Summary
No, diazepam cannot be used to treat migraines. It has not reduced migraine symptoms in conjunction with other anti-migraine medication and has a risk of drug abuse. Furthermore, diazepam can be a migraine trigger. Make sure to follow medical guidance if you experience migraines.
What is Diazepam?
Diazepam is commonly known under the brand names Diazepam Intensol, Valium (not available in the UK), and Valrelease. It is a benzodiazepine activating GABA receptor and reduces neuronal activity throughout the central nervous system [1]. It is used to relieve anxiety, control agitation caused by alcohol withdrawal and alcohol withdrawal symptoms, and manage muscle spasms and spasticity caused by certain neurological disorders such as paraplegia, cerebral palsy, athetosis, and stiff-man syndrome [1].
In addition to these first-line uses, diazepam can be prescribed with other medications to regulate seizures [1]. It is available in different forms: an oral tablet, rectal gel, and nasal spray, which are easier to administer to people in emergency departments who are having a seizure and have a quicker onset [2, 3].
Diazepam works by calming abnormal overactivity in the brain [1]. It is a powerful anxiolytic agent with sedating and anti-epileptogenic properties, making it effective in treating patients with terminal agitation, status epilepticus, and drug and alcohol withdrawal [4].
In the context of nerve agent poisoning, diazepam is an efficacious anticonvulsant, and it is considered an important part of the treatment regimen for this condition [5].
What are Migraines?
Migraines are characterised by throbbing or pulsing pain in the head or face regions of moderate to severe intensity. The pain is usually unilateral, but this may not always be the case [6].
Critically, migraines are more than just severe headaches. They are a neurological conditions that are exaccerbated by light and sounds sensitivity, and can also lead to nausea as a side effect [7].
Migraines can also present with aura, a feeling or percept one experiences just prior a migraine attach. Auras are experienced by roughly one in four people with migraines and represent the 2nd most common type of migraine [8].
Migraines are most prevalent in women but can also occur in families due to genetic factors or in patients with mental health problems, such as depression and anxiety [6].
What Causes Migraines?
The exact cause of migraines is not fully understood. However, they are believed to result from changes in neurotransmitter activity or in blood vessel diameter within the brain [9]. They can be triggered by various factors, which will be highly individual.
Examples of common triggers include:
- stress,
- anxiety,
- hormonal fluctuations, such as those throughout the menstrual cycle,
- flashing lights,
- loud sounds,
- certain medicines,
- strong smells,
- too much enough sleep,
- sudden changes in weather or environment,
- tobacco,
- caffeine or caffeine withdrawal,
- skipped meals,
- being too tired or burnt out,
- and medication overuse [10, 11, 6].
Certain foods or ingredients can also trigger migraines, especially when they are combined with other triggers. These commonly include alcohol, dark chocolate, high-sugar foods, cheese, monosodium glutamate (MSG), some fruits and nuts, fermented or pickled goods, yeast, and cured or processed meats [6].
Diazepam for Migraines
Diazepam, a gamma-aminobutyric acid (GABA) agonist, has been sparsely studied for its potential role in managing migraines. In conjunction with the anti-nausea agent metoclopramide, or the analgesic drug acetaminophen, diazepam was not found to enhance the anti-migraine properties of these drugs [12].
However, when administrated in conjunction with morphine, an opioid analgesic, diazepam could mitigate the adverse effects of taking morphine, including abnormal pupil dilation. Nonetheless, morphine is only given in severe cases of migraine, as there is a high risk of substance abuse with this opioid analgesic if taken for a long time [13].
Although diazepam is not effective at treating or alleviating migraines, sodium valproate, a related anti-epileptic drug, can be used for migraine prevention [14]. Furthermore, the benzodiazepine lorazepam, when combined with ibuprofen, reduced the severity of headache-like pain in migraines. This was demonstrated in a 2017 randomized clinical trial [15].
Although studies suggest that diazepam and other GABA agonists may have a role in migraine treatment, more research is needed to fully understand how they work, at what doses, and what side effects one can expect. Side effects are especially important during combination therapy, where drug interactions are more likely. Consulting with a healthcare provider before starting any new medication regimen is crucial.
Migraine Treatment
Migraine treatment typically involves two approaches: preventive and abortive therapy. Preventive therapy aims to reduce the frequency, duration, and intensity of attacks, while abortive therapy treats the intensity and duration of pain, as well as associated symptoms [16].
Pharmaceutical Treatments
Pharmaceutical treatments for migraines include a variety of medications. Beta-blockers, calcium channel blockers, antidepressants, and anticonvulsants are all commonly used to prevent the occurrence of a migraine episode. To address a migraine once it has already begun, the drugs sumatriptan, ergotamine, dihydroergotamine, and nonsteroidal anti-inflammatory agents (NSAIDs) are the first-line choices [16]. Other medications include CGRP antagonists and over-the-counter analgesics, like acetaminophen (brand name Tylenol) [17, 18].
Non-Pharmaceutical Treatments
Non-pharmaceutical treatments for migraines include neuromodulation techniques such as single-pulse transcranial magnetic stimulation (s-TMS), external trigeminal nerve stimulation (e-TNS), remote electrical neuromodulation (REN), and noninvasive vagus nerve stimulation (nVNS) [19].
Alternative Treatments
Alternative treatments for migraines include relaxation training, biofeedback, cognitive behavioral therapy, mindfulness and meditation, hypnosis, yoga, acupuncture, aerobic exercise, and dietary changes [20]. These can reduce the psychological aspects of migraine onset and. help people cope with an attack, increasing their resilience and reducing disability.
Invasive Procedures
Invasive procedures and injections, such as nerve blocks, trigger point injections, and botulinum toxin type A (Botox) injections, may also be used to treat migraines when medications or other alternative treatments are unsuccessful [21].
Summary: Diazepam for Migraine
To summarise, diazepam should not be used for migraines, as it has not demonstrated efficacy for reducing migraine symptoms in conjunction with other migraine medications but has not been studied as a migraine treatment alone. If you experience migraines, seek medical advice to see what treatments work best for you.