Abortive migraine drugs: effectiveness, benefits, and risks

Migraine headaches can cause throbbing or throbbing pain on one or both sides of the head. Abortive migraine medications can treat symptoms when a person has a migraine headache.

There are two treatments for migraine headaches: abortive and preventive treatment. Abortive care often includes medication to treat migraine headaches and symptoms as they occur. Preventive measures will help prevent migraine headaches.

While abortive migraine drugs can help relieve symptoms, side effects can occur. Read on for more information about medications used to treat migraines, their benefits, side effects, and more.

Abortive migraine drugs are drugs that can help stop a migraine headache after it starts.

The National Institute of Neurological Disorders and Stroke states that approximately 12% of people living in the United States have migraine headaches.

Research shows that over half of people with migraines use over-the-counter pain relievers and only see a doctor when over-the-counter medications don’t work or stop working.

For mild to moderate migraine headaches, a doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) as the first line of therapy.

However, for severe migraine headaches or those that do not respond to nonprescription drugs, a doctor may prescribe triptans or ergotamines as an abortion.

Triptans are drugs that doctors can prescribe for migraines with or without aura. This drug works by selectively binding to the serotonin receptors 5-HT1B and 5-HT1D, reducing inflammation, and blocking the pain receptors in the brain.

Ergotamine also targets 5HT-1 serotonin receptors. Unlike triptans, they are not selective. Because of potential side effects and newer medications, doctors usually prescribe this drug as a secondary line of treatment when triptans or other treatments don’t work.

Doctors will likely recommend over-the-counter (OTC) pain relievers or triptans as the first line of treatment if a person has mild or moderate migraines.

If a person’s migraine headache does not respond to nonprescription drugs, or a person’s migraine headache is severe, a doctor may prescribe triptans or ergotamines.

However, doctors will not prescribe triptans and ergotamines for everyone with migraines. Most triptans are unsuitable for pregnant or breastfeeding women. Doctors do not prescribe triptans for people who are over 65 years of age or who:

A 2013 research found that the American Academy of Pediatrics (AAP) viewed sumatriptan as a compatible drug during breastfeeding.

The researchers also suggest that eletriptan is safe for people who are breastfeeding, too. However, the AAP has not reviewed Eletriptan for this application.

People who cannot use triptans cannot take ergotamines. In addition, doctors will not prescribe this drug for people taking CYP 3A4 inhibitors, as it can lead to stroke, gangrene, or death. These inhibitors include:

A doctor will work with a person to determine the best treatment plan for their needs.

Triptans are a class of drugs used to treat migraine headaches. Currently, doctors can prescribe seven different triptan drugs, including:

  • Sumatriptan, which is also suitable for cluster headaches
  • Naratriptan and Frovatriptan, which doctors can prescribe off-label for menstrual migraine headaches
  • Zolmitriptan, which is available as a nasal spray for children aged 12 and over
  • Almotriptan, which is suitable for adolescents with migraine headaches that last longer than 4 hours

People can take triptans as soon as migraine headaches start and take them every 2 hours. However, triptans are not effective if a person takes the drug during the aura phase, before the headache develops.

effectiveness

Triptans are an effective treatment for migraine headaches. A 2015 study found that triptans relieved migraine headaches in 42–76% of participants within 2 hours and prevented pain for an additional 2 hours in 18–50% of participants.

The study found that triptans were more effective than ergotamines and equal to or more effective than NSAIDs, paracetamol, and acetylsalicylic acid (ASA). Participants reported less pain and longer pain relief with a combination of triptans and paracetamol or ASA.

The researchers also found that sumatriptan injections and oral zolmitriptan, rizatriptan, and eletriptan were more effective at treating migraine headaches than other triptan drugs.

Side effects

Triptans can have side effects. Taking triptans for more than 10 days a month can lead to triptan overuse headaches. Other possible side effects can include:

Less than 1% of people may have an irregular heartbeat, heart attack, or stroke.

Ergotamines are a type of ergot alkaloid class of drugs. Doctors may prescribe this medication if over-the-counter medications, triptans, or other medications don’t relieve symptoms.

Ergotamines are available in tablet, suppository, injection, and aerosol forms. A person can take the medication at the first sign of a migraine headache and, if necessary, take another tablet at 30-minute intervals.

effectiveness

Ergotamines are effective in treating migraines, especially when combined with caffeine. Research shows that dissolving tablets under the tongue can treat slow-onset migraine headaches, while a suppository may be best for a person with a fast-onset headache.

A 2018 study found that ergotamine, when combined with caffeine, camylofin, mecloxamine, and the pain reliever propyphenazone, was more effective than sumatriptan at treating migraine headaches without aura.

The researchers also found that while triptans were more effective at relieving pain, ergotamine was more effective for prolonged migraine headaches and in people with more frequent headaches.

Side effects

Ergotamines can have a number of side effects. The most common include:

Doctors will not prescribe triptans or ergotamines if a person is pregnant or breastfeeding, over 65 years of age, or has certain health conditions. These drugs can cause high blood pressure, which can be dangerous if a person has high blood pressure or a history of heart attacks.

Triptan overdose has a low risk of death. Signs of a triptan overdose include high blood pressure, fast heartbeat and drowsiness.

An overdose of ergotamines runs the risk of ergotamine poisoning, which can lead to death. Symptoms of an overdose include:

People should see a doctor right away if they or someone they know has taken an overdose of triptans or ergotamine.

A person should follow all of their doctor’s instructions and drug labels when taking migraine abortive headache medication. A person should not stop therapy unless their doctor recommends it.

Taking triptans and ergotamines can lead to overuse headaches. Stopping these medications is the most effective way to treat this symptom. However, a person who stops taking triptans and ergotamines may:

  • worsening of headache symptoms
  • Nausea
  • Restlessness
  • interrupted sleep
  • diarrhea

People should discuss with their doctor whether to stop taking the medication. The doctor can create a treatment plan for any withdrawal symptoms, such as prescribing anti-nausea medication.

The Food and Drug Administration (FDA) has approved two additional drugs for abortive migraine headaches: Reyvow (Lasmiditan) and Ubrelvy (Urogepant).

Reyvow can relieve symptomatic pain within 2 hours. People should not use this medication if they intend to drive or operate heavy machinery. The drug causes side effects, including:

  • dizziness
  • fatigue
  • Burning or tingling sensation in the skin

Ubrelvy can also reduce the severity of symptoms within 2 hours. People should not use this drug in conjunction with other CYP 3A4 inhibitors, and it may cause the following side effects:

A person should speak to their doctor if they are experiencing side effects from a medication, or if the medication does not relieve the migraines. A doctor will work with a person to develop a treatment plan to prevent and manage migraine headaches.

A person should see a doctor right away if they or someone they know takes an overdose of triptans or ergotamine.

People take abortive drugs as soon as migraine headaches start. The drug can relieve pain, as well as other migraine headaches.

A doctor may recommend NSAIDs for mild to moderate headaches, triptans for moderate to severe headaches, and ergotamines when other treatments don’t work.

Any drug can have side effects. A person should see their doctor if they experience side effects and see a doctor immediately if they or someone they know takes an overdose of triptans or ergotamine.