Scientists haven’t found a cure for migraines, but they’re better at treating the symptoms. In fact, they’ve made more advances in migraine treatment in the last 2 years than in the previous 30 years.
These advances include new drugs and new delivery systems (nasal sprays, needle injections) that may work better and with fewer side effects than older migraine medications. For example, some of these drugs can treat your migraine 2-4 hours into an attack, compared to older treatments that work best if taken within 30 minutes.
New neuromodulation devices that use electric stimulation to affect your nervous system also show some promise for treating migraine.
But not all doctors are up to date on the latest treatment information, which is why it can be very important to see a headache specialist -- usually a neurologist -- about your migraines.
Medications
Acute medications are designed to stop a migraine attack. Most of the time, it’s best to take them as soon as you notice symptoms. The newest acute drugs include:
- 5-HT1f drugs such as lasmiditan (Reyvow) work on pain pathways and stop pain and other bothersome migraine symptoms. Side effects include dizziness, fatigue, and a tingling and numbness in the skin.
- The small molecule CGRP antagonists such as rimegepant (Nurtec) and ubrogepant (Ubrelvy) block a molecule called CGRP, which causes blood vessels to dilate during a migraine and can trigger pain. These drugs begin to relieve pain in 60 minutes. Side effects include nausea, sleepiness, and dry mouth.
- Zavegepant (Zavzpret) is a new CGRP antagonist in the form of a nasal spray. It is for use in those who cannot take an oral medication or need fast relief from their migraine symptoms. It may cause dizziness, dry mouth, or nausea.
- Dihydroergotamine mesylate nasal spray (Trudhesa) is a new delivery system for dihydroergotamine (DHE). Doctors have used DHE to treat migraines for a while, but this nasal spray seems to allow better absorption in some people.
- Celecoxib is a drug doctors have used for arthritis since 1998. Some recent studies show it may help some people with migraine as well, though the effects appear small. The FDA recently approved a liquid form of celecoxib (Elyxyb) to treat migraine. Celecoxib has side effects, like a higher risk of certain blood clots and effects on the digestive system.
Preventive medications, sometimes called “prophylactic” medications, are designed to stop migraine attacks from starting.
- CGRP monoclonal antibodies like erenumab (Aimovig), fremanezumab (Ajovy) and galcanezumab (Emgality) are the latest preventative drug therapies. You get them by self injection about every month. Another drug in this class is eptinezumab (Vyepti) which is given by IV every 3 months.
- In addition to its use as an acute medication to treat migraine attacks (see above), the FDA has also approved the small molecule CGRP antagonist rimegepant (Nurtec) for prevention of migraine attacks as well as atogepant (Qulipta).
Devices
Neuromodulation: These devices deliver electrical current to raise or lessen the activity of your nervous system. Some research shows this may help with migraines. Some devices look like a headband or armband or handheld electrode. They can be expensive and generally require a prescription. Different types include Cefaly, gammaCore, and Nerivio (which you control with your smartphone).
SPG stimulation: Doctors implant this device through your mouth into the cheek bone, where it remains until they remove it. It stimulates a bundle of nerve cells called the sphenopalatine ganglion (SPG). Early studies have shown some promise in the treatment of migraine head pain, though more research is needed.
Botox
This treatment has been around for about 10 years. Doctors have used it more often in recent years as they learn about who benefits most and when it’s most effective.
Doctors inject it in about 31 spots around your head and neck to give relief if you have 15 or more headache days a month (chronic migraine). It stops muscles from tensing, which can prevent the onset of migraine, and usually works for around 3 months. The whole procedure takes about 20 minutes.
Mild Anesthesia
These treatments have also been around for a while, but they continue to evolve. The latest research and clinical experience have made them more common in recent years.
SPG nerve block: Doctors have done some version of this procedure since the early 1900s. They numb the SPG to block pain signals to your trigeminal nerve, a primary source of migraine headache pain. Older versions put anesthetic on cotton swabs into the back of the nose. A later version uses a needle guided by X-ray.
The latest version of the procedure uses small, specialized tubes called catheters to guide the anesthetic to the right spot. You get the procedure in your doctor’s office, and you’ll be awake for it.
Your doctor will insert the catheter into your nose, one nostril at a time. Through an attached syringe, you’ll get an anesthetic to numb your SPG and the area around it. Your doctor may use an X-ray machine to be sure the tube is inserted correctly.
Once the numbness wears off, you may still feel relief for some time.
Trigger point injections: Here, your doctor injects numbing medication into your muscle, which lessens pain signals. Sometimes doctors inject steroids to reduce swelling in muscle and tissue. The needle lengthens and separates the muscle, which can help relax it as well.
Lifestyle Changes
The latest research has made doctors even more aware of the importance of lifestyle changes in the treatment of migraine.
There are several important aspects to the management of migraine headaches.
Sleep. A regular schedule that allows you to get enough rest (about 8 hours) is essential. Follow a routine that fits your natural rhythms.
Food. Certain foods may trigger migraines for you. In addition, a healthy, balanced diet eaten at regular mealtimes can help keep migraines at bay. Some people find that smaller, more frequent meals can further ease migraine symptoms.
Exercise. Staying active, especially if it’s outside, can help regulate your sleep and eating rhythms.
Relaxation techniques like yoga, meditation, and biofeedback also seem to have a positive effect for some people.
Hormones. There is some evidence that hormones like estrogen can play a role in migraines in women. Some women notice it when estrogen dips right before their menstrual cycle starts. And some pregnant women have fewer migraines later in their term when estrogen levels are particularly high.
It may help to keep a journal of your migraine symptoms and your monthly cycle to see if there is a link. Your neurologist or primary care doctor may work with your gynecologist to figure out if it may help to adjust your contraceptive or to try a hormone replacement therapy.
Counseling
The latest research shows that counseling can help with migraines.
Cognitive behavioral therapy (CBT) is a psychotherapy approach that helps you change thought patterns and behaviors that can make you more tense and may raise your risk for a migraine attack.
In acceptance and commitment therapy (ACT), you accept that you have some migraine pain instead of trying to control it completely or avoid it.
You commit to “grow away” from a focus on migraines to discover goals and values you want more of in your life. And then you take action toward those goals.
Mindfulness-based therapy. “Mindfulness” is a practice of being aware of your mind and body right now. Distracting thoughts come up, but you let them go.
You may find that this helps you manage your migraine pain and the emotions that come with it.
Whatever counseling approach you take with your therapist, you’ll still likely need to continue with your medicine and other treatments.
Ask your doctor or mental health specialist about a professional who can help you with this and other therapy approaches.
