Migraine treatment options include medications to prevent migraines or treat them when they occur. They also can include lifestyle changes and non-pharmacologic therapies.
A migraine can be triggered by food, stress or a variety of other factors. It can cause symptoms such as a headache, a visual aura and an exhaustion called postdrome that lasts for up to a day.
Acupuncture
Migraine is a complex disorder. Its treatment consists of acute medications for relief during an attack, preventive medicines to reduce frequency and severity and lifestyle modifications to avoid triggers.
A neurologist who is certified in headache medicine can diagnose migraine based on your medical history, your symptoms and a physical and neurological examination. A magnetic resonance imaging (MRI) scan can detect abnormalities and provide detailed images of brain and blood vessel structures.
The most common migraine medications are triptans, which block pain pathways and are effective when taken at the first sign of an attack. These include sumatriptan (Imitrex, Tosymra), rizatriptan (Maxalt) and dihydroergotamine (Migranal, Trudhesa). They may not be safe for people with coronary heart disease or high blood pressure.
Antidepressants such as amitriptyline can help prevent migraine. Anti-seizure medications such as valproate acid and topiramate can also help. Calcium channel blockers, such as verapamil and flunarizine, can help, especially in patients with Raynaud’s phenomenon. Anti-CGRP medications such as erenumab and fremanezumab are newer treatments that reduce migraine frequency and intensity.
Biofeedback
Migraine is a complex neurological disorder characterized by episodes of moderate-to-severe headaches, typically unilateral, with pulsating sensations. The pain can be aggravated by light and sound, and is often accompanied by nausea. Migraine can have an impact on daily activities and quality of life.
There are two types of migraine medications: pain-relieving, also called abortive treatment, and preventive. Pain-relieving medications stop headaches during an attack, and are available over-the-counter or by prescription. Preventive medications are taken on a regular basis to reduce the frequency, severity and duration of migraine attacks.
Some examples include b-blockers such as metoprolol and propranolol, antidepressants such as amitriptyline and venlafaxine, serotonin receptor agonists such as rizatriptan (Zorvolex), and CGRP antagonists such as erenumab (Remlyx), fremanezumab (Galcanezumab) and onabotulinumtoxin A (Botox). Sleeping at the same time every night, avoiding screen time before bedtime, and staying hydrated are three healthy lifestyle habits that can help reduce the number of migraine headaches and their intensity.
Cognitive behavioral therapy
Behavioral therapy for migraine can help people identify and change their maladaptive, interrelated thoughts, feelings and behaviors. It may also teach them how to practice self-regulation strategies that decrease symptoms such as anxiety, stress and fatigue. Specifically, psychologists often focus on helping patients to learn and strengthen stress management techniques and assertive communication skills.
Other lifestyle changes might help reduce the frequency of your migraine headaches, such as avoiding food triggers and keeping a consistent sleep schedule. Regular aerobic exercise, such as walking and swimming, might also be helpful in reducing tension.
There are two main types of migraine treatments: pain-relieving drugs, which treat an active migraine attack; and preventive medications, taken daily to reduce the frequency of migraine headaches. Recently, three new medicines — ubrogepant (Ubrelvy), rimegepant (Nurtec ODT) and nizatidine (Nizatidine OTC) — have been approved for use in migraine prevention. These oral calcitonin gene-related peptide antagonists, or gepants, are effective in reducing both the intensity and duration of migraine headaches.
Meditation and yoga
Meditation can relieve stress, which is a major migraine trigger. There is also evidence that certain types of meditation may reduce migraine frequency and pain intensity. Some types of meditation involve concentrating on breathing, while others focus on relaxing the mind and body.
Yoga, an ancient Indian discipline, combines physical postures and meditation with the goal of uniting mind, body and spirit. It can be used to relieve stress and tension, including neck tension that triggers migraine headaches. It can also help with sleep and improve cardiovascular health.
Studies suggest that a combination of dietary and lifestyle changes can decrease the number and severity of migraines. These include eating regular meals, avoiding foods that trigger headaches and maintaining a consistent sleep schedule. Exercise can also reduce migraine pain, but not everyone is able to stick to a workout routine. Other options include acupuncture, biofeedback and cognitive behavioral therapy.
