When debilitating pain strikes frequently, safe effective medication becomes a vital part of daily life. Most migraine medication is taken orally, and whilst effective in many cases it can lead to problems for others. Topical medications can provide an additional or alternative treatment, with recent research indicating these may become more widely used in the future.
What Are Topical Migraine Medications?
Topical drugs provide medication without the need to swallow tablets or medicine. Instead, they are massaged into the skin and once absorbed they provide pain relief to the affected areas. Many are available without prescription and coming cream or gel forms. They are probably most familiar in the form of treatments for muscle aches and strains.
There are over-the-counter topical medications and prescription strength topicals, available as patches as well as creams or gels.
Over-the-counter topical medication typically contains methanol and methyl salicylate. The warming and cooling effect on the skin creates a distraction from the pain, providing relief. They can be used together with ice packs, which can often provide effective migraine relief.
Prescription strength topical medication contains drugs that are more potent, and these should only be used under strict medical supervision. An example is the fentanyl transdermal patch (Duragesic) that contains a strong opioid.
Incorrect use of this patch can have severe consequences, with overdose risks that could even lead to death. It is only prescribed for people who need relief around the clock from severe pain and should not be used by anyone without a prescription. Even those who do have a prescription should use this drug with extreme caution, following instructions precisely.
Choosing between Patches, Gels Or Creams
Gels and creams are generally applied several times a day, which some people may find problematical. On the other hand, some find that patches cause rashes, or don’t stay stuck where they are attached. For migraine sufferers using a topical medication that’s applied to the area of pain, creams and gels are more practical (and less noticeable) than a patch on your temple.
Why Topical Treatments Could Help with Headache Frequency
Topical pain treatments could help migraine sufferers avoid medication overuse headache’s, a syndrome caused by taking acute pain relief medicine on more than two or three days a week, or more than 10 days of the month.
Migraine sufferers tend to have episodic attacks that present multiple symptoms including nausea or vomiting as well as pain. Once the migraine subsides, patients generally feel well again until the next attack. In a medication overuse headache, however, the pain is more or less constant and dull. It is often worse in the morning, and present on most days. Episodic migraine attacks then happen on top of the medication overuse headache.
Because pain comes back as soon as each dose of medication wears off, patients tend to re-dose themselves immediately, compounding the problem. Commonly taken pain relieving drugs are associated with medication overuse headaches, and these include paracetamol, the Triptans, and codeine.
Stopping the medication is the only way of treating the syndrome, and methods vary. Some people can stop taking drugs immediately, others may gradually reduce their dosage, while for others hospitalization and detoxification under medical supervision is necessary.
Only headache pain is affected by this cycle of medication overuse, so a topical treatment that does not involve the swallowing of drugs (and which can be used alongside prescribed medications) could help patients avoid this risk.
Recent Developments in Topical Medication for Migraine
Recent studies on a transdermal gel that targets the trigeminal nerve has given optimistic results in the treatment of migraine. The research and studies shed new light on how neurogenic inflammation causes severe headaches.
Research was conducted via a crossover, randomized, placebo-controlled study of 42 adults who were all episodic migraine sufferers, both with and without aura.
Participants were asked to use the new topical gel during five moderate to severe migraine attacks, applying a pea-sized blob of gel to the peripheral trigeminal nerve ends.
Recording their symptoms, patients monitored pain levels for 24 hours, revealing that 45% of users experience pain relief from 2 to 24 hours whereas only 15% of those in the study who used the placebo experienced a reduction in pain. After four hours, 23% of those using the gel were pain-free. It was also found that the topical gel users were three times more likely to experience relief from associated migraine symptoms such as light sensitivity or nausea.
It is hoped that the gel will have prophylactic (meaning preventative) benefits in the future when used once a day. It is also thought that this could help prevent medication overuse headaches, and be gentler on patients who find that oral medications create stomach problems.