Botox and Other Off-Label Treatments for Migraines

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Doctors also recommend behavioral techniques to prevent migraines, such as biofeedback and relaxation.

"When we treat difficult headaches, you really have to rely on both off- and on-label, since there aren't that many on-label drugs," said Saper.

The fact that there are so few approved medications doesn't surprise doctors.

"It's a very expensive process to get drugs approved, and the FDA is very strict," said Rapoport.

Migraines are a genetic disorder characterized by a severe, often-throbbing headache that's often accompanied by other symptoms, including sensitivity to light, nausea and vomiting.

Migraines typically start with something called a prodrome, which is a pre-headache phase that can start anywhere from several hours to several days before the onset of the headache. During prodrome, many people will experience a wide variety of sensations, including yawning, fatigue and depression. People tend to get migraines for most of their lives, and they can vary in frequency and severity.

Seven drugs are FDA-approved for acute treatment of migraines and four others for migraine prevention. Doctors say there are more than 30 other drugs they often prescribe or suggest that are off-label, but are sometimes more effective than the FDA-approved medications.

Among the approved acute treatment drugs are medications known as triptans, including Imitrex, Maxalt and Zomig. Excedrin Migraine is also approved, though doctors say it contains the same ingredients -- aspirin, acetaminophen and caffeine - as Extra Strength Excedrin.

The four FDA-approved preventive migraine treatments are propanolol (Inderal), timolol (Blocadren), divalproex sodium (Depakote) and topiramate (Topamax).

The Dangers of Migraine Medications

Opiates, such as Demerol, are also used for migraines. They are also off-label, and doctors say they may not be the best option.

"Opiates are approved for severe pain, but not migraines, and they don't work very well," said Rapoport.

They can also be dangerously habit-forming as migraine sufferers continue to take them but get no relief, said Saper.

Medication overuse, even when that medication doesn't include narcotics, is a common problem among migraine sufferers, doctors say.

"Most people with migraines realize it takes a lot to get it under control," said Kaniecki.

He added that there are two dangers of overtreatment - headaches can return, and too much of some medications can be toxic. Too much ibuprofen, for example, can cause kidney damage.

Overtreatment can be dangerous with drugs that are approved for migraines as well. Doctors say intake should be limited.

"If you take any of these drugs for aborting a headache more than three days a week, week after week and month after month, it will actually make headaches worse," said Saper. "That's the main cause of why headaches progress from occasional to frequent."

But for people who suffer from migraines, that's not their first concern.

"My headaches were so bad that all I could think about was getting rid of the pain. They lasted for 24 hours. I didn't care about anything else," said Trupin.

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