How to Choose the Right Migraine Medication: the Conclusion

In part one, we reviewed our over the counter options for migraine relief.

In part two, we covered those that require a doctor’s scribble.

And we concluded that, while most of our choices in both categories may be more trouble than they’re worth, some are worth remembering.

But, even with things pared down a bit, the final decision can still be confusing. Like I said before, nobody wants to analyze a cost benefit decision matrix while hunched over the toilet in mind-numbing agony.

Furthermore, in this situation, time matters. The sooner you intervene with a migraine, the better your odds of success. So the less time spent fretting over what to take, the better.

So let’s make it simple.

A Simple Migraine Relief Decision Tree

Here’s my simple decision tree for deciding what to take, distilled primarily from my experience with upwards of 10,000 migraine patients. Of course, unique circumstances or coexisting conditions may mandate another approach, but this is what works for the vast majority.

In general, the viable over-the-counter choices we’ll reserve for our lesser headaches, while our big prescription guns are the go-to option for the what-did-I-do-to-deserve-this skull crushers.

[message_box color=”blue”]For a mild to moderate headache that’s not escalating quickly –> use a non-specific over-the-counter aspirin based medicine (aspirin, ibuprofen, naproxen), with or without caffeine added (Anacin, BC Powder, Bayer Extra Strength Back and Body, etc.).

If not resolved in two hours or if symptoms progress rapidly –> use a fast-acting, highly-effective oral triptan (sumatriptan, rizatriptan, almotriptan, eletriptan, zolmitriptan)[/message_box] [message_box color=”blue”]For a moderate to severe headache, or one that’s progressing quickly (i.e. you know from the start it’s gonna get ugly) –> use a fast-acting, highly-effective oral triptan (sumatriptan, rizatriptan, almotriptan, eletriptan, zolmitriptan)[/message_box] [message_box color=”blue”]For a moderate to severe headache with nausea of vomiting –> use a migraine-specific, non-oral triptan formulation (sumatriptan injection or nasal spray, zolmitriptan nasal spray), possibly in combination with a centrally acting anti-nausea medication (promethazine and metoclopramide are the primary ones)[/message_box] [message_box color=”blue”]Lastly, if you know for sure that over the counter medications never, ever do diddly squat for your headaches –> us a fast-acting highly effective triptan – by mouth if no nausea or vomiting, by nasal spray or injection if so.[/message_box]

Generic or Brand?

For the most part, the effects of brand name meds and their generic alternatives are going to be very similar. There are exceptions, however, and the differences lie primarily in their bioavailability (how much of the active drug gets into your bloodstream, and how quickly). Typically, brands are better from this perspective, but those differences may not always be enough to matter.

Brand name medications are also more likely to have an outer coating so that they go down easier (I can take Advil without water for example, but generic Ibuprofen is liable to get lodged in my esophagus for a few hours…).

But generics work just fine for a great many. My suggestion: if you have a medication that works well for you, try the generic at least once. If it works just as well, great, you’re gonna save yourself some dough. If not, you’re only out a few bucks.

So there you have it. Though the number of potential options can seem overwhelming, in the end, there’s really only a handful of stuff out there that actually works.

Will they always work? No. But following the simple decision tree above will, in my opinion, offer you the best chance of success.

A Final Word

As you probably know, I advocate an ancestral diet as the ultimate strategy for migraine prevention. The results have been so life-altering for me and the other migraineurs who’ve adopted it that I’ll likely be shouting it from the rooftops till I have no more breath left for shouting.

And, for the majority of folks, faithful adherence to this way of eating will lead to migraine freedom. So why then talk about migraine relief medications at all?

Because I’m also a realist. I know you may “cheat” from time to time. I cheat from time to time. It’s ok, we’re all human. Life goes on. Ditch the guilt, it’s not your friend.

But do be prepared. What’s more, one of the other wondrous benefits of eating this way is that you’re liable to find, as many others have, that if you do end up with a headache, migraine relieving medications work a lot better. So, should you cheat and rouse the beast, you’ll be much more likely to stop him dead in his tracks, thanks to all that mindful eating you did before you cheated.

Just don’t make a habit of it.