People who suffer from migraines (severe, debilitating headaches that are accompanied by other symptoms like nausea and vomiting) may be willing to try anything to relieve their throbbing pain. That is, until they learn that historic treatments for migraines have included rubbing fried fish on the side of one’s head and removing parts of a patient’s skull.

Although people have used a variety of treatments for migraines throughout history, fortunately for present-day migraine sufferers, there are now several types of medications used to treat migraines. While there is no cure for migraines, these medications can relieve migraine symptoms and can also be used to prevent these headaches before they occur. Different treatment strategies work better for different people depending on a variety of factors. Thus, it is important for doctors and patients to communicate with each other to determine the most effective treatment strategies.

Approximately 29.5 million Americans suffer from migraines, which are repeated headaches that cause significant pain along with other symptoms. Migraine symptoms can be so severe that they prevent people from performing their normal, daily activities. These symptoms vary from person to person but can include moderate to serve pain that occurs on one side of the head or both sides, head pain that pulses or throbs, nausea, vomiting, sensitivity to light and sound, changes in vision (blurred vision), and lightheadedness.

Some people who experience migraines experience premonitions called prodromes (fatigue or mood changes) hours or days before a migraine attack. People with migraines can also experience auras, which are sensory warning signs that often occur less than an hour before the migraine attack begins. Symptoms of auras include visual disturbances (blind spots and appearance of flashes, wavy lines, dots, or flashing lights), confusion, difficulty speaking, and tingling in the arms, legs, or face. People may experience prodromes, auras, both, or neither when they have migraines.

Migraines often begin in childhood, adolescence, or early adulthood and affect people most severely at younger ages. Women are also three times more likely to experience migraines than men are. This may be because estrogen (a chemical produced in the ovaries that is involved in the female reproductive cycle) affects levels of serotonin, a chemical thought to play a role in causing migraines.

The frequency of migraines varies from one person to another - some people may experience several migraines a month, while others may only experience a few per year. Each migraine attack typically lasts from four to 72 hours if it is not treated, but attacks can last longer than that.

Migraines are not a new condition, and people have suffered from them for thousands of years. Throughout history, people have come up with a variety of strategies for treating migraines. Some of these treatments have included the following:

• Trepanation (a kind of neurosurgery where circular pieces of the skull are removed) was used to treat migraines as early as 8500 B.C. and as late as the 1600’s. This procedure was thought to treat migraines because it allowed the evil spirits inside the head that caused the headaches to escape.

• Around 1200 BC, an Egyptian migraine treatment instructed one to tie a clay crocodile holding grain in its mouth to his or her head using a strip of linen. The names of the gods that Egyptians believed could cure them of their ailments were written on the strip of linen as well. This treatment may actually have relieved some of people’s headache pain by compressing the scalp and causing the blood vessels leading to the brain to constrict.

• Prior to the clay crocodile cure, Egyptians rubbed fried fish on their heads where they were experiencing pain to try to relieve headaches.

• During the Middle Ages in Europe, migraine treatment included rubbing a mixture of opium and vinegar on the head. Europeans thought that the vinegar would open the pores in the head so that the opium could be absorbed.

• In the late 1770s, British physician Erasmus Darwin suggested that migraines should be treated by spinning patients around in a machine called a centrifuge. He believed that migraines were caused by blood vessels in the brain expanding and that spinning patients around would force the blood from their heads to their feet.

• In the 1880s, physician William Gowers wrote a textbook called A Manual of Diseases of the Nervous System where he advocated treating migraines with a mixture of nitroglycerin in alcohol and other substances. Gowers also recommended treating migraines with marijuana.

Currently, there are two different categories of medications used to combat migraines – pain-relieving medications and preventative medications.

Pain-Relieving Medications: Medications in this category (also called acute treatment or abortive treatment) are taken during migraine attacks to stop the migraines or to relieve symptoms once they have already begun.

Ergot Derivatives: In 1938, researchers discovered that an ergot derivative called ergotamine could stop migraine attacks by constricting blood vessels. As a result, ergot derivatives (medicines derived from rye fungus) became the first drugs specifically designed to treat migraine attacks. However, these drugs affect blood vessels throughout the body, and thus can cause serious side effects. Currently, doctors prescribe ergot derivatives infrequently because of the serious side effects and typically use these medications in cases where patients do not respond to or experience side effects from other medications.

Triptans: In an effort to create a medication that worked similarly to ergot derivatives but with fewer side effects, doctors developed triptans in the early 1990s. Triptans (also called selective serotonin receptor agonists) work by increasing levels of serotonin, which causes blood vessels to constrict and reduces inflammation. For many people with severe migraines, triptans are the recommended treatment because they relieve pain, nausea, and sensitivity to light and sound quickly without causing serious side effects in most people.

However, because they do cause blood vessels to narrow like ergot derivatives, they are not recommended for patients who are at risk for strokes or heart attacks. Also, although triptans relieve symptoms quickly (patients may see improvements in as little as five minutes after taking this type of medication), patients’ headaches may return within 24 hours of taking these drugs. One other potential drawback of triptans is that they are usually expensive.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): These medications, such as ibuprofen, are pain relievers that help to alleviate mild to moderate migraine pain by decreasing inflammation. However, NSAIDs are not effective by themselves for treating severe migraines, though. Also, if patients take these drugs too often or for long periods of time, they may experience side effects like ulcers, gastrointestinal bleeding, and rebound headaches (when the initial headache returns as soon as the medication wears off).

Rescue Medications. For some people with migraines, other pain-relieving medications do not work effectively enough. Rescue medications are used as a last resort when other drugs fail to relieve migraine pain. Many medications can be considered rescue medications. For example, opioids (or narcotics such as codeine) can be used as rescue drugs because they are powerful pain relievers. However, people should be careful about taking opioids frequently because they are habit-forming (addictive). If people with migraines find that they are using rescue medications more than twice per month, they should talk to their doctors about trying to find more effective first-line migraine medications or using preventative medications.

Medications in this category are taken frequently (often daily) to reduce the severity and frequency of migraines before they occur. Most preventative medications were actually developed to treat other conditions, such as seizures, depression, or high blood pressure and coronary heart disease. Patients are good candidates for preventative medications if they have frequent migraine attacks or less frequent attacks that are very debilitating. Preventative medications may also help patients whose symptoms have not been alleviated by pain-relieving medications, patients who have experienced serious side effects from pain-relieving drugs, and patients who have other medical conditions that make taking pain-relieving medications dangerous. Examples of preventative medications include:

Cardiovascular Drugs: These medications, including beta blockers and calcium channel blockers, are typically used to treat high blood pressure and coronary heart disease. However, they can prevent migraines and reduce the length and severity of migraines as well. Researchers do not understand exactly how these drugs accomplish this, but it may have something to do with the way these medications improve blood flow.

Antidepressants: Typically used to treat people with depression, these medications, such as tricyclic antidepressants and serotonin and norepinephrine reuptake inhibitors (SNRIs), may help prevent migraines because they regulate serotonin levels.

Anti-Seizure Drugs: These medications are usually prescribed for people with epilepsy (a disorder that causes seizures), but they also seem to reduce the frequency of migraines. Doctors do not completely understand why these medications have an effect on migraines, but they may impact these headaches because they increase levels of certain neurotransmitters and reduce pain impulses.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): These medications may also prevent migraines in addition to relieving migraine pain once attacks have already begun. Doctors are not sure how NSAIDS may reduce the frequency of migraines, though.

Determining the Right Treatment Strategy

Throughout history, people have used a variety of methods for treating migraines. Currently, there are many different medication options to stop migraines once they have started and also to prevent these headaches before they occur. Doctors recommend certain drug therapies to patients depending on the frequency and severity of their migraines, the degree that the migraines interfere with patients’ normal activities, patients’ other medical conditions, and the potential side effects of the medications. Patients can help their doctors make the best treatment recommendation by providing as much information as they can about their headaches and their medical histories.