If you suffer from headaches or migraines, you are not alone. In a 2001 World Health Report, ,migraines are the most disabling and expensive chronic disorder that is non-fatal. So if you’re in this category you have probably tried several different things, medication being one of them. In our reactive and pharmaceutical based healthcare system, doctors generally prescribe medication as a first line of defense. However, being a previous migraine sufferer myself and a physical therapist, I did some research on the drugs out there that are supposedly supposed to “help” migraine pain. I have tried several types with no relief and have also clinically heard the same thing everyday from patients since working here at Novera Headache Center.
Let’s get something straight right away. The research shows migraine medications, both preventative and analgesic, don’t work for 50% of migraine sufferers. That data indicates a reduction in frequency, but not a cure.
So, there are 10 classes of migraine medication and within these classes there are dozens of drugs doctors will prescribe. Yes, I said ten. The basic over the counter analgesics everyone knows are Ibuprofen and Tylenol. Let’s be honest, Tylenol doesn’t ever seem to touch headache pain, and consistent long term use of Ibuprofen can cause liver damage. So let’s move on to Triptans, the ones that constrict blood vessels and increase blood pressure. There are warning labels on these that state they can increase blood pressure to dangerously high levels and sometimes an EKG of your heart may be needed if you use it long term to make sure your heart continues to function properly. No thanks. Then we’ve got Ergots. They also constrict blood vessels and listed under their common side effects is: numbness, tingling, weakness, dizziness, spinning sensation, nausea, vomiting; or swelling or itching in any part of your body. Do any of those sound familiar at all to symptoms of migraines? Moving on to anti nausea medications, of which the first one listed is Chlorpromazine. This was made to treat symptoms of schizophrenia and bipolar disorder and migraines are not listed. Sounds weird right? Okay, so let’s move onto another anti nausea medication, like Metoclopramide. This med increases muscle contractions in the upper digestive tract, which speeds up the rate at which the stomach empties into the intestines. It’s used for heartburn. This is a direct warning listed for this drug; “NEVER USE METOCLOPRAMIDE IN LARGER AMOUNTS THAN RECOMMENDED, OR FOR LONGER THAN 12 WEEKS. High doses or long-term use can cause a serious movement disorder that may not be reversible.” They capitalized the warning, that wasn’t me. Wow, there’s got to be a better option. So we reach a category called Glucocorticoids, like prednisone. Prednisone is a corticosteroid. It is a big-boy anti-inflammatory. Sounds okay.. Maybe? However, it also suppresses the immune system. Prednisone normally is used to treat many different conditions such as allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, or breathing disorders. Migraines are not listed. Also, their warning sticker says this: “Steroid medication can weaken your immune system, making it easier for you to get an infection or worsening an infection you already have or have recently had. Long-term use of steroids may lead to bone loss (osteoporosis).
By the way guys, we’ve only gone over 5 categories. We have 5 left. I hardly even have the energy to keep writing this essay, so hopefully you’re still reading. If you’ve stopped, hopefully you’ve gotten the gist so far.
So we had the ones above that increased blood pressure, but if that doesn’t work, let’s try decreasing blood pressure! Beta blockers like Propranolol do that. Propranolol is mostly used to help heart attacks. Common side effects include: Insomnia, fatigue, and general weakness. Again, no thanks! So let’s move on to antidepressants. They are supposed to affect brain chemicals like serotonin which can also constrict blood vessels and reduce inflammation. This one I almost got on board with. But then I read the listed common side effects (not ALL the side effects, just the common ones): Dry mouth, Drowsiness, Dizziness, Dysgeusia (distortion of taste), Weight gain, Increased appetite, and last but not least, Headache disorder. Oops! Okay, we’re getting a little desperate, so maybe let’s try some opioids. Nothing quite like the cousin of heroin! Unless you live under a rock, you probably know something about the opioid crisis, but don’t worry, I’ll recap it for you. In 2019, nearly 50,000 people in the US died from opioid overdoses. The total economic burden from this crisis is an estimated $78.5 billion a year. Again, there’s got to be a better option.
We’ve got two more… stay with me. Since we have pain in our head, it must be our brains, right!? (No, but that’s why you come to Novera Headache Center to find out it’s your neck and it’s conservatively treatable with results after the first visit :-)) So let’s try anticonvulsants which decrease nerve impulses that cause seizures and nerve pain. Oh, and they’re also used to treat bipolar disorder. Common side effects include: Acute Confusion, Diplopia (double vision), Blurred vision, Nystagmus, Drowsy, Dizziness, Ataxia, Nausea, Vomiting, Unsteady Gait. I already have these with migraines, so again, no thanks!
Okay, so on to the NEWEST and of course, most expensive category that everyone is talking about. CGRP (Calcitonin gene-related peptide inhibitors), some of the brands are called Aimovig, Ajovy, and Emgality. CGRP occurs naturally in the body and is released during a migraine. It is a small protein that is highly prevalent in sensory nerves that supply the head and neck and is involved in pain transmission. They are considered a “preventative” and you get it 1x/month via injection. However it is $575 per injection or $6,900/year. Oh, but only 50% of people get about 50% reduction in symptoms. Back to where we started, huh? Thanks for hanging in there.
If you’ve gotten a headache reading this, give us a call at Novera Headache Center at (719) 594-1010 or ,book an appointment right on our website!