Rules For Treatment of Migraine headache symptoms

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

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.  Migraine headaches may start in the back of the head and move forward behind an eye.  Treat it while it is in the neck.  Migraine without aura headaches may also start in the forehead, eye, or cheek area.  This is not sinus headache unless there is green or yellow nasal discharge or pus on a CAT scan of the sinuses---treat it as a migraine.  One of the acute onset Triptans, the generics work in 30 minutes, should usually be used and these are Imitrex (sumatriptan), Zomig (zolmitriptan), Maxalt (rizatriptan), Relpax (Eletriptan), or Axert (almotriptan).  Frova (frovatriptan) and Amerge (naratriptan) take 1-2 hours to start working and are mainly used for menstrual migraine.  Eighty percent of migraine patients may be pain free at two hours if they treat at onset.  Triptans block the release of neurochemical inflammatory drugs which come at 20-40 minutes into a migraine.  Triptans are the universal best drugs for acute therapy for migraine.  However, twenty percent of patients don’t respond to triptans and other treatment options must be pursued.

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, or an NSAID like ibuprofen or naproxen, but the severe headache patients—the type that end up in the Doctor’s Office or the ER—will usually need a Triptan.  Usually the Triptans will treat the whole migraine syndrome—headache, nausea, vomiting, photophobia, sonophobia—and they work best if taken at onset of headache.  However, a small percentage of patients will need to take something for nausea with the Triptan, such as 4-8 mg ODT Zofran (odansetron), oral 25 mg Phenergan (promethazine), or 25 mg Phenergan suppository.

TAKE ENOUGH OF THE RIGHT DRUG. 
This is a dosing situation which varies from patient to patient.  Elephant rifle load (the biggest gun) for migraine remains injectable Imitrex (sumatriptan) 3, 4, 6 mg sc which works the fastest, in 10 minutes, and gives the highest blood levels.  Oral Imitrex (sumatriptan) 50-100 mg, Treximet (sumatriptan/naproxen) 1 tablet, Maxalt (rizatriptan), 5, 10 mg, Zomig (zolmitriptan), 2.5-5.0 mg, Axert (almotriptan) 12.5 mg, Relpax (eletriptan) 40 mg, Amerge (naratriptan) 2.5 mg, or Frova (frovatriptan) 2.5 mg may be tried at onset of the headache.