain-relieving non-prescription medications. It is also the treatment that doctors offer, if you only have a few attacks, and the pain killers have a satisfactory effect.Analgesic OTC drugs are for example Aspirin, Ibuprofen and Paracetamol. There are several preparations of each of these on the Danish market. Preparations are available as tablets, effervescent tablets and suppositories. Suppositories may be a good choice if you have a tendency to nausea and vomiting during attacks. To top
What to be aware of if taking over the counter drugs?
Non-prescription drugs are available at the pharmacy and in many other stores. That does not mean that there is no adverse effects of these medicines. Migraineurs tend to take large amounts of non-prescription medication - either many tablets at once, or tablets almost every day. Both can produce unwanted effects. Aspirin has a tendency to cause stomach problems if the medication is taken in large quantities on an empty stomach. Paracetamol should never be taken in larger amounts than those prescribed in the leaflet as a single large doses causes permanent liver damage. Finally, the effects on the kidneys tend to accumulate - ie. effect adds up throughout life. Starting kidney damage may appear after around 3 kg active ingredient, equivalent to 2 tablets a day for 10 years. To top
Specific seizure medications, triptans
Triptans are a relatively new type of medication. The first came on the market in 1992. Now there are 7 different types in this group of drugs, and they are available as tablets, nasal sprays, suppositories and injections.| Triptan | Contains a sulpha group | Available as | Tablets will be effective within (hours) | Half life in the body (hours; small numbers mean that the chemical is out of the body most quickly) |
| Almogran Almotriptan |
Yes | Tablets | 1,5-2 | 3,2 - 3,7 |
| Imigran og Sumatriptan* Sumatriptan |
Yes | Injection Suppositories Nasal spray Tablet dispergibel tablet |
2-3 | 2 |
| Maxalt Rizatriptan |
No | Tablets Smelt tablets |
1-1,5 | 2 - 3 |
| Migard Frovatriptan |
No | Tablets | 1,5-2 | 26 |
| Naragran Naratriptan |
Yes | Tablets | 2-3 | 5 - 8 |
| Relpax Eletriptan |
Yes | Tablets | 1-1,5 | 4,4 |
| Zomig Zolmitriptan |
No | Tablets Smelt tablets |
1,5-2 | 2,5 - 3 |
What to be aware of when taking triptans?
Adverse reactions are primarily 'chest', ie. a feeling it might be a little hard to breathe.
Triptans work by restoring the tension in the blood vessels in the brain, which change diameter during a migraine attack. At the same time they work on the coronary artery that can be contracted so the diameter is 10% smaller than normal.This gives a less opportunity to provide oxygen to the heart, and you find that it is easier to become breathless. This contraction is also the reason why one should not take triptans if you have coronary artery-problems.
You can usually use one triptan dose per day (or two doses) to treat a migraine attack. When the active substance is excreted, you may find that the migraine returns, if the attack has not faded while the triptans worked. Triptans do not eliminate the attack, but lessens our symptoms. To top
Some of the triptans include a sulpha group as part of the active ingredient. The Sulpha group can trigger reactions in migraineurs who are sensitive to sulpha. Sulpha-preparations are used particularly against cystitis.
All the tablets contain fillers. They make the tablet large enough that we can handle it, give it colour so it can be distinguished from other tablets, and can also give the tablets a pleasant taste. It is the producer who selects the chemicals that are included in the tablets, and there is noting stopping the producers from adding substances which may trigger more migraines in particularly sensitive individuals if the Medicines Agency has estimated that the risk-benefit balance is favourable for the entire population.
If you have experience that you get migraines from aspartame (in bold red in the table below), it's probably best to opt out of those triptans, which contain this substance.
There are also a number of fillers in the tablets, which can trigger allergies or food intolerance (marked in red text in the table immediately below). Quantities of fillers in the tablets are small, but if you are particularly sensitive to one or more of the substances, it may be reason to choose a tablet that does not contain any substances you have problems with. To top
| List of fillers, colours and tasts included in the tablets (information fromthe medicines Agency's produktresuméer), October 2007.
The compounds are listed in the same order as they are in the resume. Red marking means that we have found research papers that indicate that allergies may happen. |
|
| Almogran | Mannitol (E 421) Microchrystallic cellulose Povidon Natriumstivelsesglycolat Natriumstearylfumarat Hypromellose Titandioxid (E-171) Macrogol 400 Carnaubawax Hypromellose Propylenglycol Indigocarmin (E-132) |
| Imigran injection | Sodiumchlorid Water for injections |
| Imigran nasal spray | Kaliumdihydrogenphosphat Dinsodiumhydrogenphospat (dry) Sulphuric acid Sodiumhydroxid Water |
| Imigran sprint | Microchrystallic cellulose Calciumhydrogenfosfat, dry Sodiumhydrogencarbonat Croscarmellosenatrium Magnesiumstearat Hypromellose Glyceroltriacetat Titandioxid (E171) in 50 mg tablets also ironoxide (E172) |
| Imigran suppositories | Witepsol W32 (Fat) |
| Maxalt tablets | Lactosemonohydrat Microchrystallic cellulose (E460a) Pregelatineret corn starch Red ironoxid (E 172) Magnesiumstearat (E572) |
| Maxalt smelt | Gelatine Mannitol Glycin Aspartam Pebermynt aroma Maltodextrin |
| Migard | Lactose, dry Microchrystallic cellulose Silica, kolloid, dry Sodiumstarchglycolat (Type A) Magnesiumstearat Hypromellose (E464) Titandioxid (E171) Lactose, vandfri Macrogol 3000 Triacetin |
| Naragran | Cellulose, microkrystallic Lactose Croscarmellosenatrium Magnesiumstearat Methylhydroxypropylcellulose Titandioxid (E171) Triacetin Ironoxid, yellow (E172) Indigotin (E132) |
| Relpax | Microchrystallic cellulose Lactosemonohydrat Croscarmellosenatrium Magnesiumstearat Titandioxid (E171) Hypromellose Lactosemonohydrat Triacetin Sunset Yellow FCF (E 110) |
| Sumatriptan 1A Farma | Ammoniummethacrylat copolymer (type A) Carmellosenatrium Cellulose, microchrystallic Croscarmellosenatrium Lactosemonohydrat Magnesiumstearat Grapefruit aroma** 50 mg tablets also include Ironoxide, red (E172) Ironoxide, yellow (E172) |
| Sumatriptan Actavis | Lactosemonohydrat Croscarmellosenatrium Lactose, vandfri Cellulose, mikrokrystallinsk Magnesiumstearat Mannitol Titandioxid (E 171) Talcum Triacetin |
| Sumatriptan Alternova | Tablet kerne Lactosemonohydrat Mikrokrystallinsk cellulose Croscarmellosenatrium Magnesiumstearat Talcum Silica, kolloid vandfri Filmovertræk 50 mg 100 mg |
| Sumatriptan Arrow | Cellulose, mikrokrystallinsk Croscarmellosenatrium Magnesiumstearat Lactose, vandfri |
| Sumatriptan Aurobindo | Croscarmellosenatrium (E468) Polysorbat 80 (E433) Kalciumhydrogenfosfat, vandfrit (E450) Cellulose, mikrokrystallinsk (E460) Natriumhydrogenkarbonat (E500) Magnesiumstearat (E470b) |
| Sumatriptan Bluefish | Croscarmellosenatrium (E468) Polysorbat 80 (E433) Calciumhydrogenphosphat, vandfri (E450) Cellulose, mikrokrystallinsk (E460) Natriumhydrogencarbonat (E500) Magnesiumstearat (E470b) |
| Sumatriptan BMM Pharma | Tabletkerne Mannitol Croscarmellosenatrium Hydroxypropylmethylcellulose Cellulose, mikrokrystallinsk Magnesiumstearat Tabletovertræk Opaglos® 6000P (Opaglos indeholder shellac, carnaubavoks, gul, bivoks, hvid). |
| Sumatriptan Copyfarm | Lactosemonohydrat Mikrokrystallinsk cellulose Croscarmellosenatrium Magnesiumstearat Jernoxid, rød (E172 i 50 mg tabletter) |
| Sumatriptan GSK | Lactose Mikrokrystallinsk cellulose Croscarmellose Magnesiumstearat Renset vand Methylhydroxypropylcellulose For 50 mg desuden Triacetin Jernoxid (E172) For 100 mg desuden Natriumbenzoat og industriel methyleret sprit Titandioxid (E171) |
| Sumatriptan Hexal | Ammoniummethacrylat copolymer (type A) Carmellosenatrium Cellulose, mikrokrystallinsk Croscarmellosenatrium Lactosemonohydrat Magnesiumstearat Grapefrugtaroma** 50 mg tabletter indeholder også: Jernoxid, rød (E172) Jernoxid, gul (E172) |
| Sumatriptan Merck NM | Lactosemonohydrat Mikrokrystallinsk cellulose Croscarmellose (E468) Magnesiumstearat (E470b) Titandioxid (E171) Polydextrose (E1200) Hypromellose (E484) Glyceryltriacetat (E1518) Macrogol I 50 mg tabletter desuden: Jernoxid rød (E172) og Jernoxid gul (E172). |
| Sumatriptan Ratiopharm | Lactosemonohydrat Mikrokrystallinsk cellulose Croscarmellosenatrium Magnesiumstearat Rød jernoxid (E172) (kun i 50 mg tabletter) |
| Sumatriptan Sandoz | Lactosemonohydrat Mikrokrystallinsk cellulose Croscarmellosenatrium Magnesiumstearat Majsstivelse Opløselig stivelse Mannitol Aspartam Polysorbat 80 Titandioxid (E171) Gul jernoxid (E172) Talcum |
| Sumatriptan Stada | 50 mg tabletter Lactosemonohydrat Mikrokrystallinsk cellulose Croscarmellosenatrium Magnesiumstearat Jernoxid, rød (E172) 100 mg tabletter Lactosemonohydrat Mikrokrystallinsk cellulose Croscarmellosenatrium Magnesiumstearat |
| Sumatriptan Teva | Lactosemonohydrat Croscarmellosenatrium Cellulose, mikrokrystallinsk Kolloid vandfri silica Magnesiumstearat 50 mg tabletter Hypromellose E464 Titandioxid E171 Lactosemonohydrat Macrogol 3000 Glyceroltriacetat Jernoxid rød E172 Jernoxid gul E172 Jernoxid sort E172 100 mg tabletter |
| Zomig tablet | Lactose, vandfri Mikrokrystallinsk cellulose Natriumstivelsesglycollate Magnesiumstearat Hydroxypropylmethylcellulose Macrogol (400 og 8000) Jern oxid (E172): (gul - 2,5 mg tabletter; rød - 5,0 mg tabletter) Titandioxid (E171) |
| Zomig næsespray | Citronsyre*, vandfri Dinatriumphosphat (dihydrat eller dodecadihydrat) Vand, renset |
| Zomig Rapimelt | Aspartam (E 951) Citronsyre*, vandfri Silica, kolloid vandfri Crospovidon Magnesiumstearat Mannitol Cellulose, mikrokrystallinsk Appelsinaroma SN027512 Natriumhydrogencarbonat |
| * Citronsyre anses af nogle migrænikere som migrænefremkaldende
** Grapefrugt-aroma indeholder følgende stoffer: Ascorbinsyre, Butylhydroxyanisol, Grapefruit oil, Gum arabic / Acacia E 414, Lemon oil, Lime oil, Linalyl acetate, Maltodextrin, Menthol, Alpha-Methyl benzylacetate/Sterallyl acetate, Nootkatone og Orange oil (oplysninger fra 1AFarma). |
London Cure
A combination of an antiemetic as a suppository and a painkiller and a relaxant is often described as 'London Cure'. To top
Ergotamine
Before triptans came on the market ergotamine (including Gynergen and Ergo Caffeine) was the preferred strong-acting therapy. These preparations are phased out now as they have a tendency for adverse effects such as poor blood circulation in hands and feet. To top <
Medication-induced migraine
Triptans should not be used preventively. There is a real risk of developing a drug-induced migraine from frequent use of triptans. As a rule of thumb, you can develop drug-induced migraine by taking triptans more than 10 days a month for a few months. Are there breaks for a week or more between episodes, the risk of developing drug induced migraine is less.
Non-prescription drugs taken almost every day may also give you drug-induced migraine. For this type of medication your rule of thumb is that 15 days a month with pain medication can cause drug-induced migraine. However, only those who are predisposed to migraine, will get into this situation.
Medication-induced migraine is a bit unusual - the headache has migraine-like symptoms as well as symptoms that look more like tension headaches.
If you have developed drug-induced migraine you should undergo a detoxification. This can best be implemented in collaboration with a physician. To top
Herbals etc.
There are many herbal preparations on the market. Some have a weak analgesic effect. As a general rule, there is no requirement for clinical testing of herbal remedies, and therefore not as extensive documentation on their efficacy and purity as for the conventional medicines. To top
Acupuncture, biofeedback, botox and other treatments
Acupuncture for migraine has a long history as a potential treatment. There has been a few controlled trials, and around half of the studies show a small effect as a preventive against migraines.
Biofeedback is a technique that can be learned, which makes the sufferer able to control blood pressure in the brain. There are some studies which show that migraineurs who have mastered this technique, to some extent can prevent some attacks.
Botox is injections of botulinum toxin, ie. same substance which gives botulism. The substance paralyzes muscles. Injections of botox gives some migraineurs fewer migraine days for up to 3 months after the injection - ie. the migraine comes back almost simultaneously with the wrinkles. It also seems that Botox works on best migraineurs who have had migraines for a few years.
There are also numerous other offers of alternative treatments which promise that migraine can be improved or removed. It is generally not possible to obtain scientifically based clinical tests to demonstrate this. But there are many tales about a lucky migraineur who has experienced an improvement after the treatments. To top
Updated 9th February 2009.
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