Sometimes all it may take to ease your migraine pain is a quick nap or a rest in a cool, dark place with a chilled cloth on your forehead. But if that doesn’t help, you and your doctor have a range of treatment options, either to stop a migraine attack or to prevent it from starting.
Acute Drug Therapy
These medications stop a migraine attack. Most of the time it’s best to take them as soon as you notice symptoms. Acute drugs include:
Over-the-counter (OTC) drugs. These pain relievers include acetaminophen, aspirin, and ibuprofen. These work best for mild to moderate symptoms. For stronger relief, combination medications (such as acetaminophen and aspirin) plus a bit of caffeine may help more.
NSAIDS. These medications can help stop a migraine attack or migraine pain. NSAIDS that your doctor may prescribe include:
- celecoxib (Celebrex, Elyxyb)
- diclofenac potassium (Cambia, Cataflam)
- diclofenac sodium (Voltaren, Zipsor)
- fenoprofen (Nalfon)
- flurbiprofen (Ocufen)
- indomethacin (Indocin)
- ketorolac (Toradol)
- mefenamic acid (Ponstel)
- nabumetone
NSAIDS are sometimes more effective when combined with oral triptans.
Triptans. These prescription drugs boost the levels of a brain chemical called serotonin to constrict your blood vessels. You can take them as pills, injections, or nasal sprays. These include shorter-acting drugs that work within 30-60 minutes and include:
Slower-acting, longer-lasting triptans include frovatriptan (Frova) and naratriptan (Amerge). Some triptans come in combination with nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen. Side effects include nausea, vomiting, fatigue, tingly skin, or tightness in the jaw, neck, or chest.
CGRP antagonists such as rimegepant (Nurtec) and ubrogepant (Ubrelzy) block a molecule called CGRP, which causes blood vessels to dilate during a migraine and can trigger pain. They begin to relieve pain in 60 minutes. Zavegepant (Zavzpret) is a recently approved CGRP antagonist in the form of a nasal spray that may give relief within 15 minutes. Side effects include nausea, sleepiness, and dry mouth.
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 tingling and numbness in the skin.
Ergot alkaloids. They also work on serotonin receptors in your brain and block pain signals. They work best in the early stages of migraine. You can get them as nasal sprays, injections, pills, or suppositories. They aren’t used as often because of side effects but may be used when other drugs don’t work. Common types include dihydroergotamine and ergotamine. Side effects include low blood circulation, nausea, vomiting, numbness and tingling in the hands or feet, and leg cramps.
Preventative Drug Therapy
These medications are also called prophylactic medicines. They may prevent migraine attacks or reduce the number of migraines you get. Some preventive medicines for migraine were first used for other conditions. They include:
Anticonvulsants. They treat epilepsy. Anticonvulsants increase certain brain signal chemicals (neurotransmitters) and lessen pain signals.
Beta-blockers. These were first used for high blood pressure. They also help prevent migraines in some people.
Calcium channel blockers. They’re often used to treat high blood pressure. These drugs also seem to calm the blood vessels near the brain to ease migraine as well.
Antidepressants. They may help migraine in some people because they raise levels of serotonin or other brain chemicals like norepinephrine and dopamine.
Botox. It’s approved for preventive treatment for chronic migraine, defined as more than 15 days a month with headaches that last 4 hours a day or longer.
CGRP antagonists.The FDA has approved the oral medications atogepant (Qulipta) and rimegepant (Nurtec); the self injections erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality) and the IV medicine eptinezumab (Vyepti) to prevent migraine.
Not everyone needs preventative therapy. Your doctor may recommend it if:
- Your migraines keep you from carrying on with daily activities even with acute medication.
- You get more than two migraines a week or four a month.
- You use acute medication often enough to cause “overuse” or “rebound” headaches.
- Your acute medicine causes serious side effects.
- You have one of the rare migraine types that raise your risk for other health problems (most often stroke).
It may take 2-3 months to know if your preventive medication is working. Talk to your doctor about any side effects.
Other Treatments
Botox. Doctors inject you at about 31 spots around your head and neck to help give relief if you have 15 or more headache days a month (chronic migraine). It only takes about 20 minutes. It stops muscles from tensing, which can help prevent the onset of migraine. It works for around 3 months.
Trigger point injections. 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.
Neuromodulation. This uses a device to deliver electrical current to raise or lessen the activity of your nervous system. Some research shows these devices may be helpful in people with migraine headaches. The device may 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).
Sleep, Diet, and Exercise
These are three important lifestyle habits to manage your migraine headaches.
Get enough sleep. Regularly getting about 8 hours a night may cut down the number and strength of your migraine attacks. Keep a bedtime routine, avoid screen time just before turning in, and wake up at the same time every morning.
Watch what you eat. Certain foods may trigger your migraines. Keeping a migraine diary may help spot any problem foods. On the other hand, a bit of caffeine in coffee or black tea may lessen symptoms at the start of a migraine attack. Some people find that eating smaller meals more often is a good way to manage symptoms.
Stay active. Regular exercise, especially outdoors, can help regulate your sleep and eating rhythms and ease migraine headaches.
Alternative Therapies
Relaxation techniques help some people with migraines. Some options include:
Some natural supplements and treatments may help your migraine. They include:
- Riboflavin (vitamin B2)
- Magnesium
- Coenzyme Q10
- Butterbur, an herbal extract
Ask your doctor if supplements are right for you.
