Andris Simsons, Watson Headache® Certified Practitioner, shares his thoughts on the various types of medications on the market.
Preventatives
There are several headache and migraine preventatives on the market, some more effective than others. Every person is different, so whilst one person may benefit from a type of drug, another person may not.
Each medication has its own set of side effects as well. Preventive medication can have a place, however, it is not ideal to be taking medication, everyday, for the long term. When considering a preventative medication, it is important to consider whether the benefits of the medication outweighs the side effects experienced.
Endep or Amitriptyline is most commonly used to treat major depressive and anxiety disorders. However, it has also been shown to help reduce the frequency and intensity of tension headaches and migraines. The research tells us that the average reduction is only about 30%. To put this simply… if you were to get ten headache episodes per month, using Endep you would average seven. This is definitely an improvement, but realistically is it significant enough for the patient? Common side effects include drowsiness, dry mouth, constipation, weight gain and light headedness.
Inderal or Propranolol is a beta-blocker and is used to treat high blood pressure, irregular heart rate, thyrotoxicosis, capillary hemangiomas, performance anxiety and essential tremors. It has also been shown to reduce tension headaches and migraine by an average of 50%. While more effective than the anti-depressant, common side effects include drowsiness, nausea, light headedness, irregular heartbeat, weight gain.
Acute Management
Triptans are a family of several medications used to treat or subdue migraines in their acute stage. Common ones include: Maxalt, Imagran, Zomig and Ralpax. To be most effective these drugs need to be taken at the onset of symptoms. A triptan is deemed effective if it can abort a migraine within two hours of taking the medication.
A systematic review reported triptans relieved headaches within two hours in 42-76% of patients, and two-hour sustained freedom from pain was achieved for 18-50% of patients. Freedom of pain at 24 hours was achieved in 29-50% of patients and sustained freedom from pain in 18-33% of patients. Common side effects include dizziness, nausea, drowsiness and fatigue.
CGRP stands for calcitonin gene-related peptide, and it is a protein that is released around the brain. When CGRP is released, it causes intense inflammation in the coverings of the brain, and for some migraine patients can contribute to increasing their brainstem sensitivity. This type of treatment is quite new but studies have indicated that it has about the same effectiveness as conventional preventative medication (about 50% reduction is episodes) but with less side effects.
Botox is a treatment done every three months and has shown to decrease the amount of episodes by an average of 50% or more in about 51% of the patients trying the treatment. While Botox can be quite effective at reducing the impact of headache and migraine, from my own experience as a practitioner, I have found that a combination of Botox and treatment to the neck to be quite effective at significantly reducing the frequency, intensity and duration of a patients headache or migraine episodes.
In conclusion, whilst there is good evidence that some people may find certain medications will reduce their headache/migraine episodes, it is clear that they are limited in their effectiveness. Additionally, people typically abandon their medications due to adverse side effects.
Neck treatment can quite often reduce a patient’s dependency on medication and also improve its effectiveness. I often have discussions with patients about the best way to treat their particular condition and in my opinion, when dealing with a chronic condition, it is rare that just one form of treatment will provide the relief they are looking for. The reality is that most people need to find the best combination of treatments that most effectively keep them in the healthiest state.
