Ask Your Pharmacist

August 30, 2019
Q:

I get migraine headaches once or twice a month especially in the summer heat. Prescription pills usually work, but this summer I have had a lot of nausea and taking the pills has been causing me to vomit. Do you have any suggestions?

A:

Migraine headaches can be debilitating. Luckily, a variety of options exist for their treatment and prevention as well as a growing database of research and evidence that allows for more individualized treatments.

The term “migraine headache” is misleading. Migraine headaches are the result of a complex neurological disorder that is more closely related to a seizure disorder than to the tension or sinus headaches that many of us experience. The stages and severity can be different for each individual, and each migraine can be different from the last. Before the headache stage, an individual can experience a first "prodromal” stage then an “aura” stage which occurs in roughly 30 per cent of migraines. The prodromal stage can be the first sign a headache is coming. Usual prodromal symptoms include yawning, fatigue, diarrhea or GI distress, and mood changes. There is evidence suggesting that intervention during this stage can prevent the headache stage from occurring by avoiding triggers such as bright lights and using relaxation/mindfulness techniques. The aura stage is called such because visual and sensory disturbances can occur. Seeing spots, blurred vision, tingling sensations in the skin are all examples of this. The aura can also start at the same time as the acute headache stage. This is the stage most people are familiar with, which is moderate-severe pain, usually on one side of the head that lasts on average four to 72 hours. That is the average duration but sometimes can last much longer. After this comes the hangover stage.

The first step to managing migraines is avoiding triggers. Stress, food, alcohol, lights, weather can all be triggers (not to be confused with a cause) that can bring on migraines. Keeping a diary of headaches can help you identify it and give you a plan for what to avoid. Hormones are also a trigger so birth control containing estrogen can be triggers and an alternative may be required. Next, you need a plan for what to do when nausea or pain does occur. Most commonly, over-the-counter pain medications are tried first (Ibuprofen, Naproxen, Aspirin, Tylenol). If those are not effective, “triptan” medication can be prescribed. These come in several forms with oral tablets being the most cost effective. Some are also available as rapid dissolving tablets that melt in the mouth for those who cannot swallow pills during a migraine. These tablets both take about 30 minutes to provide relief (dissolving tabs dissolve faster but are slightly slower being absorbed). Nasal spray triptans are also available which work as soon as 15 minutes. An injectable version that works in closer to 10 minutes is also available. Cost is usually what limits the use of nasal sprays and injectable forms as well as ease of use.  Depending on which product is chosen (there are several triptans on the market), doses can be repeated in a few hours but this is different for each product, so make sure you check with your pharmacist about how long you need to wait before repeating a dose. New recommendations suggest waiting until pain begins to take any product to treat an acute migraine, as taking at the start of an aura may reduce how efficient the treatment is.

Many people will require a preventive treatment if using medication for headaches isn’t appropriate or are being used too regularly. Using migraine pills more than 15 days per month can lead to medication overuse headaches. Be sure speak to your doctor if you think preventive therapy would improve your quality of life based on the frequency and severity of your headaches.

New Brunswick pharmacists can assess and when appropriate prescribe medication for acute migraines, so if you suffer from migraines and are looking to have a treatment plan, your pharmacist is a great place to start.

Jared Mactavish (BSc., Pharm) is a pharmacist at Guardian Pharmacy in Hampton and St. Stephen. His opinions expressed in this newspaper are published for educational and informational purposes only, and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment. Send your questions to AskYourNBPharmacist@gmail.com.