How are migraines treated?

There are two main treatment approaches – abortive and preventive.

Abortive medications are most effective when used at the first sign of a migraine. By stopping the headache process, abortive medications help stop or decrease the symptoms of migraines including pain, nausea, light sensitivity, etc. Some abortive medications work by constricting the blood vessels, bringing them back to normal and relieving the throbbing pain.

Preventive (prophylactic) medications may be prescribed when the headaches are severe, occur more than four times a month and are significantly interfering with normal activities. Preventive medications reduce the frequency and severity of the headaches. Medications are generally taken on a regular, daily basis to help prevent migraine from occurring.

What medications are used to relieve migraine pain?

Over-the-counter medications are effective for some people with mild to moderate migraines. The main ingredients in pain-relieving medications are ibuprofen, aspirin, acetaminophen, naproxen, and caffeine. Be cautious when taking over-the-counter pain-relieving medications. Sometimes they can contribute to a headache or their overuse can cause analgesic-rebound headaches or a dependency problem. If you are taking any over-the-counter pain medications more than two to three times a week or daily, see your healthcare provider. They may suggest prescription medications that may be more effective.

Prescription drugs include the triptan class of drugs (such as sumatriptan, zolmitriptan, naratriptan and many others), ergotamine, steroids, beta blockers (such as atenolol, propranolol, nadolol and others), antidepressants (such as amitriptyline, nortriptyline, and doxepin), antiseizure drugs (such as valproic acid, gabapentin, topiramate), calcium channel blockers (such as verapamil and nifedipine), and calcitonin gene-related peptide (CGRP) monoclonal antibodies (such as erenumab).

Drugs to relieve migraine pain come in a variety of formulations including, pills, tablets, injections, suppositories and nasal sprays. You and your doctor will discuss the specific medication, combination of medications, and formulations to best meet your unique headache pain.

Drugs to relieve nausea are also prescribed if needed.

All medications should be used under the direction of a headache specialist or physician familiar with migraine therapy. As with any medication, it is important to carefully follow the label instructions and your physician’s advice.

Other migraine management methods include:

  • Rest in a dark, quiet, cool room.
  • Apply a cold compress or washcloth to your forehead or behind your neck.
  • Massage your scalp.
  • Apply circular motion pressure to your temples.
  • Keep yourself in a calm state; meditate; start biofeedback methods. (Biofeedback training helps you recognize stressful situations that trigger migraines so you can control these situations and stop the attack before it becomes full blown.)

Other drug and non-drug treatments. Botulinum toxin type A may help reduce the number of migraine attacks. Vitamins and minerals, including riboflavin or magnesium, may be helpful. Herbal products, including feverfew and butterbur, have been studied for the treatment of migraine headache. Ask your doctor about the benefits and/or precautions before taking any of these products.

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