Migraine Headache Treatment
Migraine treatment is designed to relieve symptoms and to prevent future migraine attacks. Common migraine treatments include:
People work closely with their healthcare team to decide which medications work best for them. There are two basic categories of drugs designed to treat migraine headaches:
- Acute treatment
Acute treatment drugs help relieve the pain of a migraine headache. These medications are taken at the start of a migraine attack.
- Preventive treatment
Preventive treatment drugs help reduce the frequency and severity of migraine headaches. These medications are taken daily.
People whose migraines aren't too painful can often relieve their migraine headache pain with over-the-counter medications. Stronger prescription pain medications are needed for people with migraine attacks that are frequent, severe, or disabling.
Preventive treatment is usually prescribed for people who:
- Experience two or more debilitating migraine attacks a month
- Use pain-relieving medications more than twice a week
- Aren't helped by pain-relieving medications
Rebound HeadachesOveruse of over-the-counter and prescription pain medications can cause rebound headaches (medication-overuse headaches). People who start developing headaches every day or almost every day should contact their doctor.
The cycle of rebound headaches can be broken by stopping the pain medication. Although some pain medications can be stopped immediately, others need to be stopped gradually. A doctor can recommend which approach to use.
People who tend to overuse pain medications may be prescribed a stronger pain medication or a migraine preventive medication to avoid the possibility of developing rebound headaches in the future.
The following list of medications isn't inclusive. Additional information, side effects, and drug interactions can be obtained by clicking the name of the highlighted medications. It's important for people to ask their healthcare provider or pharmacist in advance for possible drug side effects or interactions.
Over-the-counter medicationsRegular and migraine-strength over-the-counter pain medications may help relieve mild migraine pain. People who take over-the-counter medications should check with their doctor or pharmacist for possible side effects and drug interactions with their current medications.
Pain medicationsNSAIDs and analgesics
NSAIDs (nonsteroidal anti-inflammatory drugs) relieve inflammation, pain, stiffness, and swelling. The FDA (Food and Drug Administration) recommends NSAIDs as the first-line therapy for migraine headaches. Traditional NSAIDs and migraine NSAIDS are available without prescription. Stronger doses are available in prescription form.
Although analgesics (such as acetaminophen) reduce or eliminate pain, they are usually taken in combination with NSAIDs for migraine pain.
- aspirin plus acetaminophen and caffeine (brand name: Excedrin Migraine)
- ibuprofen (Advil, Advil Migraine, Motrin, Motrin Migraine Pain)
- naproxen (Aleve)
Pediatric migrainesNo over-the-counter or prescription migraine medications are approved for children. A doctor may recommend a medication approved for adults at a reduced dose to be taken under careful supervision. Precautions when giving pain medications to children include:
- Lifestyle changes should be considered first to treat pediatric migraines.
- Ibuprofen (Advil, Motrin) is available in doses suitable for children from 2 months to 11 years old.
- Acetaminophen (Tylenol) is not indicated for migraine pain.
- Aspirin and aspirin-containing products should not be given to children who have a fever due to the risk of Reye's syndrome (a condition that affects the liver and brain).
Prescription medicationsPrescription medications are used to treat people who aren't helped with over-the-counter pain medications. Prescription medications are available in the following forms:
- Tablets (swallowed or dissolved in the mouth)
- Nasal sprays
People with nausea or vomiting may be prescribed a nasal spray or injection.
Acute medicationsAcute medications relieve migraine pain and nausea, and include NSAIDs, triptans, ergot derivatives, narcotics, and antiemetics (antinausea drugs).
NSAIDs and analgesics
Prescription NSAIDs used alone or combined with acetaminophen may be used when over-the-counter varieties are unable to relieve migraine pain.
- acetaminophen/dichloralphenazone/isometheptene mucate (Midrin)
- meclofenamate (Meclomen)
- naproxen (Naprosyn)
The Food and Drug Administration (FDA) has issued a warning about the potentially serious cardiovascular and potentially life-threatening gastrointestinal risks associated with the stronger prescription NSAIDs. This announcement does not apply to aspirin, over-the-counter preparations, or the weaker prescription medications.
Triptans are prescribed for migraine headaches that do not respond to NSAIDs. Triptans relieve migraine pain by binding to serotonin receptors and inhibiting the release of neuropeptides. Triptans must be taken at the start of a migraine.
The triptans and ergot derivatives should not be taken by people who have a history of heart disease or uncontrolled high blood pressure.
Ergot derivatives also affect serotonin and are prescribed for migraine headaches that do not respond to triptans. They have more severe side effects than triptans.
- dihydroergotamine (D.H.E. 45 injection, Migranal nasal spray)
Antiemetic drugs treat the nausea associated with migraine headaches.
Narcotics relieve pain by temporarily depressing the central nervous system. They are used for people who aren't helped by other prescription migraine pain medications. Narcotics should be used with caution, because they may become habit forming.
Preventive medicationsPreventive medications are prescribed to migraine sufferers who get more than two migraine attacks each month, have disabling headaches, use pain-relieving drugs more than twice a week, or aren't helped by pain relievers. These medications must be taken daily and require at least a month to start working.
Unlike the acute prescription drugs for migraines, preventive drugs may be taken safely by people with high blood pressure. Preventive medications include beta blockers, calcium channel blockers, antihypertensive medications, anticonvulsants, antidepressants, and an antihistamine.
Beta blockers are typically used to treat high blood pressure and cardiovascular disease. They work by relaxing blood vessels and improving blood flow. Beta blockers are prescribed to prevent migraines.
Calcium channel blockers
Calcium channel blockers typically are used to treat high blood pressure and irregular heart rhythms. They work by dilating blood vessels and improving blood flow. Calcium channel blockers are prescribed to prevent migraines.
Antihypertensive medications typically treat high blood pressure. Antihypertensive medications block the action of chemicals that tighten the blood vessels and are prescribed to prevent migraines.
People who are pregnant, plan to become pregnant, or are breastfeeding should not take these antihypertensive medications.
Anticonvulsants (antiepileptic medications) typically are used to prevent or treat convulsions (seizures) and have been approved to prevent migraine attacks.
Valproic acid and its derivatives may cause serious or life threatening damage to the liver.
Antidepressants are believed to reduce migraine frequency by regulating serotonin levels in the brain.
Antihistamines typically are used to treat allergic conditions, produce sedation, and prevent nausea. The following antihistamine is sometimes prescribed to prevent migraines in children:
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The following lifestyle changes can help prevent migraine attacks and relieve migraine pain.
Migraine diaryPeople can identify their personal migraine triggers, warning signs, and reaction to treatment by keeping track of the circumstances surrounding each migraine attack in a migraine diary. The following circumstances surrounding each migraine attack are recorded:
- Start and end date of the migraine headache
- Possible triggers in the preceding 24 hours
- Warning signs that preceded the headache
- Treatment used, and its success or failure
People then use the patterns they discover to avoid triggers, take pain medication as soon as they sense a migraine is about to start, and work with their doctor to decide which migraine treatment works best for them. It's important to bring the migraine diary to each migraine healthcare worker appointment.
Pediatric migrainesThe following lifestyle changes and non-drug therapies are recommended for children:
- Avoid dietary triggers.
- Drink plenty of fluids to prevent dehydration.
- Exercise regularly with sufficient fluids.
- Keep a headache diary to keep track of headache triggers.
- Maintain regular sleep patterns.
- Place a cool, moist cloth on the child's forehead or temple.
- Relax in a quiet, comfortable, darkened room.
- Use stress management and biofeedback techniques for children 10 years old and older.
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The following non-drug therapies used in addition to medications may help people avoid and treat their migraine headaches.
CounselingPeople with chronic health conditions sometimes become depressed, especially when they experience setbacks. Counseling helps migraine sufferers reduce their emotional stress, and learn to feel good about themselves and their lives.
Managing a migraine
Simple techniques to lessen migraine headache pain include:
Relax in a quiet, comfortable, darkened room.
Drink plenty of fluids to prevent dehydration.
- Cold packs
Place a cool, moist cloth on the forehead or temple.
Stress managementStress is often a contributing factor to migraines. Techniques people use to reduce stress include:
- Deep breathing (push out the abdomen while inhaling)
- Relaxing in a quiet, comfortable, darkened room
- Self-hypnosis (self-induced hypnosis)
- Talk therapy
Support groupsMigraine support groups provide coping suggestions, education, emotional support, social interaction, and help avoid feelings of isolation.
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Complementary and Alternative Medicine
Complementary and alternative medicine refers to those medical and healthcare treatments that are not part of traditional medicine. Whereas, complementary medicine is used with traditional medicine, alternative medicine is used in place of traditional medicine.
The following nontraditional therapies are sometimes used to reduce migraine symptoms:
5-HTP5-HTP (5-hydroxytryptophan) is a compound found primarily in the brain. Studies suggest the 5-HTP supplements may help prevent migraine headache.
AcupunctureAcupuncture is a procedure in which a practitioner inserts sharp, thin needles into the body to adjust the body's energy flow into healthier patterns. Acupuncture is sometimes used to help treat migraine symptoms.
BiofeedbackBiofeedback uses special equipment to train people how to regulate their involuntary body functions related to stress, such as heart rate, blood pressure, or brain wave patterns. Biofeedback techniques have been shown to prevent or reduce the severity of migraine attacks.
ButterburButterbur is a perennial herb which may help prevent migraine headaches.
Caffeine Caffeine helps relieve migraine pain and is added to some migraine pain medications. Due to "caffeine rebound," however, people should avoid its overuse.
Coenzyme Q10Coenzyme Q10 (CoQ10 or ubiquinone) is a naturally occurring antioxidant compound and is used for energy production within cells. CoQ10 may help prevent migraine headaches but doesn't relieve the severity or duration of migraines once they start.
FeverfewFeverfew is a popular herb for treating migraine pain. People using feverfew should notify their doctor for approval.
Fish oilOmega-3 fatty acids found in fish oil may help reduce the frequency and severity of migraine attacks.
LightTechniques to reduce or eliminate bright light triggers include:
- Tinted eyeglass or contact lenses
- Anti-glare computer screens and television screens that reduce flicker
- Daylight spectrum florescent light bulbs
MagnesiumThe mineral magnesium may help reduce frequency of headaches or relieve pain. In high or excessive doses, magnesium can cause serious side effects.
Vitamin B2 (riboflavin)High daily doses of vitamin B2 may help prevent migraine headache.
Some of these therapies haven't been well studied, and little information is available about their effectiveness, side effects, and drug interactions. It's important to discuss any of these therapies with a doctor before trying them.