Headache rescue medication
Reviewing rescue medication and tolerance
We typically divide episodic treatments into abortive medication and rescue medication. Here we discuss rescue medication.
Most rescue medications are pain medications. Rescue medications won’t abort a migraine, but hopefully they will mask the pain for a few hours until the migraine runs its course. Rescue medications are intended for use in cases of abortive medicine failure. They also are needed when one can’t take the abortive medications, for instance when the time frame for treatment with an abortive agent has passed.
Common rescue medications for headaches
Common rescue medications include opioids, the antipsychotic olanzapine, and the opioid agonist-antagonist tramadol, which has serotonin and norepinephrine effects.
Rescue drugs can be used in isolation or in combination with triptans, for instance when there is frequent rebound on a triptan.
Fioricet (combination of acetaminophen, butalbital, and caffeine) and Amidrine (acetaminophen, dichloralphenazone and isometheptene) are examples of combination medicines that have been used as rescue medications. When used in this complimentary manner, keep in mind that an adequate dose is necessary.
Over-the-counter medications
Some patients find that, if taken early, some over-the-counter medications can be effective, for example, Paracetamol (acetaminophen), and combinations with caffeine and aspirin, and some nonsteroidal anti-inflammatory drugs (NSAIDs).
Toradol (ketorolac)
Toradol injections can be used to treat acute headaches and some patients can administer this drug themselves intramuscularly or subcutaneously
Corticosteroids
Years of experience suggest that in the acute setting, corticosteroids can be helpful to ameliorate acute migraine headache. However, there is not much direct evidence of its efficacy and even less as to mechanism of action. The presumed effect is on perivascular neurogenic inflammation in the meninges caused by the trigeminal complex cascade.
Dexamethasone (4 mg) has been used with success. Prednisone, starting with a high dose followed by a rapid taper over 10 days can also be effective.
Triptans
Triptans will relieve nausea in many patients. When they do not, antiemetics are helpful. These drugs antagonize dopamine receptors and thus can treat migraine directly, decreasing pain.
This is an edited excerpt from the Medmastery course Headache Masterclass by Robert Coni, DO, EdS, FAAN. Acknowledgement and attribution to Medmastery for providing course transcripts.
- Coni R. Headache Masterclass. Medmastery
- Coni R. Clinical Neurology Essentials. Medmastery
- Simmonds GR. Neurology Masterclass: Managing Common Diseases. Medmastery
- Simmonds GR. Neurology Masterclass: Managing Emergencies. Medmastery
References
- The International Classification of Headache Disorders 3rd edition
- Rizzoli PB. Acute and preventive treatment of migraine. Continuum (Minneap Minn). 2012 Aug;18(4):764-82
- Mauskop A. Nonmedication, alternative, and complementary treatments for migraine. Continuum (Minneap Minn). 2012 Aug;18(4):796-806.
- Parikh SK, Silberstein SD. Calcitonin gene-related peptide monoclonal antibodies. Practical Neurology. 2018; 17: 20–22.
- Tepper SJ, Tepper DE. Neuromodulation and headache. Practical Neurology. 2018; 17: 42–45.
- Natekar A, Malya S, Yuan H, Nahas S. Migraine Preventative Therapies in Development. Practical Neurology. 2018; 17: 54–57.
- Blumenfeld AM. Botox for chronic migraine: Tips and tricks. Practical Neurology. 2018; 17: 27–36
- Halker Singh RB, Starling AJ, VanderPluym J. Migraine acute therapies. Practical Neurology. 2019; 17: 63–67
- Krel R, Mathew PG. Procedural treatments for headache disorders. Practical Neurology. 2019; 17: 76–79.
- Motwani M, Kuruvilla D. 2019. Behavioral and integrative therapies for headache. Practical Neurology. 2019; 17: 85–89
Neurology Library: Headache – Treatment
- Coni R. Headache treatment. LITFL
- Coni R. Headache treatment: Prophylactic medication. LITFL
- Coni R. Headache treatment: Prophylactic medication (2). LITFL
- Coni R. Headache treatment: Abortive medication. LITFL
- Coni R. Headache treatment: Rescue medication. LITFL
- Coni R. Headache: Diagnostic challenge. LITFL
Neurology Library
Robert Coni, DO, EdS, FAAN. Vascular neurologist and neurohospitalist and Neurology Subspecialty Coordinator at the Grand Strand Medical Center in South Carolina. Former neuroscience curriculum coordinator at St. Luke’s / Temple Medical School and fellow of the American Academy of Neurology. In my spare time, I like to play guitar and go fly fishing. | Medmastery | Linkedin |
BMBS (The University of Nottingham) BMedSci (The University of Nottingham). Emergency Medicine RMO at Sir Charles Gairdner Hospital Perth, WA. Interested in Medical Education and Emergency Medicine. Swimmer and frequent concert attendee.