When migraine strikes, you have many options to ease the pain. Your doctor will work with you to figure out a treatment plan.
In general, if you get headaches occasionally and only some are migraines, you want to treat them early with medications that will quickly stop the attack.
If you get headaches all the time, and they're severe migraines, your plan could be different. The goal: Choose what works, use it first, and use it fast.
This is what doctors call acute treatment: Taking something for your headache the moment you feel pain or have a symptom like aura -- seeing or hearing things before a headache starts.
Types of Acute Treatment
Your doctor may recommend one of these:
NSAIDs (nonsteroidal anti-inflammatory drugs). Many doctors suggest these as the go-to treatment for mild to moderate migraine headaches. Some examples are:
You can buy some over the counter, but others need a prescription. Talk to your doctor before taking any over-the-counter meds if you take other medicines, supplements, or have any medical problems.
Triptans. These prescription drugs help block pain and affect the nerves and blood vessels involved in migraine. Generally, they’re also a fast-acting option for migraines. Your doctor may recommend you take a triptan with an NSAID to be more effective.Triptan options include shorter-acting ones such as:
- Almotriptan (Axert)
- Eletriptan (Relpax)
- Rizatriptan (Maxalt)
- Sumatriptan (Imitrex, Onzetra Xsail, Sumavel DosePro, Tosymra, Zembrace)
Longer-acting options are:
If your migraine symptoms include vomiting, you may want to take your triptans as a shot or nasal spray since they don't need to be absorbed through your digestive system.
Triptans work best if you take them within 2 hours of the start of your pain. Because these medicines affect your blood vessels, they aren’t a good option if you have uncontrolled high blood pressure, heart disease, are pregnant, or have had a stroke.
CGRP antagonists. CGRP (calcitonin gene-related peptide) is a protein that enhances pain signaling pathways. During a migraine, blood levels of CGRP are elevated. CGRP antgonists are a new class of drugs that block the effects of CGRP. It is an option if you have a poor response with triptans or you cannot take triptans because of a history of heart disease or stroke. Oral forms of CGRP antagonists approved for acute migraine include atogepant (Qulipta), rimegepant (Nurtec ODT), and ubrogepant (Ubrelvy). Zavegepant (Zavzpret) is a recently approved CGRP antagonist in the form of a nasal spray.
5-HT receptor agonists. Another option if you can't take triptans is lasmiditan (Reyvow). This drug provides relief without affecting your blood vessels. It inhibits pain signaling pathways that cause migraine pain. But it can cause dizziness, sleepiness, fatigue, and nausea. You won’t be able to drive for 8 hours after each dose.
Ergots (dihydroergotamine, or DHE). Unlike triptans, this medicine can work even if you don't take it within 2 hours of the start of your headache. You can take it as a nasal spray, shot, under your tongue, or get it through an IV. It is sometimes combined with caffeine and is available as a pill or rectal suppository. You shouldn't take it if you're pregnant because it can cause birth defects. Like triptans, you also shouldn't take DHE if you have uncontrolled high blood pressure, heart disease, or certain other medical problems.
Combination medications. Acetaminophen, aspirin, and caffeine, when combined into one pill, is a safe option for many people. You don't need a prescription for it.
Studies show caffeine makes pain relievers work better and may help your body absorb other drugs. But it has some drawbacks. If you get used to caffeine, you can get headaches if you miss it. That can make another headache more likely.
Corticosteroids. People who have hard-to-treat headaches, a history of headaches that keep coming back, or a severe type of migraine called "status migrainosus" can get relief by taking the steroid prednisone.
Anti-nausea medications. These drugs may help you absorb your pain medication.
Neuromodulation. These treatments send signals to your brain and nervous system using electrical or magnetic waves or heat to calm brain activity. They can be a good option if traditional medication doesn’t work for you. Some are portable; others are surgically implanted.
Take Your Medication Wisely
You don't want to take your medicine too often, since it may stop working or cause more intense and more frequent "medication overuse headaches." If you get headaches often, talk to your doctor about whether you need medicine to help prevent them.
Whatever your situation, you'll probably start with the smallest dose that will ease your pain. This should cut down on potential side effects.