Brain and Nervous System

The Family Health Guide

Headache

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New Approach to Treating Migraines
Many physicians (and migraine-sufferers) consider the pill form of sumatriptan (Imitrex) as the drug-of-choice for acute migraine headaches. A Harvard Medical School neurologist believes that a less traditional approach may in fact be very effective. Because the stomach empties slowly during a migraine attack, oral medicines are often of little benefit. The more severe the headache, the more important it is for physicians to offer a non-oral treatment. Indomethacin (Indocin), in suppository form, can provide good pain relief.

A second-line approach would be for patients to take medication that stimulates the stomach to empty, for example, metoclopramide (Reglan), followed a few minutes later by an oral pain reliever such as aspirin. This combination has proved to be as effective as oral sumatriptan. If these approaches are not helpful, then the injectable form of sumatriptan is the next step.

Oral sumatriptan and its sister drugs (naratriptan, Amerge and zolmitriptan, Zomig) are very expensive, costing as much as $13-$15 per dose, yet are no more effective than the combination of metoclopramide and aspirin, which costs less than 10 cents per dose. The injectable form of sumatriptan can be very effective but is also quite expensive (nearly $50 per dose) and costs far more than indomethacin at a few dollars per treatment. Certainly, for someone suffering from a severe migraine, pain relief is nearly priceless. But tight healthcare dollars are causing headaches for everyone. So these less traditional, but no less effective treatments might be worth a try.

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