DRUGS THAT CAN PREVENT MIGRAINE ATTACKS
There are various drugs that, taken regularly, can prevent migraine attacks, or at least reduce their frequency. Beneficial effects may not be apparent until they have been taken for several weeks.
In conventional migraine treatment, these are not generally prescribed unless migraines are fairly frequent and severe, and other measures have been tried without significant success. Those ‘other
measures’ might include reducing stress, avoiding situations that trigger migraines, and avoiding foods such as chocolate, cheese, red wine and citrus fruits. By extension, it would seem reasonable to investigate food intolerance, using an elimination diet, before starting on (or continuing with) these drugs.
12A Serotonin antagonists
Serotonin, or 5HT, is a chemical messenger produced by the blood platelets that is known to play a part in migraine. Drugs that block the receptors for serotonin seem to help prevent migraine. Some of these drugs also act as antihistamines. The main drug used is pizotifen (Sanomigran) which is generally safe but can cause weight-gain and drowsiness in some people. Methysergide (Deseril) is equally effective, but it can, very rarely, cause serious side-effects with lasting damage. Anyone taking it should have close medical supervision. It is advisable to stop taking the drug for 1-2 months twice a year, to check that all is well.
These drugs block (3-receptors for adrenaline, the hormone that produces the ‘flight or fight’ reaction. Their main use is in other diseases, principally heart disease, and it is not entirely clear how they help to prevent migraine.
Some of these drugs block the effects of adrenaline generally and they should not be taken by asthmatics, since they have the opposite effect to (32 bronchodilators (see section 4A). The ones in question are nadolol (Corgard), propanolol (Angilol, Apsolol, Berkolol, Inderal LA) and timolol (Betim, Blocadren). Others are more selective, only affecting (3-receptors in the heart, and they can be taken by asthmatics, although good medical supervision is needed. The principal drug of this type is metoprolol (Betaloc, Lopresor).
All these drugs have certain side-effects, including cold hands and feet, disturbed sleep, stomach upset and wheezing. If dry eyes or skin rash develop this should be reported td the doctor immediately as it can indicate a severe reaction to the drug. The drugs should not be stopped abruptly, but gradually withdrawn.
Clonidine
Clonidine is used to lower blood pressure and when taken at low dosage (Dixarit) it can prevent migraine in some patients. It is a relatively safe drug, but some patients may suffer from drowsiness, dizziness, dry mouth or insomnia.
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