Migraine Management Essential 6: Rescue Treatment
In a comprehensive Migraine management regimen, rescue treatment is an essential element. Rescue treatments are those that are used to treat Migraine attacks when abortive medications have failed or cannot be used. (See Migraine Management Essential 5: Abortive Treatment.)
No treatment is effective 100% of the time, so it’s important to have a “rescue” treatment to use when our first-line treatment fails. This should be planned and prescribed in advance so we don’t need to call our doctors, make a trip to the office, or end up in the emergency room if our abortive treatment fails us.
Rescue treatment may be one medication, a combination of medications, or a combination of medications and comfort measures such as cold packs. Medications used as rescue medications generally won’t work to abort a Migraine attack. Their purpose is to give us relief from the headache and other symptoms until the Migraine attack ends and to do so at home, keeping us out of the emergency room.
Prescription strength nonsteroidal anti-inflammatory drugs (NSAIDs) are very commonly used as rescue medications. These include:
- indomethacin (Indocin),
- ketorolac (Toradol),
- ketoprofen (Orudis),
- meloxicam (Mobic),
- diclofenac potassium (Cataflam, Cambia) (Cambia is a new brand name of diclofenac potassium that comes in a powder that’s mixed with water to be taken so that it works more quickly than tablets. It has been FDA approved for the acute treatment of Migraine.), and
Muscle relaxants are another type of medication often used as rescue medications. These include:
- baclofen (Lioresal),
- carisoprodol (Soma),
- cyclobenzaprine (Flexeril),
- methocarbamol (Robaxin),
- tizanidine (Zanaflex), and
Since nausea and vomiting are such common Migraine symptoms, medications to treat nausea are often used, alone or in combination with other medications. These include:
- metoclopramide (Reglan),
- ondansetron (Zofran),
- prochlorperazine (Compazine),
- promethazine (Phenergan), and
Because research has shown that any use of opioids or barbiturates increases the risk of developing transformed Migraine, many doctors prefer to reserve the use of opioid pain relievers and barbiturates for use when other options have failed. They are, however, sometimes used as rescue treatments and include:
- compound medications with acetaminophen and codeine, hydrocodone, or oxycodone (Vidodin, Percocet);
- compound medications with butalbital (Fioricet, Fiorinal, Esgic);
- butorphanol (Stadol);
- hydromorphone (Dilaudid);
- meperidine (Demerol);
- nalbuphine (Nubain); and
As with many other elements of Migraine and Migraine treatment, rescue treatment can vary widely from one Migraineur to another and from one doctor to another. There are other types of medications that can be used as rescue treatments as well, depending on the preferences of both doctor and patient, including:
- medications for anxiety,
- sleep aids,
- antihistamines, and
Depending on your and your doctor’s preferences, what works for you, and your needs, rescue medications may be oral, suppository, nasal spray, or injectable. What’s important is that we have a rescue plan and treatment devised and in place before they’re needed.
If you haven’t been working with your current doctor very long, don’t be surprised if (s)he isn’t ready to work on rescue treatment with you. Selecting the right rescue treatment requires some experience with us and how we respond to treatments. It takes some time for our doctors to know which types of treatments we can handle too. Some of us can handle injecting ourselves, some don’t do so well. That said, rescue treatment is something our doctors should be willing to discuss from the beginning of our treatment, even if they’re not ready to choose rescue treatments until they’ve worked with us for a period of time.
It’s important to note that rescue treatments don’t always take the place of seeing a doctor or making a trip to the emergency room. If you’re having the worst Migraine ever, or if you’re experiencing new or frightening symptoms, it’s best to call your doctor or be checked out in the emergency room or an urgent care center.
How much has your migraine disease changed or evolved over time?