The correct self-treatment
You should never simply accept headaches, as effective pain management can help reduce the frequency and severity of attacks. Therefore, when treating pain, substances that effectively reduce or eliminate it should always be used. Enduring pain is not beneficial to you or your body. On the contrary, persistent pain leads to changes in the body that can, in the long term, significantly impair bodily functions.
Waiting is the wrong approach
For the treatment of headaches, it is important that headache medication—primarily triptans for migraines—is taken as early as possible. Especially with migraines, the absorption capacity of the medication in the stomach and intestines is very often impaired during an attack. The active ingredients can then no longer reach their site of action and therefore cannot exert their effect. For this reason, I recommend—particularly with migraines—taking the medication very early. Taking it late can mean that otherwise very effective medications cannot work and the pain can therefore last longer. However, triptans are usually still effective even if taken later in the attack.
Triptans are the first-line treatment for migraines because they effectively and specifically stop attacks. A detailed overview of triptans can be found in the left-hand column.
Suppositories, sprays and pre-filled syringes for nausea and vomiting
For migraine attacks accompanied by nausea and vomiting, nasal sprays and suppositories have proven particularly effective. Another option is to self-administer the medication subcutaneously using a pre-filled syringe. This bypasses the stomach, allowing the active ingredient to be absorbed directly. A further advantage is that the medication does not immediately pass through the liver after absorption, potentially leading to improved efficacy.
Additional rules of conduct
One of the first steps in treating a migraine attack is to reduce stimuli. Therefore, you should always retreat to a quiet and darkened room if possible.
Since many sufferers are familiar with noise and light sensitivity, but shielding themselves from stimuli is not always possible due to everyday circumstances, many people try to maintain their ability to work by quickly and excessively taking medication. This situation is a major cause of medication misuse, with the risk of chronic headaches due to medication overuse. Even if a medication provides very good and very fast relief, you should still observe this rest period.
Treatment of migraine attacks in cases of mild disability
Mild migraine attacks can be relieved by
- slow onset of headache intensity,
- mild to moderate headache intensity,
- absent or only mild aura symptoms and
- moderate nausea and absence of vomiting
to differentiate them from severe migraine attacks.
The following combinations are possible for treating these mild migraine attacks: an anti-nausea medication (metoclopramide or domperidone – both prescription-only) with a pain reliever (acetylsalicylic acid, ibuprofen, naproxen, paracetamol, or phenazone). Administering an anti-nausea and anti-vomiting medication has proven beneficial in treating migraine attacks because it directly and specifically reduces the symptoms of nausea and vomiting and can also normalize gastrointestinal activity. This can improve and accelerate the absorption of the pain medication. If mild migraine attacks are accompanied by no nausea or vomiting, you can take the pain reliever directly and forgo the anti-nausea and anti-vomiting medication.
In principle, self-medication should be limited to a maximum of 10 days per month to avoid complications (see last chapter). For migraines and other primary headache types, you should seek specialist medical treatment as soon as possible. Your doctor can recommend the appropriate medication right from the start of your headache disorder, monitor its progression with you, and provide support.
Metoclopramide and Domperidone
Loss of appetite, nausea, and vomiting can accompany migraine attacks. Additionally, the stomach muscles are often impaired in their motility, thus disrupting the movement of food. Antiemetics (medications against nausea and vomiting) are intended to correct these functional disorders during migraines. The reduced stomach activity during a migraine attack means that painkillers are barely transported into the intestines. As a result, the desired effect is not achieved. For this reason, you should take an antiemetic (metoclopramide or domperidone) 15 minutes before taking your migraine medication. Within this timeframe, the regulation of stomach motility is normalized, allowing the subsequently taken migraine medication to take effect.
Effect:
Normalization of gastrointestinal motility, relief of nausea and vomiting
Uses:
Metoclopramide: since the drops are no longer available, 1 tablet containing 10 mg, in case of early vomiting 1 suppository containing 20 mg;
alternatively, domperidone: 30 drops.
Domperidone is also available in tablet form.
Precautions:
Caution should be exercised when using this medication in patients with kidney disease and in children under 14 years of age. The medication should not be used in cases of intestinal obstruction or bleeding, epilepsy, movement disorders, certain hormone-producing tumors, or in combination with MAOIs (anticoagulants).
Possible side effects:
Fatigue, dizziness, or diarrhea occur rarely. Very rarely, movement disorders such as involuntary mouth movements, throat and tongue spasms, head twisting, difficulty swallowing, or eye rolling may occur shortly after ingestion. In this case, an overdose has occurred, and you should call a doctor. These unpleasant but otherwise harmless symptoms can be quickly resolved by administering an antidote.
Acetylsalicylic acid – the classic
Among over-the-counter medications, acetylsalicylic acid (e.g., Aspirin, ASA) has the strongest pain-relieving effect on headaches. Acetylsalicylic acid should ideally be taken as an effervescent solution, as this ensures particularly rapid and reliable absorption in the gastrointestinal tract. Absorption is similarly rapid when using a chewable tablet. If insufficient liquid (at least 250 ml) is consumed after taking a regular tablet, the medication remains in the stomach for too long due to migraine-related gastrointestinal paralysis, is not absorbed by the intestines, and can cause undesirable side effects such as gastritis (inflammation of the stomach lining) with stomach pain.
For adolescents, the dosage of acetylsalicylic acid is 500 mg, while for adults it is 1000 to 1500 mg to achieve sufficient effectiveness! Taking one 500 mg tablet is definitely not enough for adults suffering from migraines; two tablets are required. The effect usually begins after 20 to 60 minutes.
Effects:
Pain-relieving, fever-reducing, anti-inflammatory
Directions:
Acetylsalicylic acid should be taken as an effervescent solution dissolved in 250 ml of water. The medication is absorbed into the body only in the small intestine. The effervescent solution allows it to pass through the stomach quickly, thus maximizing its effectiveness. The addition of vitamin C to effervescent tablets creates the fizzy effect and improves stomach tolerance; it is not an additive in the sense of combination preparations and is therefore not detrimental. Taking a so-called buffered preparation, which has a positive effect on the stomach symptoms of migraines (e.g., Aspirin Migraine), is particularly beneficial.
Precautions:
Aspirin should not be taken in cases of stomach or intestinal ulcers, narrowing of the airways, asthma, hives (urticaria), or blood clotting disorders.
Possible side effects:
Stomach upset occurs rarely. Hypersensitivity reactions, such as skin rashes or shortness of breath, gastrointestinal bleeding, or a decrease in blood platelets, are also rare.
Paracetamol
It can be taken as a suppository, effervescent granules for drinking, as a chewable tablet, juice or drops.
Effect:
Pain-relieving, fever-reducing
Directions:
The dose for children is 500 mg, for adults 1000 mg. The effect usually occurs after 30 to 60 minutes. If vomiting occurs at the onset of a migraine attack, it is advisable to use paracetamol suppositories.
Paracetamol is only conditionally suitable for relieving mild attacks, as its duration of action is short and its strength is often insufficient.
Based on recent study results, the use of paracetamol in children should now only be recommended in very limited circumstances.
Precautions:
Caution is advised when dosing in cases of liver or kidney disease (consult a doctor). Paracetamol must not be used in cases of glucose-6-phosphate dehydrogenase deficiency.
Possible side effects: Paracetamol is usually well tolerated. Very rarely, hypersensitivity reactions such as skin rashes or shortness of breath, changes in blood count, and a drop in blood pressure leading to shock may occur.
If at all possible, paracetamol should be avoided during pregnancy.
Paracetamol should not be used during pregnancy. Some studies have suggested that taking paracetamol during pregnancy may increase the risk of undescended testicles (cryptorchidism). There is also evidence that the risk of childhood asthma is increased if the mother took paracetamol during pregnancy. However, the evidence for these causal relationships is disputed. There are no well-studied alternatives to paracetamol or ibuprofen. Ibuprofen, however, should only be used during the first six months of pregnancy.
Ibuprofen or naproxen
The efficacy of ibuprofen in treating migraine attacks is not as well studied as that of acetylsalicylic acid (aspirin). The substance is available as tablets, effervescent granules, suppositories, and capsules. Ibuprofen is believed to be similar to acetylsalicylic acid and paracetamol (acetaminophen) in its pain-relieving effect. The single dose is 200 mg for children and up to 600 mg for adults. Naproxen 500 mg is particularly effective for prolonged attacks due to its long duration of action and can also be combined with triptans.
Effects:
Pain-relieving, anti-inflammatory, fever-reducing
Application:
Ibuprofen is available as tablets, granules, or suppositories.
Naproxen is available as tablets or suppositories.
Precautions and adverse effects:
The precautions and adverse effects do not differ significantly from those of acetylsalicylic acid.
Phenazon
A recent study has confirmed that phenazone, a drug used for many decades, can also be effective in treating migraine attacks. It is well-tolerated by the stomach and can also reduce nausea as well as sensitivity to noise and light.
Effect:
Pain-relieving, fever-reducing
Dosage:
The dose is 500 mg for children and 1000 mg for adults. The effect usually occurs after 30 to 60 minutes. If vomiting occurs at the beginning of a migraine attack, it is advisable to use phenazone as a suppository.
Precautions:
Care must be taken with the dosage in cases of liver and kidney disease (consult a doctor).
Possible side effects: Phenazone is usually well tolerated. Very rarely, hypersensitivity reactions such as skin rashes occur; changes in blood cell counts are possible in case of overdose.