This article reviews a list of evidence-based acute migraine treatments to help you make more informed decisions about your treatment strategy.
Finding trustworthy, unbiased and reliable information on migraines is not easy. It can be especially difficult when considering information about treatments.
It’s become easier thanks to the research summaries by providers like Cochrane. An independent, non-profit, evidence-based research collaboration who review clinical trials in healthcare.
An acute migraine treatment is something used to treat an incoming migraine attack. Other types of treatments can be used to minimize the risk of a future migraine attack. These are often referred to as a preventive or prophylactic migraine treatment.
For an acute migraine treatment to be considered “effective” and successful it should provide ‘significant or full relief within 2 hours’ when taken at the onset of a migraine attack.
Anything that takes longer or provides only modest (not significant) relief at the 2 hour mark is considered ineffective.
If you are not getting this kind of relief consider going back to the doctor to discuss other potential treatment options or combinations of treatments that could be effective and safe for you to try.
Evidence-Based Acute Migraine Treatments
Cochrane is a non-profit organization that provides systematic reviews of scientific research and clinical trials. Stringent guidelines are applied which is why Cochrane Reviews are internationally recognized as one of the highest standards in evidence-based healthcare reviews.
Below is a table that summarises findings on available evidence for acute migraine treatments.
It’s important to remember that they can only review what studies have been conducted. There may be other effective treatments in use, but they may not have been studied in clinical trials.
If the acute medicine you use doesn’t appear below, then it’s because at the time of writing (2015) there were no scientific reviews or clinical evidence for that medicine for the treatment of migraine.
How To Read The Table
- The table is ranked from most to least effective in the treatment of an acute migraine attack, sources are listed at the end of the article.
- % ‘moderate to severe pain’ to ‘no pain’ is measured within a time period of 2 hours. i.e. 59% of those who were given an injection of Sumatriptan in the studies reviewed experienced no pain within 2 hours.
- % ‘moderate to severe pain’ to ‘mild pain’ is measured within 2 hours.
- Placebo records the number of people who still improved when they were told they were getting the full dose but actually were given a placebo yet they still improved.
- Data is provided where clinical trials support the treatment. If the acute treatment is not here there are either no trials supporting its efficacy (effectiveness), the trials are not of sufficient scientific rigor or the data is not available.
- This table does not take into account side effects which may vary by individual.
The Most Effective Acute Treatments For Migraine
Sumatriptan was found to be one of the most effective migraine treatments. Particularly when delivered as an injection. It is considerably more expensive in this format.
The majority of patients studied improved 59% from ‘moderate or severe’ pain to ‘no pain’ via injection.(1) This fell by almost half when delivered orally. Oral delivery still delivers relief for the significant majority (61%) by reducing moderate/severe pain to ‘mild’ within 2 hours.(2)
Zolmitriptan delivers comparable results with oral Sumatriptan.(3)
Higher doses of Zolmitriptan were found to deliver slightly better results with 5mg and 10mg. But they were also associated with more adverse events or side effects.(3)
According to the data available, Ibuprofen appears to be the most effective NSAID or over the counter medicine to treat a migraine attack.
The 200mg was reported to be only slightly less effective, whilst soluble formulations (i.e. those that dissolve in water) delivered quicker responses.(4)
At the bottom of the table is Naproxen. The authors of the study Law, S. Derry S et. al. indicated that “Naproxen is not a good drug for treating migraine at the doses of 500mg or 825mg used in the studies we found.” And that is was only slightly more effective than placebo for relieving migraine headache.(9)
90% Of Patients Should Find Relief
If you were to try each of the nine treatments listed in the table separately at the onset of a migraine, statistically speaking there is over a 90% chance of one of these treatments may reduce your pain levels from moderate/severe to nil within 2 hours.
That’s +90% of us would experience no pain within 2 hours by one of the above treatments. We just need to try them.
What about those who fall within the small 10% minority?
If all these treatments were tried, 99% would still experience significant relief from one or more of these treatments ‘from moderate or severe’ to ‘mild pain’ within 2 hours.
Take The Treatment At The First Signs
If you have literally tried every treatment listed and still haven’t found success it’s important to remember the importance of timing.
Taking a triptan 2 hours into a fully developed migraine attack is not going to be nearly as effective for many people versus taking a triptan at the first signs when the attack is still in its initial phase.
If you are a migraine patient and you are not currently experiencing any relief from your migraine treatment it’s time to review the situation with your doctor.
General physicians don’t have time to stay abreast of all the latest research and studies out there. But with a little information, you can prompt discussions with your doctor about what treatments might be most effective for you.
With more research, information and treatments available than ever for migraine there has never been a better time to hope for a brighter future.
This part 1 of a 2 part series. Part 2 reviews the clinical evidence of preventive migraine treatments.
What treatments work well for your migraine attacks? Let me know in the comments below.
Get a list of 11 natural and proven treatments from medically published studies sent to you.
- Derry CJ, Derry S, Moore RA. Sumatriptan (subcutaneous route of administration) for acute migraine attacks in adults. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD009665. DOI: 10.1002/14651858.CD009665
- Derry CJ, Derry S, Moore RA. Sumatriptan (oral route of administration) for acute migraine attacks in adults. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD008615. DOI: 10.1002/14651858.CD008615.pub2
- Bird S, Derry S, Moore R. Zolmitriptan for acute migraine attacks in adults. Cochrane Database of Systematic Reviews 2014, Issue 5. Art. No.: CD008616. DOI: 10.1002/14651858.CD008616.pub2
Rabbie R, Derry S, Moore R. Ibuprofen with or without an antiemetic for acute migraine headaches in adults. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD008039. DOI: 10.1002/14651858.CD008039.pub3
- Derry CJ, Derry S, Moore RA. Sumatriptan (intranasal route of administration) for acute migraine attacks in adults. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD009663. DOI: 10.1002/14651858.CD009663
- Kirthi V, Derry S, Moore R. Aspirin with or without an antiemetic for acute migraine headaches in adults. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD008041. DOI: 10.1002/14651858.CD008041.pub3
- Derry S, Rabbie R, Moore R. Diclofenac with or without an antiemetic for acute migraine headaches in adults. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD008783. DOI: 10.1002/14651858.CD008783.pub3
- Derry S, Moore R. Paracetamol (acetaminophen) with or without an antiemetic for acute migraine headaches in adults. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD008040. DOI: 10.1002/14651858.CD008040.pub3
- Law S, Derry S, Moore R. Naproxen with or without an antiemetic for acute migraine headaches in adults. Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD009455. DOI: 10.1002/14651858.CD009455.pub2
Photo credit: nima; hopographer
Unfortunately your math is too niaive. It doesn’t take into account the number of people not helped by all treatments. It also ignores the fact that this table only lists to classes of medication. There is a high likelihood that someone who does not respond to one medicine in a class will also not respond to any other in the class. If one Tristan type drug doesn’t work it is probable that no other will work.
Thank you for your feedback. As a migraineur I like to come to problems with solutions wherever possible. So how would you solve this? It sounds like a math question and you seem to have some background here. I’d welcome your answer 🙂
The solution side of this is that someone needs to try all of the medications and see what effect they have for them. 🙂 But, reality is that if Sumatriptan in one form doesn’t work, don’t bother trying the other forms and don’t have high hopes for Zolmitriptan or any other “triptan” type of drug.
The actual percentage of people helped across all of these drugs is very complex to work out, as it requires looking at the details of every study, and looking into comparisons of these medications. My experience would guess that across all these drugs you are probably looking at an 85 – 95 percent success rate.
85-95 success is good. I’d take those odds. I’ve also worked with Neurologists who’ve said that the Triptans are indeed worth trying individually. If patients don’t respond to one Triptan, it doesn’t mean that they don’t respond to another class. So I’m pretty sure it’s common practice for doctors and neurologists to trial patients through the triptans Sumatriptan, Zolmitriptan etc. to see if they respond. See Prof Goadsby medical review on migraines which includes triptans which discusses this
Yes – I tried 3 before I found the one triptan that worked for me. Imigran was too strong, Maxalt too weak. And Naramig was just right. Been using it for effective pain relief for years now.
Wow so informative! I dont think doctors in sydney research things about migrines i have yet to find a doctors that suffers with this problem that is my aim anyway ; so many triggers hard to explain to doctors
Thanks Rosanna. It is hard to talk to a doctor about it if they don’t give you the time. If you’re in Australia, try speaking to Headache Australia. They may be able to refer you to a highly recommended neurologist or migraine specialist in your area. Good luck!
Hey Rosanna, I typed out a list of my most common symptoms, and then my not so common ones. I just hand them the list now. This way I don’t forget a thing. I recently saw a doctor and forgot to say most attacks were right sided, he diagnosed something completely different (MS in fact) . After I stopped freaking out, I realized I missed out saying right sided. Then he changed to headache as diagnosis. He could not say migraine. 2 appointments now, he still says headache. Yeah right!
Holly, with 2 appointments and your doctor still sounding so far off the mark, I suggest you either ask for a referral to a specialist (neurologist or headache specialist) or find another GP. This one doesn’t sound like a keeper. Life is too short to settle for the wrong doctor as your partner against migraines.
Hi Carl! Thanks as always for the information and the chance to learn from other migraineurs.
My 13 year old daughter has tried multiple medicines (and preventatives) for her chronic migraine. She has one rescue med that works really well (besides Excedrin which helps roo!). It is Cambia, which is a powder she drinks in 2 oz of water. Roger Cady, MD, prescribed it before he retired. He said it works particularly well for Migraine with Aura. I don’t hear about it much so wantes to make sure and add it to the discussion!
We keep hoping that it keeps working!
That might be an interesting one for me to try seeing as I have migraine with aura with every attack. Cambia is the brand name of the active ingredient Diclofenac which is mentioned above.
Having it in a dissolvable format would be particularly advantageous as it would be absorbed quicker. The research above only looked at the oral tablet – so that format could potentially be more effective.
Thanks for sharing!
The generic for the old drug, Midrin, is the only thing that works for me. It is a combination of:
Acetaminophen – a pain reliever and a fever reducer.
Dichloralphenazone – a sedative that slows the central nervous system.
Isometheptene – causes narrowing of blood vessels (vasoconstriction).
Since this is an older drug from the 1950’s, I believe, the FDA has argued that the drug hasn’t been properly tested.
As a result sometimes the drug is hard to find unless a compounding pharmacy is used. I have no side effects with it and have been using it for over 30 years.
Sumatriptan, on the other hand, paralyzed my swallowing muscles which was truly frightening.
That is a scary side effect to experience. Glad you’ve found something that works. I note that it includes several of the ingredients mentioned in the list above.
You’re probably right that about the reasons why the combination hasn’t been researched thoroughly due it’s age.
You name it, I have tried it! By far the best medication I have tried is Rizatriptan which is a small wafer placed under the tongue immediately symptoms of the migraine start. Instead of a day or 2 in bed I now have 3-4 hours sleep and am headache free when wake and could even go to work if I had to. Fantastic.
That’s great. I was surprised when I didn’t find any results on Rizatriptan. It is similar to the other triptans but they all do have subtle differences.
It took me many, many years to find the winning formula. Imigran FDT (fast disintegrating tablet) WITH 2mg Valium.
The FDT tablet works much quicker. The Valium relaxes my muscles and my brain to allow the Imigran to work. I don’t to Valium for anything else, and I still struggle with the notion of "I don’t want to take it again, I only took some yesterday". But with this method I only get migraines roughly monthly, for a few days, and I can manage them so they don’t carry on for weeks at a time.
I wouldn’t feel guilty if you only taking that on a monthly basis for an acute migraine attack. I’d be surprised if your physician they had any issues with this unless you had some personal health history or other medications that could interact or put you at risk of rebound headaches.
My PERSONAL, ANECDOTAL experiences:
Rizatriptan(Maxalt): ‘Placebo effect’ w/ strong side effects. Continued pain, no change. Severe side effects; neck, jaw, chest pain.
Frovatritpan (Frova/Generic) : ‘To mild pain’ – moderate alleviation of pain. Reliable efficacy, low side effects. Moderate onset, approx 45-60 min. Negligible difference generic to brand name pharmaceutical.
Eletriptan (Relpax) 4:1 ‘To mild pain’ vs ‘No pain’ – moderate to total alleviation of pain. Reliable efficacy, low side effects. Moderate onset, approx 45-60 min. 1-2 dozen samples over a year, not long-term prescription. Only slightly more efficacious than currently prescribed frovatritpan at the time.
Almotriptan (Axert/Generic) : Averaged ‘To no pain’ – Frequent relief of pain, strong but less common side effects; discontinued due to aggravated hypersomnolence/sleep attacks. Reliable efficacy, predictable onset. Pain stopped, mild relief or sustained level of pain w/o further increase. Faster onset than Frova, approx 30 min.
Zolmitriptan (Zomig ZDT/Generic ODT [Dissolvable])
Split average between mild pain/no pain. Reliable and frequent relief of pain, infrequent strong side effects; stiffness in neck, chest, jaw. Reliable efficacy, predictable onset. Pain stopped, total relief or sustained level of pain w/o further increase. Faster onset than Axert, approx 15-20 min. Timing critical to resolve total pain, must be taken early: almost at a point where I am still rolling the dice as to whether this will be a migraine or not. *Note, the dissolvable version contains a low amount an artificial sweetener.
Diclofenac Sodium (Cambia)
Early relief of pain, severe digestive side effects; discontinued due to aggravated lower stomach/duodenum. Reliable efficacy, predictable onset. Mild pain relief or first step pre-Triptan. 10-20 min. onset in buffered powder solution. Low efficacy to ‘no pain’ when taken without further preventative medication unless taken early on in migraine onset. *Note, the powdered solution for oral liquid consumption has an anise-like flavouring.
Hope it helps, just remember these are my personal experiences and everyone’s medical condition is different. My co-morbid disorders, syndromes, diseases, viruses, bacteria, pH level, and favorite color are different than yours: this won’t all apply exact.
Paracetamol and naproxen have negligible effects depending when although I continue to take both on a semi-daily basis for tension headaches and cluster attacks.
I feel as though the nasal spray preparation of zolmitriptan or the injectable imitrex solution may provide better results personally. Both would offer quicker delivery onset; useful in self-doubting situations where you may wait too long.
Again, this is my personal experience.
Wishing you all the best,
Wow, what a fantastic account of your experiences Eric. I think we could all follow your example in keeping such a great record.
And you’re absolutely right when you warn that your health profile, response to treatment and favorite color 😉 are likely to be different to others. But this is still fantastic. Thank you very much for your insight!
Thanks Carl, I Have been a migraine sufferer for 40 years. I’ve tried everything and right now seem to be having most success with 200mg Topiramate daily and then when I get my migraine I take the Sumatriptan plus 800mg Motrin, an anti-nausea pill, a Benadryl and cup of coffee. Within 2 hours this typically takes the aura and migraine pain away. (*My last physician visit the doctor switched my Motrin to Naproxen for no reason and your data is 💯 % accurate! It DID NOT WORK! After 2hrs I was holding my heading telling my husband how much Naproxen is crap! Lol) So needless to say…I Won’t be using Naproxen with the Sumatriptan again!
I’ve tried Sumatriptan oral tablets and didn’t find success personally. I also have migraine with aura. If you’re not getting results with Sumatriptan alone it might be worth trying something else.
I’m noticing a pattern in those with migraine with aura in these comments. Cambria and Motrin are both NSAIDs which seem to work. I also seem to respond to more to NSAIDs versus the triptans for migraine with aura.
3 Tylenols works for me! Gotta take 3 though. Plus I take a Reglan along with for the nausea.
Thank you for sharing Erin. I often still use Paracetamol (Acetaminophen) with Metoclopramide for the nausea… which is simple but surprisingly helpful. Metoclopramide has some contra indications so speak to your doctor or pharmacist before trying it.
I use Sumatriptan if Excedrin for migraine doesn’t help first. I also take Metropolo to help lesson the amount of migraines I get. Some months are better then others since weather a huge trigger for me. If nothing helps I’m stuck with it for 2 days…I wake up with most of mine. I just found out there’s 3 migraine centers in Dallas. None of my doctors I have seen even mentioned them. Insurance might be an issue.
Interesting to hear you wake up with them. My last migraine I woke up with an attack as well. I remember I had a stressful dream and I had also woken up early (because of it). For me exercise and meditation help prevent those types of attacks.
Definitely worth checking what you’re insurance will cover Mitzi… if it’s covered, it may well be worth investigating.
I am allergic to Imigran (Sumatriptan), and so for years my GP told me I could not take any siimilar medications, as I would be allergic to all of them. I finally went to a neurologist who prescribed Relpax (eletriptan) and these work very well for me. I have migraine with aura. Although I will say that it did not take long before I had to take them more and more frequently. I suspect that I now get a ‘withdrawal’ migraine from these tablets.
Hey Jenny, if you’re unsure about how much you can take before you put yourself at risk of rebound headaches or medication overuse this article is very helpful: https://migrainepal.com/rebound-headache/
I’m allergic to sumatriptan. I take Gabapentin and paracetamol now. The last time I saw my neurologist I asked about other triptans and got told they were all very similar to each other. Also if you have migraine with aura your advised to take the triptan after the aura phase. Otherwise it isn’t as effective.
Hi Gem, that is very interesting. I have never heard of Gabapentin. My neurologist says that the reason I can take Relpax when I’m allergic to Sumatriptan is because it contains a different chemical. Do you take Gabapentin only when you have a migraine? Or is it a type of preventative?
Gabapentin is a type of migraine preventative. It usually isn’t the first choice doctors will use, but again that depends entirely on the individuals health profile, history and responses to treatments etc.
I have been told to take a triptan after the aura phase by a doctor as well. However, I’ve recently learnt from Andrew Charles, a senior neurologist and certified headache specialist based at UCLA that you can indeed take a triptan at the first signs of an aura or during an aura. The rationale is that triptans aren’t as strongly vaso-constrictive as once thought and the benefit to migraine patients is likely through another mechanism.
Check this with your doctor… but this was news to me when I learnt this earlier in Jan 2017.
I live in Birmingham UK. I’ve been talking zolmitriptan in the orodispersible form for years plus sometimes the Nasal spray. Tesco pharmacy couldn’t get hold of any a while back and said they have been discontinued. I looked up the manufacturer and emailed them who also said they’re discontinued. Tesco recently ‘found’ some from somewhere.
They are almost always effective for me. And I’ve tried other triptans, they don’t work as well.
Has anyone else had the same problem?
Also. I’ve been taking amiltryptiline for about 6 months as a prophylaxis. It’s partially successful though I’ve really played about with the dose due to side effects. Considering going onto a beta blocker though I’m concerned about the side effects..
Carl. Thanks and please keep up the good work!
Thanks Kevin for the feedback.
Are there any online options for ordering Zolmitriptan in your desired format with a prescription. I know a few platforms in the USA that are doing this… I would imagine there are some in the UK too. Might be worth investigating.
Alternatively, speaking to the pharmacy manager at your local store can also be helpful in finding out some tips about where to find things. They might know who supplies it.
Most treatments have side effects to some extent. Much of it varies on the dose and our unique response. Your doctor is going to be the best guide to inform you.
Preventatives are a means to an end in my mind. Ideally you use them for a temporary period to get a grip on your condition whilst you embed protective habits that ensure you keep on top of your condition. i.e. consistent sleep routine, healthy diet (most of the time), regular exercise, regular relaxation etc. These are things that you can keep doing for the rest of your life ideally.
Good luck Kevin.
I have had regular, very severe migraines with aura since the age of 7yrs old (for 46 years).
As anyone who suffers migraines will know, the impacts and costs of regular severe attacks are many, varied and significant.
I had used Imigran (sumatriptan) to treat my migraines with some success, but was changed to Relpax (eletriptan) by my neurologist – which proved slightly more successful.
My observation was that often the success of treatment correlated with how quickly I could take the medication after onset of the aura.
However, I am very happy to report that after so many years of being a migraineur I am now 12 months almost totally ‘free’ of any significant symptoms and no serious attacks having been treated with a preventative medication – Topomax (topiramate). It really has been life changing for me.
Fantastic result Bill. This preventative medication does have some good evidence behind it’s efficiacy. Some people have trouble with the side effects but for those who tolerate it can be game changing. Congratulations!
I’m 50 and been a migraine sufferer since I was 19. They have "ramped-up" since my early 30’s and during certain times of the month, before and during menstrual cycle I get migraine for an average of 2-3 days. I use Sumatriptan(50mg) orally from the doctor. She also prescribes me Almpotriptan(5mg) to "kick it into touch" if the migraine doesn’t go/comes back having used Sumatriptan. I am under a neurologist at one of the top London teaching hospitals and have been given all the usual awful treatments, that work for a while with their awful side-effects, then the migraines come back again. I’ve been given various beta-blockers – that make you breathless and unable to workout at the gym. These include such drugs as Candesartan, Pizotifan (make me very sleepy), Propranalol(makes me drowsy), Topiramate and Amitriptyline. Amitriptyline was ok for around 4 weeks then the migraines came back. Amitriptyline made me grin like a fool for the first few days of taking it(not a good look at work). The neurologist doesn’t think I should keep taking triptans, fine but don’t start handing out pills with other debilitating side-effects then. I think he finds migraine sufferers an irritant more than anything lese and has little time for them. he just starts with the cheapest drug and works his way down a list of possible treatments till they start getting more expensive to dispense. He has much more "serious" neurological conditions to deal with! In summary, triptans are the only solution for a migraine sufferer like myself. I am occasionally bed-ridden with a really bad migraine but normally with the help of triptans can lead a fairly normal life, like going to work!
Hey Suzie, sounds like your migraines are hormonally related which is extremely common in women with migraine. What some doctors do is prescribe Frovatriptan which is almost considered to be a specialist for dealing with hormonal migraines. If you haven’t tried that, it could be one to consider.
I know that this exact topic will comes up in detail during the Migraine World Summit 2017 so stayed tuned for that!
I am one of those lifelong migraine sufferers that is resistant to acute medications. I’ve found great results (with the help of my neurologist) during severe attacks with an infusion therapy approach. My neuro office offers these infusion cocktails to their headache patients and customizes the cocktail to the individual. All patients typically start out with the same combination of Benadryl, Toradol, SoluMedrol/Steroid, Compazine/Reglan, + fluids/dextrose. Many patients also find the addition of Magnesium to be helpful. I’ve been lucky to respond to the original cocktail and can rely on this to bring my pain level from >8 down to a 1-3.
Hey Kelley, thats very handy and proactive by your doctor. I know that those combinations of medications are often used to break status migraine. It’s great you’ve got a doctor whose been able to put these together for you. If it keeps you out of the ER then everyone wins!
Carl, Thanks again for your dedication to helping migrainers. Triptans stopped working for me years ago. I use dihydroergotamine (DHE) injections when needed.
Cambia, a water soluble diclofenac, has taken aspartame out of its ingredients recently. The box is blue and pink now. This does work for me now for a first try med or for mild pain. Feel better all.
The injections are generally are much more effective treatment due to it’s delivery straight into the bloodstream. Thank you for letting me know about the removal of aspartame from Cambia. I hadn’t seen that.
Best wishes Leslie,
Carl, you just put everything in terms I can understand, THANKYOU.
Naawwww, thanks Holly!
Hi Carl, I use Relpax , after a long time of using Maxalt & Imigran , as they lost their efficacy. Relpax has few side effects , I can keep on working & sleep it off later. It does take a while to kick in but it works most of the time . I am very thankful it does ! Thanks for your work Stephanie
Thank you. Great to hear you have something that works for you Stephanie.
Firstly, I want to thank you Carl for all your efforts in helping the migraine community, without any financial benefit to yourself (unlike so many others who see it as a money making scheme). I always find your artcles informative, helpful, easy to understand and always relevant, so thank you.
I am a 53 old woman who started migraines in my early forties (sadly I can find very little info about this relatively late onset) and they have steadily increased to around 8 per month. None of the preventatives have worked for me, but fortunately the triptans are very effective. Like Kevin, I used to take orodispersable Zolmitryptan, but as he says these no longer seem to be available, so I have just started taking the non orodispersable form with a Metoclopramide. This generally works though the other day I did have to take a second dose. I had always thought that if the tryptan doesn’t initially work on your migraine then a second dose for that particular attack will be ineffective. However, I recently found an article saying that Zolmitryptan was the one tryptan that you can take a second dose for and be effective. Personal experience has shown this to be the case, though I have only has to do this a couple of times. Kevin – if you really need to take an orodispersable form I also used to take orodispersable Rizatryptan which was just as effective as Zomig.
With later life onset of migraine make sure you’ve had your precautionary scans. It’s also possible that car accidents, whiplash or head trauma can induce migraine later in life. So can peri-menopause or menopause. If any of these factors are involved it will also give you clues to the potential solution. There are approaches for all of them. I hope that provides some assistance Karen. Thank you for your kind words.
Carl – Thanks for this! I’ve been using Naproxen rather than Ibuprofen as an "early symptom" treatment, so this is extremely helpful! Will you soon be posting the second part of this article? I’m extremely interested in reading it.
Hi Leonard, I’m working on getting something up. Will let you know when it’s ready.
In Australia Codeine (for example in "Panadeine" branded tablets where it is combined with paracetamol) is (or was, I think the rule is about to change) available over the counter at phramacies/drugstores. it is relatively cheap, it works very well for my own migraines.
I moved to the US a couple of years ago and here Codeine is by doctor’s script which is super annoying especially since they will only give you a very small supply.
That’s true. Codeine is actually in a class of medications called narcotics or opioids.
In excessive quantities they can be dangerous and lead to addiction, overuse and medication overuse headaches (rebound headaches).
The US is much more acutely aware of an opioid overuse problem which has had serious public health consequences.
I didn’t find codeine particularly helpful myself for my attacks when I tried it but everyone is different.
I have had PFO Closure for Migraine with positive results. No more pain meds. 😊👍
Oh great tip Sarah! Thank you for sharing!! I’ve been meaning to check if I have a PFO (Patent Foramen Ovale).
Hi Carl, I’ve been suffering from menstrual migraine for about four years. This actually coincided with stopping an SSRI antidepressant (coincidence? Or a link to changing levels of Serotonin?) The migraine will last about 2/3 days each month and can be crippling. After years of trying different NSAIDs and strong painkillers I finally was prescribed Sumatriptan and it changed my life! I take 50mg orally and can be pain free within about half an hour of taking it. However, they only seem to last approximately 5 hrs before the pain returns.I’ve been told I should only take 100mg per day, i.e two tablets per day. This will only give me relieve for about ten hours out of 24 and I’m suffering in between tablets. I’ve read that I can take up to 200mg per day which would be ideal as I could then take a tablet every 6 hours which would pretty much cover me. I would very much welcome your thoughts on this as I’m currently living abroad in the USA with no access to my GP. I’m having to order my Sumatriptan from the UK and get my sister to post it out to me. The cost of seeing a doctor and getting a prescription here would be a few hundred dollars a month which I can’t afford! Thanks for your interesting post. It’s good to know I’m not alone! Helen.
Dr Susan Hutchinson discussed several treatment options on this topic in detail at the Migraine World Summit. You can watch some of her talk at https://www.migraineworldsummit.com/public-susan-hutchinson/
There is also an article about this topic specifically at: https://migrainepal.com/prevent-menstrual-migraine/
I hope that helps.
Oxygen E tank set at 3 takes care of my cluster migraine headache in 15 minutes or less.
For cluster headache and Oxygen is an extremely effective treatment for most people.
what about nerve blocks and surgery for migraine? is there any evidence of their effectiveness?
Surgery for migraine was discussed during the Migraine World Summit, short answer is no. Results aren’t great, so no, not unless it’s part of a robust clinical trial.
Re: evidence for nerve blocks, here is an excerpt from a published study on nerve blocks for migraine by Ashkenazi, A. and Levin, M:
"Several studies suggested efficacy of GON (Greater Occipital Nerve) block in the treatment of migraine, cluster headache, and chronic daily headache. However, few were controlled and blinded. Despite a favorable clinical experience, little evidence exists for the efficacy of GON block in migraine treatment. Controlled studies are needed to better assess the role of GON block in the treatment of migraine and other headaches."
I hope that helps Alfredo.
The best I have seen so far on the subject, and the mechanism behind the CGRP inner workings is very clearly explained. Very good!
Thank you Tommy, I appreciate your kind feedback.