The right self-treatment
Under no circumstances should you simply accept a headache, as effective treatment of the pain can help reduce the frequency and severity of attacks. For this reason, when pain requires treatment, substances that are able to effectively reduce or eliminate the pain should always be used. You don't benefit yourself or your body if you endure pain. On the contrary: constant pain leads to changes in the body that can lead to a significant impairment of body functions in the long term.
Waiting is the wrong approach
When it comes to treating headaches, it is important that the headache medications – primarily triptans for migraines – are taken as early as possible. Especially with migraines, the ability of the stomach and intestines to absorb food is often disrupted during the course of the attack. The active ingredients can then no longer reach their site of action and therefore cannot develop their effect. For this reason, I recommend taking the medication very early, especially for migraines. Taking it late can mean that otherwise very effective medications cannot have their effect and the pain can therefore last for a long time. However, triptans usually still have good effectiveness if they are taken later in the attack.
Triptans are the first choice for migraines because they effectively and specifically stop attacks. You can find a detailed overview of the triptans in the left column.
Suppositories, spray and pre-filled syringe for nausea and vomiting
Nasal sprays and suppositories have proven to be particularly beneficial for migraine attacks with nausea and vomiting. Another option is to inject the medication under your skin using a pre-filled syringe. Reason: The stomach is bypassed and the active ingredient can be absorbed directly. Another advantage is that the active ingredient does not pass through the liver immediately after absorption, which means that an additional improvement in effectiveness can be achieved.
Additional rules of conduct
One of the first measures in the treatment of a migraine attack is to initiate a stimulus barrier. If possible, you should always retreat to a quiet, darkened room.
Since the sensitivity to noise and light is well known to many of those affected, but due to everyday conditions it is not always possible to shield themselves from stimuli, many people try to keep themselves able to work by taking medication quickly and excessively. This situation is a major reason for medication misuse with the risk of permanent headaches due to medication overuse. Even if a medication helps very well and very quickly, you should still take this rest period.
Treatment of migraine attacks with mild disability
Mild migraine attacks can be tolerated
- slow onset of headache intensity,
- mild to moderate headache intensity,
- missing or only mild aura symptoms and
- moderate nausea and absence of vomiting
Differentiate yourself from severe migraine attacks.
To treat these mild migraine attacks, the following combinations are possible: an anti-nausea medication (metoclopramide or domperidone - both require a prescription) with a pain reliever (acetylsalicylic acid, ibuprofen, naproxen, paracetamol or phenazone). The administration of a medication against nausea and vomiting has proven to be useful in the treatment of migraine attacks, as on the one hand it directly and specifically reduces the symptoms of nausea and vomiting and on the other hand it can normalize stomach and intestinal activity. This can improve and accelerate the absorption of the medication against the pain. If there is no nausea or vomiting at all during mild migraine attacks, you can also take the painkiller directly and forgo the anti-nausea and vomiting medication.
In principle, self-medication should be carried out on a maximum of 10 days per month to avoid complications (see last chapter). For migraines and other primary types of headaches, you should seek specialist treatment as soon as possible. Your doctor can recommend the right medication for you right at the start of your headache and can work with you to monitor its progress and support you.
Metoclopramide and domperidone
Loss of appetite, nausea and vomiting can be symptoms of migraine attacks. In addition, the muscles of the stomach are often impaired in their mobility and thus the movement of the food pulp. So-called antiemetics (medicines against nausea and vomiting) are intended to correct these functional disorders in migraines. The restricted stomach activity during the migraine attack means that the painkillers are hardly transported into the intestine. Consequence: The desired effect does not occur. For this reason, you should take an antiemetic (metoclopramide or domperidone) 15 minutes before taking the migraine medication. Within this period, the control of stomach motility is normalized again and the migraine medication subsequently taken can then develop its effectiveness.
Effect:
Normalization of gastrointestinal motility, relief of nausea and vomiting
Application:
Metoclopramide: 20 drops, for early vomiting 1 suppository with 20 mg;
Alternatively Domperidone: 30 drops.
Both active ingredients are also available in tablet form.
Precautions:
Cautious use should be made in kidney disease and in children under 14 years of age. The medication must not be used for intestinal obstruction and bleeding, epilepsy, movement disorders, certain hormone-producing tumors and in combination with MAO inhibitors (stomach acid inhibitors).
Possible undesirable effects:
Rarely, fatigue, dizziness or diarrhea occur. Very rarely, movement disorders in the form of involuntary mouth movements, throat and tongue spasms, head turning, difficulty swallowing or turning of the eyes can occur shortly after ingestion. In this case, there is an overdose and you should call a doctor. These unpleasant but otherwise harmless symptoms can be quickly remedied by administering an antidote.
Acetylsalicylic acid – the classic
Among the over-the-counter medications, acetylsalicylic acid (e.g. aspirin, ASA) has the strongest pain-relieving effect on headaches. Acetylsalicylic acid should, if possible, be taken as an effervescent solution, as this ensures particularly rapid and safe absorption in the gastrointestinal tract. Absorption is similarly quick when using a chewable tablet. If you don't drink enough liquid (at least 250 ml) when using a normal tablet, the medication stays in the stomach for too long due to the gastrointestinal paralysis caused by migraines, is not absorbed by the intestines and can have undesirable effects in the form of inflammation of the stomach lining (gastritis). with stomach pain.
For adolescents, the dosage of acetylsalicylic acid is 500 mg, for adults 1000 to 1500 mg to achieve sufficient effectiveness! Taking one 500 mg tablet for adults is definitely not enough for migraines; 2 tablets are required. The effects usually begin after 20 to 60 minutes.
Effect:
Pain-relieving, fever-reducing, anti-inflammatory
Application:
Acetylsalicylic acid should be taken as an effervescent solution dissolved in 250 ml of water. The drug is only absorbed into the body in the small intestine. The effervescent solution allows it to pass through the stomach quickly and is therefore best able to achieve its effectiveness. The addition of vitamin C in effervescent tablets serves to produce the fizzy carbon dioxide and increase stomach tolerance; It is not an admixture of a substance in the sense of combination preparations, so it is not disadvantageous. It is particularly advantageous to take a so-called buffered preparation, which has a positive effect on the gastric symptoms of migraine (e.g. aspirin migraine).
Precautions:
ASA must not be taken if you have stomach and intestinal ulcers, narrowing of the airways, asthma, hives (urticaria) and blood clotting disorders.
Possible undesirable effects:
Stomach problems rarely occur. Hypersensitivity reactions such as skin rashes or shortness of breath, gastrointestinal bleeding or reduction 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
Application:
For children the dose is 500 mg and for adults 1000 mg.
The effect usually occurs after 30 to 60 minutes. If you vomit at the start of a migraine attack, it makes sense to use paracetamol as a suppository. Paracetamol is only partially suitable for stopping mild attacks, as the duration of action is short and the potency is often not sufficient.
Based on new study results, the administration of paracetamol to children should only be recommended to a very limited extent.
Precautions:
If you have liver or kidney disease, the dosage must be taken carefully (consult your doctor).
Paracetamol must not be used if there is glucose-6-phosphate dehydrogenase deficiency. Possible undesirable effects: Paracetamol is usually well tolerated. The following occur very rarely: hypersensitivity reactions, such as skin rashes or shortness of breath, changes in the blood count and a drop in blood pressure up to shock.
If at all possible, you should avoid taking paracetamol 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 asthma in childhood is increased if the mother took paracetamol during pregnancy. Evidence for the causal relationships is controversial. There are no better researched alternatives to paracetamol or ibuprofen. However, ibuprofen can only be used in the first six months of pregnancy.
ibuprofen or naproxen
The effectiveness of ibuprofen in treating migraine attacks is not as well studied as that of acetylsalicylic acid. The substance is available as a tablet, effervescent granules, suppositories and capsules. Ibuprofen is believed to be similar to acetylsalicylic acid and paracetamol in its pain-relieving effects. The single dosage is 200 mg for children and up to 600 mg for adults. Naproxen 500 mg is particularly effective in long attacks because of its long duration of action and can also be combined with triptans.
Effect:
Pain-relieving, anti-inflammatory, fever-reducing
Application:
Ibuprofen is available as a tablet, granular solution or suppository.
Naproxen is available as a tablet or suppository.
Precautions and undesirable effects:
The precautions and undesirable effects are not significantly different from those of acetylsalicylic acid.
Phenazone
A recent study confirmed that the drug phenazone, which has been used for many decades, can also have a good effect in the treatment of migraines. It is well tolerated by the stomach and can also reduce nausea and sensitivity to noise and light.
Effect:
Pain-relieving, fever-reducing
Application:
For children the dose is 500 mg and for adults 1000 mg. The effect usually occurs after 30 to 60 minutes. If you vomit at the beginning of a migraine attack, it makes sense to use Phenazone as a suppository.
Precautions:
If you have liver or kidney disease, the dosage must be taken carefully (consult your doctor).
Possible undesirable effects: Phenazone is usually well tolerated. The following occur very rarely: Hypersensitivity reactions such as skin rashes and changes in the blood count are possible in the event of an overdose.