Migraine Treating
Goals of Treatment
There are two main approaches to treating migraines: acute treatment and preventive treatment. In some cases people with migraine use both forms of treatment. With either approach, in general the goals of treatment are to: 1,2
- Provide relief from pain and other symptoms linked with your migraine
- Improve your ability to do normal daily activities
- Reduce any mental and emotional suffering you may have related to your headaches
- Help you manage your migraines and give you a sense of control over them
Types of Treatment
Medicines for migraine treatment come in a variety of forms – medicines taken by mouth, nasal sprays, and injections. There are also non-drug therapies and medical devices that can be used to help treat migraine. 3
Acute treatments: With acute treatment, medicines are used to stop a migraine that has already started. They work best when taken right away – when you first notice symptoms. 4
Pain relievers. For mild-to-moderate attacks, pain relief medicines (analgesics) such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, aspirin, and naproxen may be useful. Some analgesics are combined with caffeine. These medicines are available over-the-counter and by prescription. 1
Migraine-specific treatments
Migraine-specific medicines work on the pain pathways involved in your migraine. They have little effect on other pain pathways such as those involved in a sprained ankle. These medicines are used to treat moderate to severe migraine attacks. They can also be used for mild to moderate attacks that don't get better with other treatments such as pain relievers. They include: 2,5
- Triptans
- Ditans
- Gepants (Some gepants can be used for both types of treatment – acute and preventive)
- Ergot derivatives
Nerve stimulation devices. These devices use electrical currents or a magnetic pulse to stimulate nerves involved in migraine pain. Four devices have been approved by the Federal Drug Administration (FDA) to treat acute migraine. These devices can be used alone or together with medicine. They include: 2,6
- Electrical trigeminal nerve stimulation (eTNS)
- Noninvasive vagus nerve stimulation (nVNS)
- Remote electrical neuromodulation (REN)
- Single-pulse transcranial magnetic stimulation (sTMS)
Preventive treatments: With preventive treatment, medicines are taken regularly, up to daily, to reduce the severity of any future migraine attacks or to prevent them from happening. 1
Treatment for other conditions. Some medicines that were originally designed to treat other medical conditions such as depression, seizures, and high blood pressure, can also be used to help prevent migraine. 1,4
Migraine-specific treatments. Certain migraine-specific treatments can be used for preventive treatments. 5,7
- Gepants (CGRP receptor antagonists)
- CGRP monoclonal antibodies
Botulinum toxin (Botox). Botox is a neurotoxin that's injected around the nerve fibers that are involved in your headache to help block pain signals. 7
Factors to consider for preventive treatment 2
Preventive treatment can be considered if you experience any of the following:
- Your migraine attacks interfere with your daily activities even with acute treatment
- You have frequent migraine attacks
- Acute treatments are not working for you, or they have been overused
- You've experienced unwanted side effects with acute treatments
Nerve stimulation devices. Some devices can also be used before a migraine occurs to prevent future attacks. Three devices (eTNS, nVNS, and sTMS) have been approved for preventing migraines. These devices can be used alone or along with other preventive migraine treatment. 2,6
Non-drug therapies. These non-drug therapies for migraine prevention can be used to help you learn how to cope with and control the development of pain, and your body's response to stress. They include: 2,4
- Biofeedback
- Cognitive behavioral therapy (CBT)
- Relaxation therapy
Other Ways to Feel Better and Ease Pain When You Have a Migraine 3,4
- Take a nap or rest with your eyes closed in a quiet, cool, dark room
- Place a cool cloth or ice pack on your forehead or behind your neck
- Drink lots of fluids, especially if you're vomiting
- Massage your scalp
Practice Healthy Habits
Lifestyle changes that help reduce and prevent migraine attacks in some people include: 1,3,4
- Taking your medicines as directed and following your doctor's advice
- Being physically active on a regular basis
- Avoiding or limiting things that trigger headaches, including foods and beverages
- Eating meals at regularly scheduled times and not skipping meals
- Drinking plenty of fluids to stay hydrated
- Limiting alcohol and caffeine intake
- Maintaining a regular sleep schedule
- Talking with your doctor about any medicines you should stop taking or avoid
- Losing weight if you are obese
Working with Your Doctor
Migraine can't be cured. But treatment can ease your symptoms and help to make migraines less frequent and less severe. Take part in your care. Talk with your doctor about the types of treatment you prefer and your treatment goals. Then work with your doctor to come up with a treatment plan that's best for you. 3
A thorough headache history is the most valuable information you can give your doctor. Sharing details about your headache symptoms will help lead to the most appropriate diagnosis and treatment for you. A headache journal can help you to track this information and prepare you for questions about your symptoms. 8
Information about your medical history 8
- Medical conditions you have
- Previous surgeries to your brain, neck, or back
- All medicines you are taking
- Medicines you've tried for your headaches (over-the-counter and prescription) including the dose and how long you took them. If you stopped taking any medicine, why did you stop taking it?
- Your family history of headaches including how often they occur
Levels of Headache 8
è
Mild Headache
You can do most things without difficulty
Information about your headaches 8
- Number of days per month you experience a headache
- Time of day your headaches occur
- Symptoms you experience before, during and after a headache
- Where the pain is located
- How long your headaches last – with medicine and without
- How bad the pain is
- Things you identified that cause your headaches (also called triggers)
- Words that describe your headache pain such as sharp, dull, throbbing, pressure
- How your headaches have changed in recent months
- If your migraines impact your work and home life
- If avoiding the things (triggers) that cause your headaches impacts your life
- If you get anxious about your next migraine attack
S
Moderate Headache
You are able to do some things but you are less able to do normal daily activities
C
Severe Headache
You are unable to do normal daily activities
- Office on Women's Health. Migraine. Updated February 22, 2021. Accessed February 8, 2023. https://www.womenshealth.gov/a-z-topics/migraine
- Ailani J, Burch RC, Robbins MS. The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache. 2021;61:1021-1039. doi:10.1111/head.14153
- Cleveland Clinic. Migraine Headaches. Reviewed March 3, 2021. Accessed February 27, 2023. https://my.clevelandclinic.org/health/diseases/5005-migraine-headaches
- National Institute of Neurological Disorders and Stroke. Migraine. Reviewed January 20, 2023. Accessed February 8, 2023. https://www.ninds.nih.gov/health-information/disorders/migraine
- Morales-Brown L. What to know about anti-CGRP migraine treatment. Medical News Today. Published June 29, 2022. Accessed March 2, 2023. https://www.medicalnewstoday.com/articles/cgrp-migraine
- Food and Drug Administration. Treating migraines: more ways to fight the pain. Accessed February 17, 2023. https://www.fda.gov/consumers/consumer-updates/treating-migraines-more-ways-fight-pain
- John Hopkins Medicine. Botulinum toxin injectables for migraines. Accessed March 7, 2023.
- American Migraine Foundation. Talking to your doctor about migraine. Accessed March 7, 2023. https://americanmigrainefoundation.org/