Migraine Treatment | Acute | Preventative

Unfortunately there is no universal cure for migraine. There are effective migraine treatments. That means that it is still possible to eliminate migraine attacks, significantly reduce them or otherwise live migraine free for extended periods of time. It’s not easy, but it is possible.

Migraine can be managed

There is always hope for a solution. There are a many different ways you can bring your migraines under control.

Studies show that over 50% of migraine sufferers have not even been diagnosed¹.

Effective migraine management involves a partnership between you and your doctor. If you have been to a doctor, but haven’t found a solution, it is worth another visit or finding a migraine specialist who comes recommended. Different treatments affect people differently. We are all unique and you will need to find what works for you with the help of a doctor or specialist to get the best results.

Below is a good starting point to evaluate different options, treatment strategies and consider what may work for you.

There are two main types of migraine treatment

1. Acute treatments – treating as soon as an attack happens; and
2. Preventative treatments – stopping attacks from happening in the first place.

Acute treatments

Some over the counter medications to treat a migraine attack include painkillers (also called analgesics):

Aspirin

A common and effective first option for migraines. A single oral dose of 1000mg of aspirin has been shown to reduce pain to none for 1 in 4 migraine sufferers. For roughly 50% of sufferers, pain was reduced to mild.  It is best used in a soluble form for maximum effect².

The European Headache Federation recommends soluble aspirin as the first option for migraine sufferers given its success rate. Aspirin is not recommended for children.

Non-steroidal anti-inflammatory drugs (NSAIDs)

These reduce inflammation by inhibiting the production of certain chemicals in the body.  Ibuprofen, for example, has been found to provide relief for about 50% of sufferers, but complete relief from pain and symptoms in a minority (around 1 in 4 sufferers). It is a good option for those experiencing minor to moderate migraines.³ This is particularly so for children and adolescents for whom aspirin is not recommended. If children are suffering from migraine then ibuprofen is commonly recommended as the first option.

Paracetamol

Caution should be exercised with Paracetamol. There is conflicting evidence about its efficacy for migraine relief. Paracetamol is widely known to relieve pain, fever and reduces stiffness but there is a lack of strong evidence to support its effectiveness with migraines. Some research shows that it can offer relief but not to the same level as aspirin or ibuprofen. Despite this, paracetamol remains one of the most commonly use drugs for migraine worldwide alongside aspirin due to its relative low cost and widespread availability⁴.

Painkillers that can be dissolved in water work faster

Painkillers can more effective for migraines when taken as soluble (dissolvable in water) or liquid format so they can be absorbed faster. This is important because migraines can prevent the effective absorption of medication once the symptoms occur (such as nausea) which then block the action of the medicine if left too late before a migraine attack.

Options for more severe attacks

For more severe migraines, the following medications may be prescribed:

Triptans

For a nonresponder to aspirin, the 2^nd option may be a triptan. This is effective for approximately 50% of those who try it according to the 17th Expert Committee on the Selection and Use of Essential Medicines to the World Health Organisation (WHO), Geneva, March 2009⁵.

There are several types of triptans available. Sumatriptan has the strongest supporting evidence for its efficacy according to the WHO Expert Committee.

Ergotamine Compounds

Ergots like the triptans constrict blood vessels but tend to cause more constriction in the heart and other parts of the body that lead to the head. Their affect on the heart is more prolonged than Triptans, therefore they are not deemed as safe. Side effects exist for both, but may be more pronounced for the ergots.

Stronger narcotic-type painkillers (analgesics)

This kind of painkiller is sometimes used to treat migraines. But given they are potentially addictive they are not recommended for initial treatment.

Anti-nausea medications

Medication that acts on nausea may be taken alongside a migraine medicine to allow for the absorption of the migraine medicine.  Metoclopramide is an example.

Preventive Treatments

Even after serious attempts have been made to reduce your migraines by identifying and avoiding triggers, disabling migraine attacks may continue. In these severe cases, if appropriate, your doctor may advise medication to try to stop the attacks from happening. This medication is taken daily regardless of whether a migraine is present or not to reduce migraine attacks.

Doctors may look not only at the frequency of your attacks but the severity and broader impact that migraines are having on your quality of life. The prescribed medications have different costs and many have noticeable side effects.

There are different types of preventative migraine drugs available. Many have originally been developed for other purposes but have been found to be helpful for migraine sufferers.

You may be prescribed:

Anticonvulsants

These are anti-seizure medications. Mode of action in migraine is not clear. They may reduce the capacity of the nerves to transmit pain signals to the brain.

Antidepressants

These can help prevent migraines which alter the levels of serotonin, a brain chemical that regulates mood.

Beta-blockers

These are a class of drugs which block the effects of beta-adrenergic substances produced by the body like adrenaline. It is not known exactly how beta blockers help prevent migraine headaches. It is thought that by decreasing the production of these substances, they affect serotonin and/or the arteries.  The most common beta-blocker for migraine is propranolol.

Anti-CGRP monoclonal antibodies

Anti-CGRP monoclonal antibodies are the first type of preventative medication designed specifically for migraine. They help neutralize the release of a molecule called CGRP during a migraine attack.

Review this list of evidence-based treatments proven to prevent migraine attacks. 

Herbal remedies and supplements

Riboflavin

Also known as Vitamin B2. Riboflavin has being reported as useful in migraine treatment due to its role in helping heal and strengthening brain cells. This can be taken as a supplement or you can simply eat foods high in Vitamin B (such as Milk, Cheese, Leafy Vegetables, Liver, Kidneys, Legumes, Yeast, Mushrooms & Almonds, Soybeans, Wheat Bran, Salmon or Sun-dried Tomatoes).

Feverfew

A herb whose leaves contain natural anti-inflammatory qualities which may help obstruct the release of blood vessel dilating substances in the brain and may reduce inflammatory substances from developing which may increase pain levels. It does provide relief for some sufferers and given its low side effects, it is a relatively low-risk option.

Butterbur

A herbal supplement which has been reported to be effective in reducing the frequency and severity of migraines in some migraine sufferers. However caution should be exercised with Butterbur as it contains components called pyrrolizidine alkaloids which are toxic to the liver and may cause cancers. The concentrations of this toxin vary depending on which part of the plant is harvested and where the plant is grown. Getting butterbur from a reputable source is important. The long-term health effects of butterbur have not been studied.

There are several other supplements which may assist with migraine including magnesium and CoQ10.

Complementary migraine treatments

The benefit of many of these complementary treatments is their comparative lack of side effects of the medical options. However, the level of relief from migraines may vary widely for different options and by person. Expect a greater variance in their success rates for migraine sufferers. Some treatments have more side effects than others. Not all therapies listed here are appropriate for all people and medical advice should be sought prior to consultation if in doubt.

How to manage your migraine condition

It takes a proactive effort to control of your migraines. But it is well worth it. Successfully managing your migraines means getting your life back.

Now that you have a number of options to consider, here are a few simple steps to manage your migraines.

Step 1) Keep a diary

Start relying on the facts, not your brain fog for how well you’ve been feeling, migraine frequency, symptoms and medication effectiveness.

Step 2) Get a good doctor

Develop a partnership with them to help put together a robust strategy and help reduce your attacks.

Step 3) Manage the migraine attacks

Consult with your doctor about suitable migraine medicine to manage the pain. Work with your doctor until you find a satisfactory solution as there are a 100s of treatments available. If appropriate discuss a preventative daily medicine to break the chronic cycle of migraines in your life. Note: these all have different costs and side effects which need to be evaluated for your own individual circumstances, tolerances, side effects, health profile etc.

Step 4) Uncover and manage your migraine triggers

To do this you will need to record these in some kind of migraine diary or journal each time you get an attack. Use each attack as a clue for suspected triggers that day and the day prior. Record as much as you can remember about what you eat, how you felt and what you did.

Once you identify your key triggers it becomes much easier to manage your migraine condition. For example, if caffeine is a key trigger- then gradually replace your morning coffee and soft drinks with herbal teas and water/juices. If it’s stress-related then explore ways to better cope with or manage stress in your life. This may include regular exercise, meditation, yoga, massages, vitamins or complementary therapies and any other stress management techniques or options your doctor may recommend.

Step 5) Prevent attacks

What you should begin to see with a better management of your the key triggers is your migraines start to decrease in both severity and frequency. If this is not the case, then go back to step 3) as you have may not have discovered enough or all of your key triggers leading to your migraines.