OTC pain relievers are an effective solution for mild to moderate migraine attacks. NSAIDs such as ibuprofen, naproxen sodium and acetaminophen (Tylenol) reduce both headache pain and inflammation simultaneously.
Triptans are medications designed to block pain pathways in the brain. Available as pills, injections or nasal sprays. Dihydroergotamine (Migranal, Trudhesa) may help ease nausea and vomiting symptoms but may worsen them for some people.
Medications
Over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve, Noroxin) may temporarily relieve mild migraine symptoms; however, overuse could result in medication-overuse headaches. To address this risk more safely and quickly, triptans such as sumatriptan (Imitrex, Tosymra) and rizatriptan (Maxalt Maxalt-MLT) block pain pathways within 60 minutes and can also be taken as nasal spray or injections.
Beta-blockers such as metoprolol, timolol, bisoprolol and pindolol have limited evidence of effectiveness for migraine prevention; however, they may cause low blood pressure, shakiness and depression and should not be used during pregnancy.
Anti-CGRP therapies — such as rimegepant (Nurtec) and ubrogepant (Ubrelvy) — are oral preventive treatments that target the CGRP molecule. By blocking its receptor or ligand, these preventive drugs block activating blood vessels that produce pain as well as headache symptoms; additionally they can stop release of inflammatory substances by cells within the brain that contribute to headaches. Studies conducted have demonstrated their efficacy over a one-year period, though full efficacy will likely take another year before full efficacy is achieved.
Lifestyle changes
Studies that support lifestyle modifications as effective migraine treatments have overturned long-held notions that medication alone was the only effective remedy. Primary care providers must now advise patients to modify their behavior by avoiding triggers and staying hydrated.
Sleep is key to migraine prevention. Advise patients to develop a regular bedtime routine and strive to get at least seven hours of shuteye every night. A headache diary should also be kept to monitor patterns and identify whether particular health factors, such as diet, alcohol or caffeine consumption may be contributing factors.
Exercise can also be an invaluable preventive remedy for migraine sufferers, as exercise releases chemicals that block pain signals in the brain and manage stress while alleviating anxiety and depression – which are known triggers for migraine attacks. A regular workout session may also help manage stress better while decreasing anxiety and depression that often contribute to migraine attacks.
Patients should be evaluated shortly after commencing preventive therapy or making any modifications in treatment and at least every six months thereafter, with referral to specialist care reserved for those whose results fall below par.
Avoiding triggers
Identification and avoidance of migraine triggers is vital. Triggers vary between people, but may include foods, hormones, stressors, changes to daily routine, certain medicines, light or odor triggers and environmental conditions. You may find helpful tracking your symptoms using an app such as Headache Diary to keep a diary or log for yourself of what causes migraine attacks.
Tyramine, an ingredient present in aged cheese and many processed foods like hot dogs and pepperoni, can trigger migraines in some people. Caffeine consumption, changes in weather and stress may also bring on migraine symptoms.
Biofeedback and relaxation therapy may also help relieve your stress. Yoga, meditation and maintaining a regular sleep schedule may also prove helpful. Furthermore, avoiding triggers may prevent an attack before it occurs and should be used along with acute and preventive medication for best results.
Seeking help
Migraine may not be curable, but medical treatments may help relieve symptoms and prevent future headaches. If you find yourself frequently experiencing migraine attacks, talk with a headache specialist or your physician in order to identify possible triggers; and consider keeping a diary to track patterns as well as gain insights into what helps and doesn’t.
An expert headache specialist (neurologist) will assess you and ask about your family history of migraines and other health problems, before conducting an MRI scan to create detailed images of your brain and blood vessels that can help detect tumors, stroke, bleeding in the brain and other headache-related conditions.
Pain-relieving medications are often the first line of defense against migraines. Triptans increase serotonin levels in the brain to block pain signals more effectively and decrease transmission. Ergotamine and dihydroergotamine derivatives may also help. For long-term relief, celecoxib (Celebrex and Elyxyb) may help block specific hormones to stop headaches from occurring.
