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.
- 1 Migraine can be managed
- 2 There are two main types of migraine treatment
- 3 Acute treatments
- 4 Options for more severe attacks
- 5 Preventive Treatments
- 6 Herbal remedies and supplements
- 7 Complementary migraine treatments
- 8 How to manage your migraine condition
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
- Acute treatments – treating as soon as an attack happens; and
- Preventative treatments – stopping attacks from happening in the first place.
Some over the counter medications to treat a migraine attack include painkillers (also called analgesics):
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.
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.
There could be a very big difference in the effectiveness of the same medication when taking the medication at the first signs of a migraine…. versus 5-10 mins after the migraine attack has already begun.
See a list of evidence-based treatments proven to help abort an acute attack.
Options for more severe attacks
For more severe migraines, the following medications may be prescribed:
For a nonresponder to aspirin, the 2nd 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.
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.
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.
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:
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.
These can help prevent migraines which alter the levels of serotonin, a brain chemical that regulates mood.
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
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).
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.
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.
|Acupuncture||A traditional and ancient Chinese technique which involves the insertion of very fine, solid needles into certain points of the body. According to Chinese medicine, acupuncture helps headaches by encouraging the production the body’s natural painkillers called endorphins.|
|Alexander Technique||Is a system designed to retrain poor posture to ensure minimum effort, strain and help prevent the headaches that can result.|
|Biofeedback||A technique that teaches people how to control certain body functions like blood pressure, heart rate and spasms in the arteries supplying the brain with the help of a sensory device. Once skills are learned they can be practiced anywhere.|
|Chiropractic Therapy||Chiropractors seek to relieve headache disorders based on the diagnosis and manipulative treatment of misalignments of the joints, particularly those of the spinal column. Manual techniques on the re-alignment may benefit corresponding nerves, muscles or organs.|
|Dietitian/ Nutritionist||What you eat can play a very significant role in your migraines. There are a number of foods that are problematic for a large number of migraine sufferers. Understanding which foods trigger your migraines are essential to successful migraine management. Common food triggers to be aware of are food additives such as nitrites and MSG (monosodium glutamate), food colouring, chocolate, aged cheese, red wine, beer, caffeine, citrus fruits, cured meats such as bacon, hot dogs, aspartame, ice cream. Not all trigger foods are listed here. If you are unsure, it may be worthwhile speaking with your doctor or seeing a dietitian or nutritionist to manage your diet, they can also help determine if you have any food allergies which may be contributing to your migraines.|
|Exercise / Personal Trainer|
Exercise helps with rest, relaxation and it also helps release stress – a common trigger for migraines. Most experts recommend you need at least 30mins of moderate exercise daily to get the best results for stress reduction. i.e. running, swimming, bike riding. If you can find things you enjoy doing then you’re more likely to be consistent, try Yoga or Pilates. Something is better than nothing. Start small and build slowly from there.
|Hydrotherapy||Using ice packs on the head, splashing the face with cold water can help provide relief. Having hot and cold showers dilates then constricts blood vessels which stimulates circulation.|
|Massage||Can reduce headaches by relieving muscle tension throughout the body.|
|Meditation||Recent research has shown very promising results for meditation with all participants reporting less severe migraines.|
|Optometrist||Do you need prescription glasses? Could the glare from the fluorescent lights or computer screen at school or work be causing your migraines. It may be worth getting your eyes checked if you think you may need glasses. Or seeing a behaviour optometrist to see if you respond to coloured lenses. Glare from the sun may also be contributing to migraines. Ensuring you have sufficient sunglasses with UV protection and polarization to reduce glare may provide significant relief. Wear sunglasses even with the smallest amount of sunshine if you are sensitive to sunlight.|
|Osteopathy||Can be used to correct misalignments which may cause migraines.|
|Physiotherapy||A more scientific approach than plain ‘massage’ to treating muscle tension to release pressure that may lead to headaches.|
|Relaxation Techniques||Does your mind race after your head hits the pillow? Try relaxation techniques to put your mind at ease before you go to bed to fall asleep faster and in a more peaceful and calm state. With a little practice you’ll sleep better and feel more refreshed in the morning – you may even become a calmer, more balanced person.|
|Shiatsu||A Japanese form of therapy which involves hand massage and pressure to certain body points to help restore the ‘energy balance’ and promote relaxation.|
|Yoga||A form of exercise that involves stretching, poses, breathing control to strengthen muscles and increase blood flow. It can promote calmness and is often used in combination with meditation exercises.|
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.
- World Health Organization, The global burden of disease: 2004 update.
- Kirthi, V. Derry, S. Aspirin With Or Without An Antiemetic For Acute Migraine Headaches In Adults Cochrane Pain. Apr 2013.
- Rabbie R, Derry S et al. Ibuprofen With Or Without An Antiemetic For Acute Migraine Headaches In Adults.Cochrane Pain. Oct 2010.
- Derry, S. Moore, AR. Paracetamol (Acetaminophen) With or Without an Antiemetic for Acute Migraine Headache in Adults Cochrane Pain. Apr 2013
- Johnston MM, Rapoport AM. Triptans For The Management Of Migraine. Drugs. August 2010
- World Health Organisation, 17th Expert Committee on the Selection and Use of Essential Medicines. Geneva, Mar 2009.
- 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
- Bianchi, A, et.al. Role of Magnesium, Coenzyme Q10, Riboflavin, and Vitamin B12 in Migraine Prophylaxis. Vitamins & Hormones. Vol. 69, 2004.
- Rios, J. Passe, MM. Evidence-Based Use Of Botanicals, Minerals, And Vitamins In The Prophylactic Treatment Of Migraines. Journal of the American Academy of Nurse Practitioners. 2004
- Posadzki, P; Ernst, E. Spinal Manipulations For The Treatment Of Migraine: A Systematic Review Of Randomized Clinical Trials. Cephalalgia. Jun 2011.
- Bray, N.N et.al. Migraine: Burden of disease, treatment, and prevention. Osteopathic Family Physician. May 2013.
- Holland, S; et. al. Evidence-Based Guideline Update: NSAIDS And Other Complementary Treatments For Episodic Migraine Prevention In Adults. Neurology, Apr 2012.
- Nestoriuc, Y. Martin, A. et.al. Biofeedback treatment for headache disorders: A comprehensive efficacy review. Applied psychophysiology and biofeedback. Sept 2008.
- Smith, LW. Culvenor, CC. Plant Sources Of Hepatotoxic Pyrrolizidine Alkaloids. Journal of Natural Products. Mar 1981.
- European Headache Federation. The Journal of Headache and Pain: Aids for management of Common Headache Disorders
- International Headache Society ICHD – II: Diagnostic criteria for Migraine.
- Chaibi et.al. Manual Therapies for Migraine: A Systematic Review The Journal of Headache and Pain. Apr 2011.
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Thanks a lot Carl for your wonderful suggestions on this topic..God bless you
I’m glad this helps Shobha. Thank you for your warm encouragement.
Hi Carl ,
Would you be so kind to tell me which magnesium and in which for you suggest to take ?
Hi Claudio, any type of magnesium chelate has been recommended to me personally. I.e. something like Magnesium Glycinate or Magnesium Diglycinate. The dose is usually 200mg in the morning and at night to begin. Use a good brand. I currently use Doctor’s Best.
I think my trigger is caffeine, I drink coffee every morning recently and it happens more frequent than before! Actually, I was mean to drink coffee to prevent my migraine!
Coffee can cause rebound headaches from the withdrawal. For most people it may be a mild headache. For those with migraine, especially with severe or frequent migraine it could trigger an attack. You have two options. 1) Keep the caffeine you have each day exactly the same and the same in terms of timing. Or 2) gradually wean off caffeine altogether. Start by reducing the number of coffees and caffeinated soft drinks gradually. i.e. one drink at a time over a week. Until you are feeling normal at that level. Then once you are down to just one coffee or soft drink for example each day. Switch to caffeinated teas which have less caffeine. Then go to decaf tea, then to herbal teas. Each time taking around a week and adapt to your new caffeine level. Only wean off on days you feel good as well. Not on a migraine or vulnerable day. I hope that helps Laura.
Generally note about soft drinks. Soft drinks are terrible for migraine. Generally full of sugar and caffeine. Even if sugar free, often the other supplemented ingredients do harm in other ways.
Good afternoon Carl. ive been having this headache everyday for over a week now. i have used Cafergot since i was told it is migraine but it keeps coming back. most times i feel like my brains are working too much and needs rest but when i sleep and wake up, its still there. please what can i do?
5 years ago, i treated sinus headache and i never experienced it again, this headache is just starting but my doctor said its migraine cos no yellowish mucus this time, But the fowl smell comes sometimes. please help
Migraine can be expressed in the sinuses. It is often confused. If you are taking medications every day it can lead to medication overuse headaches or rebound headache. There are lots of reasons why you could be waking up. Here is another article that may be helpful on this topic.
I read your whole website and thank you for all this complete information.
If you can please help me. I’m going crazy because of my headaches. Help me if you have any tips
I have had migraine headaches for 5 years and I took medicine for two years under the supervision of different doctors, but it didn’t help me. I tried all the medicines you mentioned here. Sodium Valproate, Propranolol, Nortriptyline, Topiramate and several other medicine… I tried Magnesium, Riboflavin and Q10 too, but not effect on me. I tried Botox and Acupuncture but it made me worse. I bought Cefaly too but it dosn’t help me. Medical science is weak in my country(Iran) and it has few medical facilities because of political sanctions. No doctor in my country could help me. If you can, please help me
There are several new devices available and a new generation of preventive treatment such as the anti CGRPs and there are also the gepants and ditans which are coming out or newly released in the USA. In addition, there are new devices like Niverio Migra and Gammacore. Treatment and prevention is an important component of migraine management but it is not the only part of it. Lifestyle and behavioral factors like sleep, diet, movement/exercise, relaxation, stress management are all important. I hope that helps.