Migraine is a debilitating neurological disease affecting millions worldwide, often leading sufferers on a complex journey to find effective relief. While various treatments can help manage migraine attacks, certain medications may actually increase migraine symptoms.
Understanding which medications can potentially increase migraine attacks or symptoms is crucial for anyone managing this neurological disease. In this article, we will explore seven types of medications that can inadvertently exacerbate migraine attacks.
Before we dive in, it’s important that you not change your medications without the consultation and advice from your doctor. This information is for educational purposes and not medical advice nor a substitute for medical advice.
** While Migraine Strong writes about the latest in migraine treatments, this is not medical advice. We are patient educators and all information you read should be discussed with your doctor.
1. Selective Serotonin Reuptake Inhibitors (SSRIs)
Selective Serotonin Reuptake Inhibitors (SSRIs) are commonly prescribed for the effective treatment of depression and anxiety disorders. These medications work by increasing serotonin levels in the brain, which can have varying effects on different individuals. For some migraine sufferers, SSRI medications can deliver the opposite effect intended, potentially increasing migraine attacks instead of alleviating them.
The relationship between serotonin and migraine attacks is complex, and while increased serotonin levels can stabilize mood for many, they can also lead to an imbalance that triggers migraine attacks in susceptible individuals. A recent study also showed that SSRIs were no better at treating migraine than placebo. (4) It’s essential to monitor migraine patterns when starting or adjusting SSRIs and discuss any changes with your healthcare provider.
SSRIs can be very effective in treating anxiety, depression and other conditions, which are common co-morbidities with migraine. While the potential of these medications to increase migraine attacks is there, it’s won’t be a trigger for everyone.
2. Proton Pump Inhibitors (PPIs)
Proton Pump Inhibitors (PPIs) are used to treat conditions like acid reflux and gastroesophageal reflux disease (GERD). They work by reducing the amount of acid produced in the stomach.
However, a significant issue with PPIs is their long-term use. Many people continue using these medications even after their symptoms have resolved. Long-term, regular use of PPIs has been associated with an increased risk of triggering migraine attacks.
It’s best to use PPIs intermittently and only as needed. For more insights on this topic, you can check out our live discussion about PPIs and migraine available on our Instagram grid.
A recent study found a strong association between these medications and migraine, showing a 70% increase of migraine attacks in people on PPIs and a 40% increase in those on H2 blockers. It also showed that other acid-suppressing medications such as famotidine and other H2 blockers as well as generic antacids are also implicated in the findings. (3)
Years ago, I didn’t know that PPIs could be a migraine trigger and I was just so thankful to have a medication that could treat my severe GERD. Having an intractable migraine attack that lasted for years was hard enough without intolerable reflux as well. When I finally came off of the omeprazole, with the help of my doctor, my extended migraine attack finally responded to medication and diet changes.
I have tested omeprazole again over the years and it consistently triggers an attack for me. Oddly, I tolerate pantoprazole, another PPI, very well. If you feel like a PPI you are taking could be a migraine trigger, talk with your doctor about other options.
3. Nasal Steroids and Decongestants
Nasal steroids and decongestants are commonly used to treat allergies and nasal congestion. However, extended use of these medications, particularly intranasal corticosteroids, has been shown to trigger migraine attacks.
These medications can cause rebound congestion and headaches when used continuously over extended periods.(1) It’s crucial to use these medications as directed and to discuss alternative treatments with your healthcare provider if you find yourself relying on them frequently. Migraine as a potential side effect of intranasal corticosteroids. (2)
If nasal corticosteroids are a personal trigger for migraine, the migraine symptoms will usually present within 4 days of beginning the course of treatment. This is a common response for a few members of my family.
4. Oral Contraceptives
Oral contraceptives can have a dual effect on migraine attacks. Some women taking low-dose contraceptives may find an improvement in their migraine attacks, especially menstrual-related headaches. However, for others, hormonal fluctuations caused by these contraceptives can trigger migraine attacks.
Dr. Andrew Charles, speaking at the Migraine World Summit, recommended working closely with your primary care doctor or gynecologist to find an effective low-dose contraceptive and using it continuously to minimize hormonal fluctuations.
Taking the pill continuously avoids the drop in estrogen when taking the placebo pills. This drop in estrogen is thought to be the trigger for hormonal migraine attacks. (5) Individual responses to oral contraceptives vary, so it may take some time to find the most suitable option.
5. Hormone Replacement Therapy (HRT)
Hormone Replacement Therapy (HRT) is often used to relieve common symptoms associated with menopause, such as hot flashes, vaginal dryness, night sweats, and bone loss. Like oral contraceptives, HRT alters estrogen levels through the use of pills or patches. However, taking too high a dose of HRT can trigger migraine attacks.
To optimize HRT dosage and minimize migraine attack risk, it is advisable to consult a menopause specialist. Staying informed, through resources like OBGYN Dr. Mary Claire Haver on Instagram, can also provide the latest information and guidance on managing menopause symptoms without exacerbating migraine attacks.
Her recent and exceptional book called The New Menopause helps to educate women on perimenopause and menopause. We have enjoyed reading her book because of the great information it contains as well as being up to date on all of the latest research and treatment guidelines.
6. Opioids & Barbiturates
Opioids and barbiturates are powerful pain medications sometimes used to treat severe migraine pain when other specific migraine medications are ineffective. However, their use can lead to a heightened response to pain, a phenomenon known as medication overuse headache (MOH) more recently renamed medication adaptation headache (MAH). (6)
Instead of relieving pain, these medications can make it worse over time, leading to chronic daily headaches. This paradoxical effect occurs because opioids and barbiturates can alter the brain’s pain pathways, making the body more sensitive to pain signals.
Due to the risk of dependency and increased migraine attack frequency, it is generally recommended to use these medications sparingly and under strict medical supervision. Most specialists agree that use of these medications more than four days a month can lead to increased attacks.
7. Medication adaption headache (MAH)
Medication Adaptation Headache (MAH) is a common issue among individuals who frequently use over-the-counter or prescribed medications to relieve acute headache pain. MAH typically occurs in patients with an underlying migraine or headache disorder, transforming episodic headaches into chronic daily headaches.
MAH can also complicate treatment for chronic migraine as it may become difficult to differentiate between head pain from the underlying neurological disorder of migraine versus head pain from frequent use of acute medications.
The cycle of taking medication to relieve headaches, only to experience rebound headaches as the medication wears off, can be challenging to break. To prevent MAH, it is crucial to limit the use of acute headache medications and work with a healthcare provider to develop a comprehensive migraine management plan. (6) This will include both preventive medications and an acute medication not already being taken.
Conclusion
Managing migraine attacks effectively often requires a nuanced approach, especially when it comes to medication use. While certain medications can provide relief for various health conditions, they may also inadvertently increase migraine attacks or symptoms. Being aware of the potential risks associated with SSRIs, PPIs, nasal steroids, oral contraceptives, HRT, opioids, and the risk of MAH can help you make informed decisions about your treatment options.
For more personalized support and up-to-date information on managing migraine attacks, stay connected with Migraine Strong in our private Facebook group and on Instagram. We look forward to chatting with you!.
**Always consult with your healthcare provider before making any changes to your medication regimen and consider seeking specialized care when dealing with complex cases of migraine management.
References:
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4111119/
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9392821/
3. https://www.neurology.org/doi/10.1212/CPJ.0000000000200302
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6513227/
5. https://www.ccjm.org/content/84/8/631
6. https://my.clevelandclinic.org/health/diseases/6170-rebound-headaches
Important information- thank you!
Linda