Migraines can be debilitating headaches that should be treated as soon as they arise for maximum effectiveness. Early treatment should always be considered.
Treatment options may include over-the-counter painkillers, antiemetics (to treat nausea), and preventive medications.
Propranolol, commonly prescribed to treat angina and high blood pressure, has also been proven to prevent migraine attacks by being taken daily as a tablet form regardless of any attacks occurring.
1. Over-the-Counter (OTC) medications
OTC medications can help treat mild to moderate migraine headaches when taken at the first sign of an attack, particularly when taken within two hours. Medicines such as acetaminophen, aspirin and ibuprofen may reduce pain as well as other symptoms including nausea and light sensitivity – helping prevent migraine attacks from worsening further. Migraine-specific OTC remedies such as Nizatidine NRT(r) (Nizatidine nasal spray), Ergotamines riboflavin caffeine etc may provide temporary relief; additional studies have demonstrated effective relief within two hours! In clinical trials ubrogepant (Ubrelvy) and rimegepant (Nurtec ODT) were shown effective in clinical studies at relieving migraine pain within two hours.
OTC medications can be easily misused, making it important to follow the prescribed dosage and use. If patients experience more than 15 migraines a month and overuse OTC medicines, they should consult their primary care provider and seek prescription treatment from them; other potential treatments could include acupuncture, cognitive behavioral therapy or relaxation techniques such as biofeedback.
2. Tricyclic antidepressants (TCAs)
Prodromal symptoms typically accompany migraine attacks and typically last 48 hours before they manifest as headaches. They include yawning, mood changes, neck stiffness, light or sound sensitivity, tingling/numbness sensations and restlessness.
There are various preventive medications used to decrease migraine frequency and severity, such as nortriptyline, amitriptyline and topiramate; other medications including propranolol have also proven useful as prophylactic treatments of migraine with double-blind randomized controlled trials and systematic reviews providing evidence of their efficacy.
These medications may be combined with other treatments for migraine such as diet changes, stress reduction and neuromodulation devices such as Cefaly (which utilizes external trigeminal nerve stimulation); GammaCore (which utilizes vagus nerve stimulation); and SAVI Dual (which utilizes single-pulse transcranial magnetic stimulation). A health care professional will discuss any benefits, risks or anticipated side effects prior to prescribing any medication.
3. Nonsteroidal anti-inflammatory drugs (NSAIDs)
Migraine treatment plans often include preventative medication to lessen how often and severe migraine headaches are. This medication should typically be taken daily.
These medicines are used to quickly stop migraine attacks as soon as they begin, providing pain relief, nausea relief and other symptoms relief. They are usually administered in either pill form or prefilled syringes (injectable). Triptans (injectable medicines) tend to work faster than tablets for acute attacks of migraine; Ergotamine/dihydroergotamine injection may be effective against some acute attacks with aura; however it should not be used chronically due to serious risks including stroke or heart attack.
Anticonvulsants, often prescribed to treat epilepsy, may also provide relief for migraine sufferers by increasing certain brain signal chemicals and decreasing pain signals. Calcium channel blockers often used for high blood pressure may also help alleviate migraine in some individuals; calcium channel blockers may help with some cases as well. Some headache specialists also recommend oral calcitonin gene-related peptide antagonists (or gepants), like Ubrelvy and Nurtec ODT which work differently from traditional migraine medicines and require a valid prescription to take.
4. Caffeine
If over-the-counter pain medications aren’t helping, speaking to your GP can be invaluable in pinpointing what’s triggering your headaches and prescribing more effective prescription. A migraine diary can also provide valuable insights for GPs into what may be triggering them and when.
Migraine medications range from acute treatments designed to stop an attack quickly to preventive medications that reduce both frequency and severity. Acetaminophen, nonsteroidal anti-inflammatory drugs, triptans, ergot alkaloids and combination analgesics may all help. Triptans are drugs that block pain pathways in the brain – pills, shots or nasal sprays of triptan medications like Imitrex(r) (rizatriptan(r) Maxalt), Naratriptan(r) Almotriptan(r) Zomig(r) or frovatriptan (Frova).
Neurologists or migraine specialists will diagnose headaches by reviewing your medical history, performing physical examination, and performing diagnostic tests. An MRI (Magnetic resonance imaging) scan may also help in diagnosing migraines by showing changes to blood flow or changes to brain structures.
