Why You Need to Experiment With Migraine Medication

Make sure you find a good medication match for you. The drugs used to prevent and abort migraines can have side effects, but migraine patients shouldn't simply accept these as the price of using effective drugs. Taking the time to try different medications and talking with your doctor can help you find an effective treatment with the least amount of side effects.

The anticonvulsant topiramate (brand name Topamax), used as a preventive and taken once or twice daily, may cause mental fogginess and difficulties with memory. Beta-blockers, also prescribed as a preventive, can cause fatigue. But you may not have to live with those kinds of side effects.

"If I have you on a beta-blocker," says Larry Newman, MD, director of the Headache Institute at St. Luke's-Roosevelt Hospital Center in New York City, "and you tell me that your headaches are completely gone, but you are so exhausted you can no longer work out anymore, I don't say, 'Oh at least your headaches are gone.'"

Instead, Dr. Newman moves on to a different drug, seeking the right balance of relief and minimal side effects.

New treatments are emerging

These days relief can come from surprising places. Botox, the same nerve toxin that causes the potentially fatal food poisoning called botulism, and made famous as a temporary wrinkle smoother, is now providing relief for some migraine patients. In particular, it is prescribed off-label for chronic migraines—headaches that occur more than 15 days a month. Although Botox was once thought to work by numbing muscles in the face and head, it's now believed that it probably affects nerve endings by blocking any transmission of pain from them.

Jenny DeFino, 36, of Yonkers, N.Y., had found relief during a clinical trial of Botox injections, and since then has been able to continue the treatment by prescription, with one shot every 11 weeks. "It's a little stinging sensation, but it's nothing compared to what the headaches would be," says DeFino. "I now only get migraines two or three times a month, and I feel great. I would have paid anything to have this quality of life back. It's terrific."

Communication is key

Press your doctor to investigate the full range of therapies, and if she or he lacks experience, find a headache specialist.

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