Acute Migraine Treatments

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:

  • Aspirin
  • Ibuprofen (Advil, Motrin, Nuprin)
  • Diclofenac (Cambia, Zipsor, Zorvolex)
  • Naproxen (Aleve, Naprosyn)

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 or ditans. These prescription drugs help block pain and affect the nerves and blood vessels involved in migraine. They’re also a fast-acting option for severe migraines. If you take triptans and don't get enough relief, you can take NSAIDs with them. You might take:

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 and ditans 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. And doctors don't prescribe them if you have migraine with brainstem aura (you might hear it called by its old name, basilar migraine) or hemiplegic migraines. We need more studies to be sure they’re safe for people with these types of headaches.

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If you can’t take triptans, because you have risk factors like heart disease, your doctor might try lasmiditan (Reyvow). This new drug provides relief without affecting your blood vessels. But it can cause dizziness, sleepiness, fatigue, and nausea. And 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, or get it through an IV if you have long-term or hard-to-treat migraines. 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.

CGRP antagonists - CGRP (calcitonin gene-related peptide) is a molecule involved in causing migraine pain. CGRP antgonists are a new class of drugs that block the effects of CGRP. They include rimegepant (Nurtec ODT) and ubrogepant (Ubrelvy)

Combination medications. Acetaminophen (Panadol, Tylenol), 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 a medication 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.

WebMD Medical Reference Reviewed by Arefa Cassoobhoy, MD, MPH on January 27, 2020

Sources

SOURCES:

Anne H. Calhoun, MD, partner/co-founder, Carolina Headache Institute, Chapel Hill, NC.

American Headache Society: "Acute Migraine Treatment," "Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) for Acute Migraine Treatment."

American Academy of Neurology: "Pharmacological Management of Acute Attacks."

Tepper, D. The Journal of Head and Face Pain, 2014.

Gilmore, B. American Family Physician, 2011.

Woldeamanuel, Y. Current Pain and Headache Reports, 2014.

UpToDate: “Acute treatment of migraine in adults,” “Lasmiditan: Drug information,” “Migraine with brainstem aura (basilar-type migraine),” “Patient education: Migraines in adults (Beyond the Basics).”

American Migraine Foundation: “Hemiplegic Migraine,” “Spotlight On: Neuromodulation Devices for Headache.”

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