Migraines can be extremely painful, yet there are treatments to ease their severity. Your doctor might prescribe painkillers like aspirin or paracetamol which do not lead to rebound headaches caused by other painkillers.
Analgesics come in various forms – dissolvable tablets or suppositories (placed between gum and cheek). If nausea is an issue during a migraine attack, these can be particularly useful.
Acute Medications
Migraine medications used for treatment when symptoms appear fall into three general classes of medications: analgesics, ergot alkaloids, and triptans. They are often first-line treatments due to their effectiveness, cost effectiveness, ease of use and convenience; however they vary widely in their side effects and routes of administration – making a determination based on frequency, severity, disabling symptoms associated with migraines as well as nausea/vomiting factors and personal medical history the main determining factors.
Most analgesic drugs are available either over-the-counter or with a valid valid prescription, and may take the form of pills, liquids, or rectal suppositories. Many also contain caffeine which has been proven to relieve pain effectively while increasing effectiveness of analgesics.
NSAIDs are often prescribed and tolerated well for migraine, but taking too much can lead to medication overuse headaches (rebound). Before prescribing such medicines, however, a headache specialist must assess each individual patient’s overall health and medical history before providing an individual treatment plan containing NSAIDs – they are not advised for pregnant women.
Second-Line Medications
Migraines cause symptoms that range from pain, vision loss or distortion, nausea and light/sound sensitivity to inability to function normally and the need to find a dark and quiet place until their migraine has subsided.
Triptans, NSAIDs and antinausea drugs are the top acute treatments for migraines, and may include pills, nasal sprays or patches. Triptans don’t usually prevent migraines (with some exceptions), but when one starts they help stop it quickly.
Some NSAIDs — such as ibuprofen and naproxen — have been shown to be effective treatments for migraine headache in randomized trials, with either tablet form or rectal suppository preparation being available for taking. If nausea becomes an issue, additional drugs such as metoclopramide, prochlorperazine or ketorolac may help ease it; these should only be taken alongside NSAIDs to limit side effects; opioids aren’t an evidence-based second-line treatment option but can still be considered in certain instances as second line treatments in emergency departments.
Third-Line Medications
Many individuals struggle to find effective preventive treatments for migraine attacks. Therefore, it is crucial that all available options be discussed with their provider.
Consider taking a step-care approach to treating your condition, which entails acute and preventive therapies that are cost-effective. Also ensure you are taking your medications correctly so as to minimise side effects; taking it early during an attack will maximize its efficacy.
Aspirin, nonsteroidal anti-inflammatory drugs (ibuprofen, naproxen and celecoxib), and acetaminophen are effective acute treatments. To avoid medication adaptation headache, be mindful when taking these medicines on a frequent basis.
Attempts at treating migraine with first and second line medications have failed, your doctor may prescribe third line medication as a last resort. Studies have demonstrated the efficacy of CGRP monoclonal antibodies such as erenumab, fremanezumab and galcanezumab in relieving symptoms for those suffering refractory migraine attacks; more research needs to be conducted into their long-term safety and efficacy as preventive therapies; newer agents targeting calcitonin gene related peptide are being studied as potential preventive mechanisms.
Preventive Medications
Migraine prevention medications help decrease both the frequency and severity of attacks. You can choose when and how often to take them; typically it will take three months before you see any real benefits of preventive drugs like propranolol (Inderal, InnoPran, Hemangeol) and antidepressant amitriptyline both work to prevent migraines while your doctor may also recommend topiramate (Qudexy XR, Topamax).
Other prescription migraine medicines to treat and prevent headaches include anti-sickness drugs like domperidone or prochlorperazine, painkillers nizatidine and paracetamol (Aleve), triptans which constrict blood vessels in order to stop migraine attacks quickly at their early stages, and newer preventive medicines like rimegepant that block the action of calcitonin gene-related peptide, which transmits pain signals in migraine headaches.
