Medication for migraine attacks with severe disability
In the acute treatment of a severe migraine attack, various situations can be distinguished:
- General measures
- Warning signs of a migraine
- Treatment of a migraine attack
- Emergency treatment of migraine by a doctor
- Measures to take if the migraine attack lasts longer than three days
General measures
As with mild migraine attacks, you should, if possible, immediately retreat to a quiet, dark room and try to relax.
Warning signs
Many migraine sufferers are familiar with warning symptoms of a migraine attack. Such symptoms can include, for example:
- Mood swings in the sense of irritability
- Especially great enthusiasm
- Hyperactivity and high motivation
- Excessively good mood
- Increased appetite, especially for sweets
- pronounced yawning
- depression
Such warning symptoms appear in over a third of migraine patients up to 24 hours before the onset of a migraine attack. If you suspect an impending migraine attack based on these warning symptoms, you should try to counteract it with behavioral medicine measures as soon as possible.
These can include: relaxation techniques, taking extra breaks, establishing a regular daily routine, taking an extra sachet of fast-acting magnesium citrate, going to bed on time, eating a small carbohydrate-rich snack before bed to mitigate the drop in blood sugar during the night, getting as much rest as possible, and trying to avoid avoidable triggers.
If migraine attacks occur very regularly in connection with menstruation, you can proceed in the same way 24 hours before the expected period.
Treatment of migraine attacks with severe disability
A severe migraine attack is present when the initial treatment regimen for mild migraine attacks, using self-medication (see last chapter), proves insufficiently effective. Severe migraine attacks are also present when pronounced individual aura symptoms or combinations of several aura symptoms occur at the outset. Severe disability is also characterized by long and frequent attacks, frequent and prolonged absence from work, or an inability to participate in social life.
Severe migraine attacks are now treated very successfully with
- selective 5-HT agonists, the triptans, are treated.
Ergotamines – no longer up to date
Until 1993, ergotamines (ergot alkaloids) were the only effective treatment for severe migraine attacks. They were available in tablet, suppository, and inhalation spray form. However, ergotamines are no longer used in modern migraine therapy because frequent use can very quickly worsen the frequency and intensity of migraine attacks! This can easily lead to constant, daily headaches—the aforementioned medication-induced chronic headache. Furthermore, discontinuing ergotamine causes withdrawal headaches. Therefore, those affected must continue taking ergotamine, increasing the dosage over time, to avoid these withdrawal headaches.
Long-term therapy can also lead to severe circulatory disorders in various organs, usually initially affecting the arms and legs. These circulatory disorders can have very serious consequences, even resulting in a fatal heart attack. Organs can also die, or fistulas can develop in various organs. Furthermore, ergotamines very frequently cause nausea and vomiting. Their effectiveness in treating migraines is also very weak. For all these reasons, ergotamines are now only used for treating migraines in rare, exceptional cases.