Managing Severe Migraine Symptoms and Side Effects

Medically Reviewed by Melinda Ratini, MS, DO on September 27, 2022
Written by Nicole Hollimon
5 min read

If you have migraines, you might still be trying to figure out the best way to handle them. There’s no cure for migraine, but you can take steps to ease the pain and make your attacks happen less often.

Turn off lights and sound. If you can, find a dark and quiet room as soon as you feel one coming on. Bright light and loud noises can make migraine worse.

Sleep if you can. Sleep is one of the best ways to ease the pain of a migraine. It can also shorten the attack. In one small study, more than one-fourth of the subjects could shorten their attacks by taking a daytime nap. But don’t oversleep if you are prone to migraines -- too much sleep can set one off.

Use hot or cold compresses. Put them on your head or neck. Cold helps numb pain. The heat may relax your muscles. A warm bath or shower might help, too.

Drink something with caffeine. Small amounts might ward off a migraine if you do it early. It might also help over-the-counter medications, such as acetaminophen and aspirin, work better. But don’t drink too much of it, or drink it all the time. That can cause you to have a withdrawal migraine if you stop suddenly. Remember that many over-the-counter headache medicines have caffeine in them too.

Take your medication. Some drugs treat migraine headaches after they’ve started. This is called acute or abortive treatment. Take yours as soon as possible. They work best that way.

These treatments include: 

  • OTC pain meds and combination pain meds such as Advil Migraine or Excedrin Migraine
  • Ergots, including dihydroergotamine (D.H.E. 45 Injection, Migranal Nasal Spray), and ergotamine tartrate (Cafergot)
  • CGRP antagonists: rimegepant (Nurtec), ubrogepant (Ubrelvy), and zavegepant (Zavzpret)
  • Triptans, such as naratriptan (Amerge), sumatriptan (Imitrex), and zolmitriptan (Zomig)
  • Calcium channel blockers, such as verapamil (Calan, Covera, Verelan)
  • Beta-blockers, such as atenolol (Tenormin), nadolol (Corgard), and propranolol (Inderal LA, InnoPran XL)
  • Prescription NSAIDS: celecoxib (Celebrex, Elyxyb), diclofenac potassium (Cambia), indomethacin (Indocin) 
  • Calcitonin gene-related peptide monoclonal antibodies, such as eptinezumab (Vyepti), erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality)

A good first step is to keep a headache diary. This may help you and your doctor figure out your triggers. You should write down:

  • When your migraine starts
  • What you were doing, eating, or drinking before it started
  • How long it lasted
  • Anything that helped

 

Some people can identify certain things that trigger their migraines and stay away from them. But you may not always be able to do this. In that case, it might be more helpful to try biofeedback or relaxation training.

With these methods, you work with a trained psychologist or therapist to learn how to control your body’s responses to pain and stress.

During a biofeedback session, sensors connect your body to a machine that gives you information about your breathing, body temperature, muscle tension, and other functions. For headaches, electromyography (EMG) to measure muscle tension and temperature feedback training are the methods used most.

Your therapist will help you use this information to learn to change physical responses that may cause your headaches. For example, you’ll learn to relax muscles that tense up and cause pain. Eventually, you’ll be able to do this on your own. How long it takes to do this depends on how bad your headaches are and how fast you learn the technique.

Research shows that biofeedback and muscle relaxation can lessen migraine pain and the length of an attack by 45% to 60%.

For relaxation training, you usually go to a therapist’s office. You’ll learn techniques for breathing, muscle relaxation, and visualization to help you relax and ease tension that can trigger a migraine.

It might also help to get regular exercise. Physical activity can help you manage your migraines in several ways. It can:

  • Lessen stress
  • Release endorphins that boost your mood and ease pain
  • Help you sleep
  • Help control your weight -- there’s a link between extra weight and more frequent migraines

For some people, exercise can trigger a headache. Start gradually and don’t push yourself.

What you eat -- and when -- can affect how often you have a migraine attack. Try to eat a balanced diet with plenty of whole grains and vegetables. Stay away from too much salt. Don’t skip meals -- if you go too long without eating, your blood sugar can drop and trigger an attack.

Some foods, such as chocolate, artificial sweeteners, alcohol, and aged cheeses, can trigger migraines in some people. If you keep a migraine diary, it can help you track which foods might do this for you. If you think a certain food is behind your attacks, stay away from it for a while and see if your symptoms get better.

Studies show that good sleep habits, or sleep hygiene, can drastically cut down on how often migraine attacks happen and how long they last. Use these habits for better sleep:

  • Go to bed and get up at the same time each day.
  • Keep cellphones, TVs, and other electronic devices out of your bedroom.
  • Keep your bedroom dark and quiet.
  • Get some exercise during the day before evening.
  • Stay away from big meals, alcohol, and caffeine before bed.

 

There are drugs made for other conditions that may lower the number of headaches you have in a month. They could lessen how severe they are and how long they last, or get rid of them completely. They include:

The FDA has approved some medications specifically made to prevent migraine. They are:

These drugs block or stick to calcitonin gene-related peptide, or CGRP. That’s a neurotransmitter that sends pain signals to your brain. Your body releases it when you have a migraine. Atogepant (Qulipta) can be taken orally. With the others, you give yourself shots of the medication every 1 to 3 months, depending on the medicine. Eptinezumab (Vyepti) is a CGRP inhibitor that you get in an IV every 3 months to help prevent migraines.