Treating Your Migraine Headache

You've got lots of options to ease the pain. First, your doctor will need to know how often you get headaches and how bad they are. That will help your doctor figure out a treatment plan for you.

It helps to keep a daily diary about your headaches. Every day, simply note whether you got one, and if you did, what symptoms you had. Keep tabs on what you had to eat or drink, what was going on that day in your life, and how you slept the night before. Share that information with your doctor.

Anne H. Calhoun, MD, partner and co-founder of the Carolina Headache Institute in Chapel Hill, NC, recommends "treating early with the medication that will quickly get rid of the attack" if you get headaches occasionally and only some are migraine.

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.

Whatever your situation, you'll probably start with the smallest dose that will ease your pain. This should cut down on potential side effects.

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.

Types of Treatment

Meds that can ease migraine pain as it's happening are called "acute" treatments. Your doctor may recommend one of these:

NSAIDs (nonsteroidal anti-inflammatory drugs). Many doctors recommend 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 vessel involved in migraine. They also offer fast-acting option for severe migraines. If you take triptans and don't get enough relief, you can take NSAIDs with them.

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Triptans include:

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're not 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 types of migraines known as basilar migraines or hemiplegic migraines.

DHE (dihydroergotamine). 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.

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, Calhoun says. But it has some drawbacks. If you get used to caffeine, you can get headaches if you miss it.

"Caffeine is a two-edged sword," she says. "It can help an acute [sudden] migraine, while making the next one more likely to occur."

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.

Cefaly. Another option to consider is a device approved by the FDA called Cefaly. Designed for use in people over age 18 with migraines, it helps cut down how often you get migraines. Cefaly is a portable headband-like device that gives electrical impulses on the skin at the forehead to stimulate a nerve linked with migraine headaches.

You use Cefaly once a day for 20 minutes, and when it's on you may feel a tingling or massaging sensation.

WebMD Feature Reviewed by Melinda Ratini, DO, MS on November 08, 2017

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.

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