Britt Talley Daniel M.D.

7777 Forest Lane Suite B-220

(972)566-4556

Dallas, Texas 75230

Rules for acute treatment of Migraine:

This refers to the medication you take for the headache you have now.

1. Treat at onset. This means that all medication should be taken at the very first beginning of the headache. Don’t wait, thinking it’s not going to be “one of those.” It very well may be a bad headache coming on. Treat early.  Carry your medication wherever you go.  It is self defeating to have a  migraine start at the office when your medication is home in the bathroom.  Migraine is like a fire in your brain and no one would sit and watch a fire burning on the kitchen stove; they would put it out.  Migraine has 4 stages and by 2 hours the typical patient is at stage 3 with trigeminal activation, neurochemical release, and arterial vasodilation fully developed.  After 2 hours the tryptans don’t work as well.  Treat early and when the headache is mild.

2. Take the right drug. In general, for severe migraine patients this is going to be a triptan. Yes, many patients with mild migraine can treat their headache with Excedrin, a NSAID, or some low level drug like Midrin, but the severe headache patients—the type that end up in the Doctor’s Office—will need a triptan. Only triptans can give 2 hour pain free data after treatment. Also usually the Triptans will treat the whole migraine syndrome—headache, nausea, vomiting, photophobia, sonophobia—and they will work anytime during the headache. However, as stated above they work better when taken early on the migraine attack.

3. Take enough of the right drug. This is a dosing situation which varies from patient to patient. Elephant rifle load for migraine remains injectable Imitrex which works the fastest, in 10 minutes, and gives the highest blood levels. Either oral Imitrex 50-100 mg, Treximet, Maxalt 10 mg, Zomig 2.5-5.0 mg, Axert 12.5 mg, or Relpax 40 mg should be taken at onset of the headache.  All of the triptans may be repeated in 2 hours and that then is the full dose for 24 hours, except for Maxalt where 3 pills may be given in 24 hours.  Also a new idea is to combine a triptan with the NSAID naprosyn.  This is what is in Treximet, the new drug that replaced Imitrex.  Several migraine treatment papers have show that a triptan taken with 500 mg of naprosyn (2 Alleve) works better than just the triptan alone.