sedation or addiction or if you can’t take medication orally because you tend to vomit with your migraines. Like many other medications, this drug is more effective when injected than when swallowed in pill form. The injections are available in convenient, prefilled syringes, but the needle is large. Individual vials are now available.
TYPICAL DOSE : When injected, 60 mg is a typical dose, which may be repeated in an hour if needed. No more than 120 mg per day, only once a week.
SIDE EFFECTS : Stomach upset or pain, occasional sedation. Possible liver or kidney problems; people with any liver or kidney impairments should not take ketorolac; older people should use it very cautiously.
3. C ORTICOSTEROIDS
Cortisone (either pill or injection) is one of the most effective medications for severe, prolonged migraines and menstrual migraines, but it can only be taken in small doses and for brief periods of time. Long-term use of cortisone can cause serious side effects, such as weight gain, adrenal gland suppression, and predisposition to fractures and liver failure.
Dexamethasone (Decadron) and prednisone are oral medications; Depo-Medrol is administered by injection.
TYPICAL DOSE : One tablet or a half, usually 20 mg prednisone or 4 mg Decadron, taken with food, and repeated every four to six hours as needed. No more than three tablets per month. None of the corticosteroids should be taken with NSAIDs, or gastrointestinal bleeding can occur.
When migraines are triggered by flying, a half or whole Decadron or prednisone pill should be taken a half hour before flight time. For altitude migraines, take one pill a half hour to an hour before your plane arrives in a high-altitude city or before you reach a high summit. Take another pill four hours later. The dose can be repeated for two days.
For severe, prolonged migraines, Depo-Medrol injections (40 to 80 mg) may help, but limit to once per two months at most.
SIDE EFFECTS : Possibly nausea, insomnia, stomach upset, nervousness, and facial flushing. Occasional weight gain or water retention. More rarely, fatigue or agitation.
4. N ARCOTICS AND S EDATIVES
When triptans, DHE, ergotamine, ketorolac, or one of the corticosteroids doesn’t help or causes too many side effects, a strong narcotic, usually given with an antinausea medication, may be the answer. Doctors may be somewhat more reluctant to use these medications because of their potential for nausea as well as for abuse that can lead to addiction. Typically, these medications can calm you and induce sleep. They are useful only for one to three days and shouldn’t be used every day unless every other method for controlling daily headaches has failed. (See the section on addiction versus dependence earlier in this chapter.)
• M ILD N ARCOTICS
The milder narcotics, or opioids, can be taken by mouth.
—A CETAMINOPHEN WITH C ODEINE (T YLENOL 3, WITH 30 MG C ODEINE, AND T YLENOL 4, WITH 60 MG CODEINE ) has no aspirin and therefore induces less nausea.
—A SPIRIN WITH C ODEINE contains aspirin (which is good for migraines) and codeine, but also tends to induce nausea.
—H YDROCODONE WITH A CETAMINOPHEN (V ICODIN , Z YDONE , N ORCO, AND L ORCET ) is well tolerated for a narcotic medication. Zydone and Norco contain less acetaminophen.
—V ICOPROFEN contains 750 mg hydrocodone plus zoo mg ibuprofen. This is an effective combination but may lead to stomach upset. More effective than Vicodin.
TYPICAL DOSE : One every four to six hours, as needed.
SIDE EFFECTS : Nausea, sedation, addiction.
—P ROPOXYPHENE (D ARVON OR D ARVOCET ) is sometimes helpful for migraine sufferers when the other mild narcotics aren’t. As with many medications, each person responds differently.
TYPICAL DOSE : One or two pills every three or four hours, as needed. Limit to six pills per day at most.
SIDE EFFECTS : Nausea, sedation, addiction.
—T RAMADOL (U LTRAM ) is an excellent milder painkiller. Ultram has combined
TYPICAL DOSE : When injected, 60 mg is a typical dose, which may be repeated in an hour if needed. No more than 120 mg per day, only once a week.
SIDE EFFECTS : Stomach upset or pain, occasional sedation. Possible liver or kidney problems; people with any liver or kidney impairments should not take ketorolac; older people should use it very cautiously.
3. C ORTICOSTEROIDS
Cortisone (either pill or injection) is one of the most effective medications for severe, prolonged migraines and menstrual migraines, but it can only be taken in small doses and for brief periods of time. Long-term use of cortisone can cause serious side effects, such as weight gain, adrenal gland suppression, and predisposition to fractures and liver failure.
Dexamethasone (Decadron) and prednisone are oral medications; Depo-Medrol is administered by injection.
TYPICAL DOSE : One tablet or a half, usually 20 mg prednisone or 4 mg Decadron, taken with food, and repeated every four to six hours as needed. No more than three tablets per month. None of the corticosteroids should be taken with NSAIDs, or gastrointestinal bleeding can occur.
When migraines are triggered by flying, a half or whole Decadron or prednisone pill should be taken a half hour before flight time. For altitude migraines, take one pill a half hour to an hour before your plane arrives in a high-altitude city or before you reach a high summit. Take another pill four hours later. The dose can be repeated for two days.
For severe, prolonged migraines, Depo-Medrol injections (40 to 80 mg) may help, but limit to once per two months at most.
SIDE EFFECTS : Possibly nausea, insomnia, stomach upset, nervousness, and facial flushing. Occasional weight gain or water retention. More rarely, fatigue or agitation.
4. N ARCOTICS AND S EDATIVES
When triptans, DHE, ergotamine, ketorolac, or one of the corticosteroids doesn’t help or causes too many side effects, a strong narcotic, usually given with an antinausea medication, may be the answer. Doctors may be somewhat more reluctant to use these medications because of their potential for nausea as well as for abuse that can lead to addiction. Typically, these medications can calm you and induce sleep. They are useful only for one to three days and shouldn’t be used every day unless every other method for controlling daily headaches has failed. (See the section on addiction versus dependence earlier in this chapter.)
• M ILD N ARCOTICS
The milder narcotics, or opioids, can be taken by mouth.
—A CETAMINOPHEN WITH C ODEINE (T YLENOL 3, WITH 30 MG C ODEINE, AND T YLENOL 4, WITH 60 MG CODEINE ) has no aspirin and therefore induces less nausea.
—A SPIRIN WITH C ODEINE contains aspirin (which is good for migraines) and codeine, but also tends to induce nausea.
—H YDROCODONE WITH A CETAMINOPHEN (V ICODIN , Z YDONE , N ORCO, AND L ORCET ) is well tolerated for a narcotic medication. Zydone and Norco contain less acetaminophen.
—V ICOPROFEN contains 750 mg hydrocodone plus zoo mg ibuprofen. This is an effective combination but may lead to stomach upset. More effective than Vicodin.
TYPICAL DOSE : One every four to six hours, as needed.
SIDE EFFECTS : Nausea, sedation, addiction.
—P ROPOXYPHENE (D ARVON OR D ARVOCET ) is sometimes helpful for migraine sufferers when the other mild narcotics aren’t. As with many medications, each person responds differently.
TYPICAL DOSE : One or two pills every three or four hours, as needed. Limit to six pills per day at most.
SIDE EFFECTS : Nausea, sedation, addiction.
—T RAMADOL (U LTRAM ) is an excellent milder painkiller. Ultram has combined
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