Migraine Abortive Medications

By: Li Ming Wong

Doctors prescribe two types of migraine medications. One type is designed to help stop a migraine that has already begun. This is called abortive therapy and these drugs work best when taken as soon as the headache begins. The other type is a daily medication designed to reduce the frequency of migraine attacks. This type of medication is called prophylactic or preventive therapy.

There are two common classes of migraine abortive prescriptions, triptans and ergots.

Triptans (sumatriptan, zolmitriptan, naratriptan, et al.) work by attaching to serotonin receptors on the blood vessels and nerves in the brain. By blocking these receptors, inflammation is reduced and the vessels are able to constrict. This effectively ends the migraine for many. Triptans are available as injections, tablets, and nasal sprays. When used early enough triptans can abort up to 80% of migraine headaches within two hours of taking the medication.

Common triptan side effects are facial flushing, tightness in the chest and/or throat, and skin tingling. Less common, though still not considered serious, are dizziness, drowsiness, and fatigue. The biggest danger of triptans is heart attack or stroke in people with previously undiagnosed heart disease or risk factors like obesity and high blood pressure.

Ergots (ergotamine or dihydroergotamine preparations), like triptans, abort migraines by constricting of blood vessels. Ergots are not as targeted as triptans, however, and cause constriction of vessels throughout the body, not just in the brain. They are not considered to be as safe as triptans and are generally only recommended for patients who are unable to find relief with safer alternatives.

Ergots cause prolonged contraction of the uterus and can cause a pregnant woman to miscarry. Ergots are also much more likely than triptans to cause nausea and vomiting. Ergot brand names include Cafergot, Wigraine, Migranal, and Ergomar.

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