Ways to Break That Migraine
If you’ve had chronic migraine at any point in life chances are you’ve had at least a brush with status migraine, intractable migraine, or have developed a medication over use headache (formerly known as rebound).
Intractable Migraine – Is a migraine which is not responding to traditional treatment.
Status Migraine – A debilitating migraine that lasts over 72 hours.
Medication Overuse Headache – Develops when medications are overused for the treatment of migraine.
There are multiple ways to treat these pesky migraines, what might work for you may be different than what works for someone else. We are still in the process of understanding migraine well enough to know what treatment to break a migraine is likely to be effective for a given individual.
DHE is a partially synthetic form of Ergotamine. It has been shown to be less likely to cause Medication Overuse Headache than triptans, and it has also been shown to be successful at treating migraine later into an attack.
DHE is given via IV, injection, or nasal spray. Inpatient and clinic settings most often use DHE by IV. DHE often causes severe nausea and usually given with Reglan or another anti-emetic.
Both oral and IV steroids are popular means of breaking migraines. IV steroids are readily available in most ERs and one IV treatment with a steroid (usually Dexamethasone) assists in resolving a migraine.
Oral steroids also can be effective the most common being Prednisone. Prednisone however needs to be tapered down in dose over time. Oral Dexamethasone is a more targeted steroid and can be taken over a period of days, versus Prednisone which can take several weeks.
There have been multiple studies showing that the anti-seizure medication Depakote can resolve migraines when given through IV. Usually it is given through one IV treatment in a headache clinic infusion center, or an inpatient treatment unit which specializes in migraine.
- Intravenous Valproate Acid Resolves Migraine Quickly (Headache)6
- Intravenous Valproate Sodium Injection for Prolonged Migraine Headache (Chicago Headache Clinic)7
Ketamine is a powerful anesthetic medication. Ketamine is usually only used for migraine treatment when other methods of stopping an ongoing migraine have failed.
Ketamine often needs to be given in an inpatient setting due to the high potential for side effects and complications. However, it has some promising research.
- For Refractory Migraine Consider Ketamine (MPR)8
- Ketamine for Migraine Management (Migraine.com)9
- Ketamine Drug Info (Drugs.com)10
Lidocaine is another powerful anesthetic and can only be used in inpatient settings for the treatment of migraine. It can cause severe side effects such as hallucinations and can cause complications. However, it has promising data and is given by specialized headache centers when other methods have failed.
- New Article on Ketamine and Migraine (Time.com)11
- Lidocaine (National Headache Foundation)12
- Intranasal Lidocaine for Migraine (Headache)13
If you’ve had ongoing issues with a migraine that just won’t go away and these options are not being offered to you it is likely time to get a neurologist who is a headache specialist, or more ideally begin working with a Headache Clinic.
Also, it may be worth reading the Agency for Healthcare Research and Quality summary on Treatment of Acute Migraine in the Emergency Setting14.
- existential.rip/ergotamines-dhe-for-migraine/ 4