Migraine Treatment and Warfarin

Publication Date:
Mon, 07/25/2016
By: Alere Staff

 

If you suffer from migraine headaches, you are not alone. According to the National Institute of Health, 12% of the US population experience migraines, and women are three times more likely to have migraine headaches than men. It is not clearly known what causes migraine headaches; the most recent research indicates there may be a genetic predisposition.2

 

What Are Migraines? 

A migraine headache is usually a recurring attack that may include symptoms of moderate to severe pain; a throbbing or pulsing sensation in the head, often occurring on one side; sensitivity to light and sound; and nausea and vomiting.2 These symptoms can last a few hours or persist for several days and some sufferers experience an attack once a month or more frequently.3 A migraine headache can be a debilitating event if not treated, causing the sufferer to retreat to a quiet dark place until the symptoms pass. 

It is important to seek immediate medical attention (call 911 or go to the nearest emergency room) if you develop a sudden and severe headache; a headache with fever, stiff neck, confusion, seizures, numbness or weakness on one side of the body, difficulty speaking; or a headache after a head injury.3 This is especially true if you are on chronic anticoagulation like warfarin. 

Treating Migraines 

There are many triggers for migraines and if you suspect recurring headaches to be migraines you should keep a diary of the frequency and duration of events to discuss with your doctor. Triggers can include foods, certain alcoholic beverages, lack of food or sleep, anxiety, stress or hormonal changes (for women). Avoiding or eliminating the triggers will often help to reduce the frequency and intensity of events and this may be the first course of action in the treatment of your migraines.1,2 

Your doctor will evaluate your symptoms and possibly order further testing like a CT scan or MRI. Treatment of migraines can include medications to relieve pain during an attack and medications to prevent an attack from starting.3 If you are on an anticoagulation medication such as warfarin, it is important to discuss with your doctor the appropriate treatment to prevent any possible side effects. This is because primary pain treatment for migraines is over the counter, non-steroidal anti-inflammatory drugs or NSAIDS. Common NSAIDS on the market include brands containing ibuprofen and naproxen. Unfortunately, studies have shown that patients taking anticoagulation medications, such as warfarin, with an NSAID are two times more likely to have major bleeding. Bleeding can occur after only one week of use.1,3 A brand of acetaminophen is considered a safer alternative for pain relief for patients on anticoagulation medications1, although most migraine sufferers find that acetaminophen is not effective in relieving symptoms.3 Triptans (such as Imitrex® or Zomig®) are medications used to treat an attack once it has started; however this class of medications is not recommended for anyone with a risk of stroke or heart attack. Opioid medications can also be prescribed for pain relief, but these medications can be habit forming and may also interfere with the ability of warfarin to work properly.3 

Preventative treatment can include cardiovascular medications such as beta blockers, calcium channel blockers or angiotensin converting enzyme inhibitors; antidepressants; anti-seizure medications; or Botox® injections. Preventative treatment may be prescribed if the migraines occur more than four times per month or the duration of each attack is greater than twelve hours.  There are side effects to all of the preventative treatment options.3 You should discuss all of your current medications and medical conditions with your doctor to determine the best option for you. 

If you take warfarin and start any new medications (over the counter or prescribed), it is important to notify your anticoagulation team so that close monitoring of your INR can be done. Your INR may need to be checked weekly during treatment and your warfarin dose may need to be adjusted accordingly. 

While 12% of the US population suffers from migraines, special consideration needs to be taken when you also take an anticoagulation medication such as warfarin. Knowing signs and symptoms which require emergency evaluation is important. It is also important to notify any caregivers of your current medications and medical conditions so that you can avoid any side effects and receive proper treatment. 

References:

  1. Cleveland Clinic Heart and Vascular Team. Choose Painkillers Carefully If You Take Coumadin. Health Essentials. August 20, 2014. Retrieved from the website: https://health.clevelandclinic.org/2014/08/choose-painkillers-carefully-if-you-take-coumadin/.
  2. U.S. National Library of Medicine. Migraine. MedlinePlus. Last updated June 1, 2016. Retrieved from the website: https://www.nlm.nih.gov/medlineplus/migraine.html.
  3. Mayo Clinic Staff. Diseases and Conditions: Migraine. MayoClinic. June 4, 2013. Retrieved from the website: http://www.mayoclinic.org/diseases-conditions/migraine-headache/basics/definition/CON-20026358?p=1.  

Imitrex® is a registered trademark of the GlaxoSmithKline group of companies. Zomig® is a registered trademark of the AstraZeneca group of companies. Botox® is a registered trademark of the Allergan group of companies.