How To Treat A Migraine
A migraine is a type of headache that causes throbbing pain, usually on one side of the head. But a migraine is much more than a headache. It can cause intense pain, nausea, vomiting, sensitivity to light, and sensitivity to sound that can last for several days. The throbbing pain and other migraine symptoms can interfere with your daily activities.
Currently, there is no cure for migraine, but there are things you can do to relieve migraine symptoms and reduce the frequency of migraine attacks. Migraines are complex, so you may need several different tools to treat and manage your migraines. Use these steps to control your migraine.
- Have a Treatment Plan
- Migraine Medications
- Migraine Prevention Medications
- Neuromodulation Devices
- Home Remedies For Migraine Relief
- Adopt a Healthy Lifestyle
- Keep a Migraine Diary
Have a Treatment Plan
Migraine treatment varies from one person to another. There is no perfect “one-size-fits-all” method for managing migraines, which is why it’s important to work with your doctor to develop a migraine treatment plan that’s right for you.
Migraine treatment is aimed at stopping symptoms once an attack begins (also known as acute or abortive treatment) and preventing future attacks (preventive treatment). Your plan may include over-the-counter (OTC) pain relievers, prescription medications, neuromodulation devices or some combination of these treatment options. Your treatment plan will depend on the frequency and severity of your headaches, whether you have nausea and vomiting with your headaches, how disabling your headaches are, and other medical conditions you have.
These types of drugs are taken during migraine attacks and are aimed to stop symptoms.
OTC pain-relieving medications – These include acetaminophen (Tylenol), nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen (Advil, Motrin). When taken for a long period of time, these medications might cause medication-overuse headache (increase in the frequency and severity of the headaches), and possibly gastrointestinal problems. Medications that include a combination of caffeine, aspirin, and acetaminophen (Excedrin) may also be effective.
Triptans – Triptans are a group (class) of prescription medications designed specifically for migraine treatment. Triptans include almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan, and come in different brand names. They work by imitating the action of a brain chemical called serotonin which causes the blood vessels around the brain to narrow (contract). Because triptans affect blood vessels, they might not be safe for people with heart or blood vessel problems.
Triptans are available as tablets, injections, and nasal sprays and are thought to work best when they’re taken early when the pain is still mild. They may cause a warm sensation, tightness, tingling, drowsiness, feelings of heaviness in the face, limbs or chest, and if taken too often, may increase the risk of developing medication overuse headache (and by that worsen the migraine).
Ditans and gepants – Ditans and a gepants are new types of prescription oral tablets which have been recently approved by the FDA. The ditan has a sedative effect and may cause dizziness, so people taking it are advised not to drive or operate machinery for at least eight hours. Gepants are calcitonin gene-related peptide (CGRP) receptor antagonists aimed to treat migraine symptoms when they occur. Common side effects include dry mouth, nausea, and excessive sleepiness. These treatments provide an alternative treatment solution for people who can’t take triptans.
Migraine Prevention Medications
These types of drugs are taken regularly to reduce the frequency and severity of migraines. Preventive medications may take a few months to start working.
Blood pressure-lowering medications – These include beta-blockers such as propranolol and metoprolol tartrate which are taken several times a day depending on the dose.
Tricyclic antidepressants – These are taken daily and may cause side effects such as sleepiness and weight gain.
Anti-seizure drugs – These include valproate and topiramate, are taken daily and can cause side effects including dizziness, weight changes, and nausea.
OnabotulinumtoxinA (Botox) injections. Injections of Botox about every 12 weeks. Common side effects may include muscle weakness near where the medicine was injected, trouble swallowing for several months after treatment, muscle stiffness, neck pain, pain in your arms or legs, and blurred vision.
Calcitonin gene-related peptide (CGRP) monoclonal antibodies – These are newer drugs that are given by injection monthly (or in some cases every three months). These medications block a protein called calcitonin gene-related peptide (CGRP) which may cause inflammation and pain in the nervous system during a migraine attack. The most common side effect is a reaction at the injection site.
Neuromodulation devices offer an alternative drug-free treatment option with minimal side-effects. These devices work by inhibiting brain activity to reduce migraine symptoms, that is they modulate neural activity in the brain. They are worn or placed against your skin and use electrical or magnetic signals to communicate with neurons. So far, the FDA has approved four neuromodulation devices for acute and/or preventive treatment of migraine. All these devices require a prescription from your doctor. Most devices stimulate nerves in the neck or head. One of the newer devices is Nerivio, a smartphone-controlled wearable worn on your upper arm for 45 minutes. It is used to relieve migraine symptoms of an attack that’s already begun by using electrical signals that reduce messages of pain in the brain that occur during a migraine attack.
Home Remedies For Migraine Relief
Beyond taking migraine medications, you may want to try a few home remedies. Natural remedies are a drug-free way to reduce migraine symptoms. You can use these as alternatives or to supplement pharmacological treatment.
Rest in a quiet, dark place – Migraines often increase sensitivity to light and sound. Relax in a dark, quiet room. Sometimes sleep helps to diminish the pain. If you are outside, wear sunglasses.
Try a cold pack – Put a cold pack on your forehead, scalp, or neck to relieve the pain. Ice cubes wrapped in a towel or a bag of frozen peas may lessen the pain since cold packs have a numbing effect, which may dull the sensation of pain.
Try hot compresses – Some people find a heating pad or hot shower to help with the headache pain. Try putting a heating pad or a warm cloth around your neck or head.
Get some caffeine – A cup of tea or coffee (or something with caffeine in it) may help ease the pain. It can also help over-the-counter pain relievers like acetaminophen work better. Just go easy, because caffeine withdrawal can lead to more headaches.
Adopt a Healthy Lifestyle
Some lifestyle habits can help reduce the number of headache days per month and their severity even without using medications.
Diet – Avoid foods and drinks known to trigger migraines such as chocolate, red wine, and caffeine (unless you’re having a headache right now and you want to try it as a home remedy). Some studies show that magnesium and vitamin B2 (riboflavin) may prevent migraines, so you may want to add to your diet dark-green veggies, whole grains, and nuts that contain magnesium and cheese, fish, and chicken which have vitamin B2 in them.
Don’t skip meals – Eat breakfast, lunch, and dinner at the same time every day. Skipping meals may cause migraines.
Sleep well – Don’t sleep too much or too little as this may trigger headaches and reduce your pain threshold. Follow a consistent daily sleep and wake schedule.
Exercise – Engaging in regular exercise has extensive health benefits and can also reduce the number of migraines you are experiencing. Choose an aerobic activity you enjoy such as walking or cycling. This type of exercise causes your body to release endorphins, which are chemicals that reduce pain. It may also decrease stress and help you sleep better.
Practice relaxation – Learning how to relax using yoga, meditation, or progressive muscle relaxation, can help with the pain. These techniques also teach you ways to deal with stressful situations, which might help reduce the number of migraines you have.
Keep a Migraine Diary
Knowing how to manage a migraine with lifestyle and behavioral measures, as well as medication, can often be the most effective way to control migraines. A migraine diary is an important tool recommended by physicians to help better manage migraines. Keeping track of the foods you eat, your sleeping patterns and when you experience migraines can help identify potential triggers. Once you find what may cause your migraines, try avoiding it.
A migraine diary also enables you to monitor the frequency, duration, and severity of your migraines and the effectiveness of the treatments you use, all of which may help identify migraine patterns and improve treatment. It’s important to continue recording in your diary even after you see your doctor because it will help you learn more about what triggers your migraines and what treatment is most effective.
There are printable versions of migraine diaries as well as some free diary apps you can download to your smartphone. The app of one of the neuromodulation devices, Nerivio, also includes a diary so you can treat your migraine headaches and track them using the same app.
American Headache Society. (2019). The American Headache Society position statement on integrating new migraine treatments into clinical practice. Headache: The Journal of Head and Face Pain, 59(1), 1-18.
Taylor, F. R. (2009). Lifestyle changes, dietary restrictions, and nutraceuticals in migraine prevention. Techniques in regional anesthesia and pain management, 13(1), 28-37.
Kumaraswamy, B., Latha, V. M., Divya, P. S., Raju, M. D., & Ramachandran, S. (2013). Migraine-A Complete Review. The Pharma Innovation, 2(2, Part A), 135.
Nappi, G., Jensen, R., Nappi, R. E., Sances, G., Torelli, P., & Olesen, J. (2006). Diaries and calendars for migraine. A review. Cephalalgia, 26(8), 905-916.