Abortive medications would be Triptans - these are the kind of gold standard. Things such as Imitrex, Maxalt, Zomig, there's 9 different Triptans on the market. Even if you failed one, it doesn't mean that you would fail or have a side effect to another and it may take a while to figure out which one is the best for you. Other options: maybe nonsteroidal antiinflammatories - things you have in the cabinet: Ibuprofen, Naproxen, aspirin, things of those nature. However, you have to be careful about those medications as they can cause a bounce-back or rebound headache if you use them too often. Most commonly, I see people prescribed Fioricet or Fiorinal (the generic name is Butalbital with other ingredients along the list.) You have to be very, very cautious with this medication because it has multiple medications in it. It's the most common medication that can cause a bounce-back or rebound headache. I'm not saying that patients are addicted or dependent on this medication, but the brain gets used to having those chemicals and it can actually make the headache worse long term. Actually, so can Excedrin. Other options for treatment include physical therapy, which can be sometimes beneficial - it kind of depends on the patient and where their pain is at. I get often asked about manipulation or chiropractic treatment, which is fine, except that we don't like fast manipulation of the neck (so only gentle manipulation) and I'm very cautious about manipulation the neck whatsoever because it depends on arthritis and other conditions of the neck. I'm very cautious to ever recommend that. Fast manipulation of the neck can actually increase your risk of stroke. I also do some therapies here in the office, sometimes if you're having a very bad migraine just to try and break that headache cycle. Those can include a short burst of steroids that I may prescribe. Those may include coming into the office for an injection such as Toradol or an Imitrex injection or even a nausea medication. Those may also include coming in for nerve injections, so sometimes I'll actually give a shot in the various places that you're having pain and try and actually numb up that nerve temporarily.
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