What is the difference between a reliever and a preventer in migraine treatment?
There are two main types of migraine medications commonly used.
- “Reliever” medications are taken to relieve the pain of the migraine
- They are often best used at the start of an episode
- These medications include aspirin, ibuprofen, paracetamol and “triptans” – such as sumatriptran (Imigran), eletriptan (Relpax), rizatriptan (Maxalt wafer) etc.
- “Preventer” medications are designed to prevent migraines from starting, and reduce the total number of migraines you have.
- Older preventative medications are generally oral drugs and need to be taken every day. These include medications such as amitriptyline, propranolol, topiramate, and candesartan.
- Other preventative medications include Botulinum toxin (Botox) and the CGRP monoclonal antibody class of drugs (Emgality, Ajovy, Vyepti) which are injectable or intravenous therapies given either monthly or every three months.
What are the indicators to use a preventer medication?
Most people with migraine occurring more than four times per month, or more than four headache days per month, will benefit from being on a preventative medication. However, it is always a good idea to have an effective reliever as well, because breakthrough migraines can still occur even if you are well controlled on a preventative medication.
Nausea and Common Medications
Other medications commonly used in migraine are “anti-emetics” which are not migraine specific drugs, but can help with another common and disabling symptom in migraine which is nausea and vomiting.
In migraine, the stomach has delayed gastric emptying, which means your food doesn’t move on from the stomach at the usual speed – this is why so many people have nausea/vomiting as a feature.
Medications such as metoclopramide (Maxolon) help empty the stomach and can be effective, but as it is a tablet, if it is not taken early it can be ineffective in tablet form. Ondansetron wafers can be very helpful, as they dissolve in the mouth and therefore are absorbed even if there is significant vomiting.