Pharmacy Times

Compounded Treatments for Migraines

Author: Shannon W. Fields, BA, CPhT

Millions of Americans suffer the debilitating effects of migraines. The exact cause of migraine headaches remains something of a mystery, and there is no specific cure, though symptoms can usually be managed with lifestyle changes and medications to reduce the frequency of occurrence and reduce the pain once it begins. While traditional medicine offers many options, some patients instead turn to a compounding pharmacist for advice about treatment alternatives. Compounding offers a variety of choices for relief of migraine pain, which are often more cost-effective than commonly used commercial prescriptions and may, in some cases, have a lower risk of side effects.

Treatment Options

A good compounding pharmacy is often able to offer both OTC and prescription alternatives for the treatment of migraines. One highly effective OTC medication is a capsule dosage containing ketoprofen 12.5 mg, riboflavin 100 mg, and caffeine citrate 100 mg.1,2 This combination offers pain relief quickly, with some reports of relief within as little as 15 minutes. Directions generally indicate 2 capsules at the onset of headache and every 4 hours as needed until pain subsides. If needed, the strengths may be increased with a physician's prescription.

A prescription compound that has proven effective in treating migraine pain is a lidocaine nasal solution, usually written in a 2.5% to 4.5% concentration. Typical directions for use are 10 to 15 drops instilled into the nostril on the affected side at the onset of headache. The dose may be repeated after 15 to 20 minutes if needed and may be used up to 4 times daily.3 This therapy has few side effects, aside from a localized stinging or burning sensation.

Another time-tested alternative for the treatment of migraine pain includes combination ergotamine and caffeine capsules or suppositories, which may also include pentobarbital upon physician's orders.4 The dosage can be tailored to the patient's individual needs. Antiemetics such as promethazine may also be added to many compounded preparations to counteract symptoms of nausea, which often accompany migraine pain. While oral dosage forms are still the most commonly prescribed, it is important to remember that, with current compounding technology, a host of other options exist to meet the needs of specific patients. Dosage forms are widely varied and may include any of the following:

Other Important Considerations

Other factors to consider when dealing with the issue of chronic or recurrent migraines are hormone balancing and adrenal function. Three times as many women as men suffer from migraine headaches, and this fact alone warrants careful examination. With many of today's compounding pharmacies specializing in bioidentical hormone replacement therapy, patients may in fact be better served to examine their hormone levels, perhaps by charting their headaches in relation to their cycle. If a hormonal imbalance is in fact a potential cause for the migraines, the problem can be addressed from that perspective, potentially eliminating the need for medication to treat migraine pain altogether.

Conclusion

With the increasing number of treatment options available for migraine pain, nearly every patient who suffers the painful effects of migraines can obtain relief. When a patient, physician, and pharmacist work together to aid the patient, with the resources of commercial medicine and the expanded possibilities available through prescription compounding, successful treatment and/or prevention of migraine pain is all but inevitable.

Ms. Fields is with the International Journal of Pharmaceutical Compounding and is a pharmacy technician at Innovative Pharmacy Services in Edmond, Okla.

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