How Migraines Are Treated

Migraines can cause a variety of unpleasant symptoms. These can include head and neck pain, severe exhaustion, visual effects, trouble concentrating, and numbness of the hands or fingers.

Treating a migraine episode often relieves the pain. But you may continue to experience other migraine symptoms even after the pain subsides.

Luckily, there is a wide spectrum of effective treatment approaches available for migraines. These include treatments to address active migraines and help prevent future migraines.

Below, you'll find an overview of the different medications, procedures, lifestyle changes and home remedies that can help treat your migraines. Be sure to speak with your healthcare provider about your symptoms and medical history to determine which migraine treatment strategy is best for you.

Home Remedies and Lifestyle

When you have a migraine headache, home remedies can sometimes prevent it from getting worse. They may also reduce the symptoms or even completely alleviate them. A variety of options are effective and worth trying. 

Use Cold Packs

Placing a cold pack on the sensitive area can reduce head, neck, shoulder, or facial pain that accompanies your migraine. Sometimes it can fully eliminate the symptoms.

Cold therapy has an anti-inflammatory effect that constricts blood vessels and soothes nerves so that the brain senses less pain. As a general rule, you shouldn't apply cold packs for more than 30 minutes at a time.

Manage Stress

Stress is one of the most common triggers for migraines. However, simple stress management practices like mindfulness meditation, exercise, and journaling can help minimize stress and prevent migraines.

Stress management is important for overall mental health. It may also reduce chronic pain in the body.

Get Enough Sleep

Another common migraine trigger is insufficient sleep. Catching 7-9 hours of sleep every night can help prevent migraines.

You may find it helpful to set a consistent sleep schedule, as changes in sleep patterns can trigger or worsen migraines. Sleep disorders are closely associated with migraines as well. So your healthcare provider may order a sleep study to rule them out.

Consume Caffeine

The link between caffeine and migraines can be complicated. If you don’t regularly drink caffeinated beverages, just one serving can reduce your migraine symptoms or may even completely stop your migraine. That said, some people experience severe migraines after consuming caffeine, so this solution isn’t for everyone.

Remember that caffeine withdrawal can also induce a migraine, so it's best to wean yourself off of caffeine rather than cutting it out abruptly. Being aware of your caffeine intake is crucial for migraine prevention.

Get Fresh Air

Sometimes, getting outside can help alleviate a migraine. This is especially true if you are enclosed in a space without good air circulation or exposed to strong, bothersome odors.

Excessively cold weather or humidity can trigger or exacerbate migraines, however. So, if you feel that your migraines could be weather-related, it may be helpful to keep track of the weather in a migraine journal.

Enjoy Yourself

Migraines are true neurological events, and sometimes they are unavoidable. Finding a calming and enjoyable activity can distract you from the symptoms, especially if you are dealing with a mild to moderate migraine.

Over-the-Counter (OTC) Therapies 

Some non-prescription medications can help lessen the symptoms of a migraine or help prevent them. These tend to be more effective when they are taken right at the start of a migraine or even before it starts (for instance, if you notice a prodrome before your migraine):

• Non-steroidal anti-inflammatories (NSAIDs): Medications such as aspirin, ibuprofen, and naproxen are pain relievers and anti-inflammatories that can help take the edge off migraine symptoms. In addition, they may eliminate a migraine or aid in the prevention of a migraine. However, be sure to use as directed, as these medications can cause stomach upset and may increase your risk of bleeding, especially when taken frequently or at high doses. 
• Acetaminophen: Tylenol is a pain reliever that is not an NSAID. It is not associated with the stomach upset and bleeding effects that can occur with NSAIDs.
• Excedrin Migraine: This medication contains a combination of acetaminophen, aspirin, and caffeine. Remember that aspirin is an NSAID, so you should ask your healthcare provider before taking any other NSAID with Excedrin Migraine.

Aim to take the lowest dose of OTC medications that can relieve your migraine episodes. This strategy can help prevent rebound migraines. These are headaches that return when medication wears off. It also makes it less likely that you'll constantly need to increase your medication dose.

Prescriptions

You can use prescription medications during a migraine attack. Several medications are specifically indicated for the treatment of migraine episodes. In addition, some treatments intended for other conditions are often used to treat migraine episodes as well. 

If you have recurrent migraines, your healthcare provider might give you a prescription for one of these medications.

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Triptans

There are many different triptans, and this category of medicines is approved to treat acute migraines. Triptans include:

• Imitrex (sumatriptan)
• Relpax (eletriptan)
• Zomig (zolmitriptan)
• Amerge (naratriptan)
• Maxalt (rizatriptan)
• Axert (almotriptan)
• Frova (frovatriptan)

These medications are serotonin agonists, which means that they work directly on serotonin receptors to stop migraines. They also cause vasoconstriction (narrowing of the blood vessels), which may be related to their therapeutic effect.

Fioricet and Fiorinal

Fioricet is a combination of acetaminophen, caffeine, and butalbital. Fiorinal is a combination of aspirin, caffeine, and butalbital, which can also be combined with codeine (a narcotic).

Butalbital is a barbiturate, which means that it acts as a depressant and can make you sleepy. It is also addictive and can cause side effects such as shaking, confusion, and tremors. 

The American Academy of Neurology strongly recommends against using butalbital for migraines, except as a last resort. While Fioricet and Fiorinal have been used for migraines in the past, they should no longer be used because the risks outweigh the potential (modest) benefit.

Ergots

Dihydroergotamine and ergotamine (Cafergot) are potent vasoconstrictors that are effective in alleviating migraine symptoms. However, they can cause serious side effects and are not recommended if you have blood vessel disease, kidney disease, or heart disease.

Steroids

Oral steroids have been used to both prevent migraines and reduce symptoms of acute migraines. Many people experience relief from pain and other migraine symptoms with this treatment. Speak with your healthcare provider to find out if this is a viable treatment for your migraines.

Opioids

Opioids, also referred to as narcotics, have been used in some instances to treat migraines. However, the American Academy of Neurology says opioids should be used only in exceptional circumstances.

Opioid medications, including codeine, fentanyl, and hydrocodone, are not the most effective option for treating migraine symptoms. In addition, one of the major risks of opioids is that they are highly addictive. 

Reglan

Reglan (metoclopramide) is an anti-nausea medication used for the treatment of nausea and gastroesophageal reflux (heartburn). In addition, you can also use it for migraine relief.

Reglan is often the preferred migraine therapy during pregnancy.

However, the medication is associated with a distressing side effect called focal dystonia, which causes a strong involuntary muscle contraction often described as “lockjaw."

Periactin

An antihistamine medication generally used for allergies, Periactin (cyproheptadine) is often used to treat migraines in children. 

A common side effect of Periactin is drowsiness. So you should not drive or operate machinery until you know how Periactin affects you.

Reyvow

Like the triptans, Reyvow (lasmiditan) is a serotonin receptor agonist. However, it works a little differently. Instead of inducing vasoconstriction, it alters electrical activity in the brain.

Reyvow was approved by the Food and Drug Administration (FDA) in 2019.

CGRP Antagonists

CGRP (calcitonin gene-related peptide) is a protein in the brain and nervous system that increases during a migraine attack. When this happens, it causes vasodilation (blood vessel widening), light sensitivity, and pain.

CGRP inhibitors relieve symptoms by suppressing CGRP. FDA-approved medications that target CGRP for acute pain relief include Nurtec ODT (rimegepant), Ubrelvy (ubrogepant), and Zavzpret (zavegepant).

Injections and Neuromodulators 

Injections and neuromodulators are generally considered preventive approaches to migraine therapy; they are not typically used for the treatment of an acute attack.

However, some techniques can help treat acute migraine attacks that do not respond to oral medications.

Injections

In some cases, injection of an anesthetic, muscle relaxant, or steroid can be used when a migraine is not responding well to any other therapy.

Intravenous (IV) infusions of ketamine or propofol, both powerful anesthetics sometimes used for surgical anesthesia, have been used for acute migraine treatment.

For chronic migraines, injections of botulinum toxin can be used as preventive therapy.

Neuromodulators

Neuromodulators affect the activity of the nervous system. This therapy uses electrical currents or magnets to adjust brain activity. Most devices are available by prescription, but one FDA-approved device, called CEFALY DUAL, is available OTC.

Examples of neuromodulators include:

• Transcranial magnetic stimulation (TMS): This magnetic stimulator is placed at the back of the head to deliver a magnetic pulse, which can stop a migraine attack.
• Transcutaneous vagus nerve stimulator: This handheld device uses electrical stimulation to target the vagus nerve.
• Transcutaneous supraorbital neurostimulator: This device uses electrical stimulation to target the supraorbital nerves.
• Multi-channel brain neuromodulation system: This headset targets multiple nerves in the head.
  

FDA-approved neuromodulation devices are labeled as "minimal risk." That means that no significant side effects are known or expected.

Complementary and Alternative Medicines (CAM)

CAM approaches to migraine treatment can be very effective for some people. However, not everyone experiences relief with these options.

They are considered safe, and if you experience migraines, it may be worth trying CAM treatments to see if they can work for you. 

Ginger

In terms of oral supplements, ginger is the only one that has been consistently proven effective in alleviating the symptoms of acute migraine. You can consume it raw, as gum or candy, or in hot or cold tea.

Tiger Balm

As a topical treatment, Tiger Balm is more effective than placebo (sham therapy) and equally as effective as medication in reducing tension headaches. It has also been used in migraine treatment with some success.

Lavender Oil

Lavender oil is the only aromatherapy that has been proven effective in the treatment of episodes of migraine. Inhalation of lavender oil may reduce the severity of a migraine and possibly eliminate the symptoms as well.

Summary

When migraines happen, they can seriously disrupt your life. So finding a treatment that tackles your acute migraine pain and that helps prevent future attacks is important.

There are many treatment options for migraines. These include home remedies, OTC medications, prescription medications, injections, and devices.

Talk to your healthcare provider about your migraines. It may take some experimentation, but together, you can establish a treatment plan that works best for you.