Migraine: The Future of Migraine Therapy (cont.)

"It's called 'central sensitization,' and it tends to perpetuate the headache," explains Seymour Solomon, MD, director of the Montefiore Headache Unit at Albert Einstein College of Medicine in the Bronx, N.Y. At that point, the chain-reaction of pain begins traveling along nerve pathways throughout the head, to the base of the neck and to the spine.

That's when everything starts hurting, Solomon tells WebMD. The pain-nerve cells are stuck in the "on" position. The slightest touch or movement hurts. Even the pulse of blood in your brain causes pain. Your intestinal system gets thrown out of whack, too, by the onset of nerve chemicals. You feel nauseous, you throw up, you get diarrhea. Your hands and feet grow cold. The color drains from your face.

There's nothing pretty about having a migraine.

Not everyone has this threshold or central sensitization effect, researchers say. Luckily, these patients can take existing painkillers such as Motrin, Advil, Excedrin, or certain prescription pain drugs. These are nearly 100% effective in kicking their headaches, says Solomon.

But most people with migraines need more effective drugs. They must take them before the headache lasts an hour. After that, some relief will come, but usually not enough.

Too many people ignore those very early symptoms, Solomon tells WebMD. "These people get lots of headaches, which are often tension headaches, and they hope against hope that this one isn't a migraine. So by the time the window is past, it's too late to stop it."

In the early days of migraine research, a class of drugs called ergots (short for ergotamines, such as dihydroergotamine or DHE) was aimed at stopping migraine pain in progress. Then came the triptan drugs, which were even more effective at halting pain. They include:

Both ergot and triptan drugs are still prescribed today, Solomon says. However, because both drugs work to constrict swollen blood vessels, not all patients can take them. "If a patient has heart disease or high blood pressure, they just can't take those drugs," he tells WebMD.

Preventing Migraines in the First Place

More recently, to try to stop migraine headaches from developing at all, doctors have prescribed drugs used to treat other disorders. These drugs are taken daily to suppress the brain chemical or blood vessel activity that leads to migraines. The hope is to prevent a migraine from getting started. These drugs include:

  • Antiseizure drugs such as Topamax and Depakote, used to treat epilepsy
  • Beta-blockers such as Inderal, used to treat high blood pressure and abnormal heart rate
  • Calcium channel blockers such as Cardizem, also prescribed for high blood pressure and abnormal heart rhythms (arrhythmias)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), over-the-counter painkillers such as Aleve and Anaprox
  • Tricyclic antidepressants such as Elavil and Norpramin