While there is currently no cure for migraine, there are treatment options available to help prevent migraine from starting and treat migraine attacks when they start.
Specific treatments for migraine will be recommended by your healthcare provider based on the specifics of your condition and factors such as your age, overall health, and medical history.
Types of treatments for migraine
Most treatments for migraine fall into the categories of preventative medication or acute medication for treating migraine attacks when they start. Some people try lifestyle changes, clinical trials, and alternative pain relief techniques. Many people use multiple medications for treating migraine.
Some migraine medications must be used within strict limits. When overused, they increase the risk for progressing to chronic migraine – defined as migraine that occurs 15 or more days in each month.
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Some drugs are prescribed to help prevent or reduce the frequency of migraine attacks. Many medications used to treat migraine are not approved by the U.S. Food and Drug Administration (FDA) specifically for migraine, but are frequently prescribed off-label for this purpose.
Beta blockers such as Propranolol (sold under the brand names Inderal and InnoPran XL) and Lopressor (Metoprolol) are believed to help prevent migraine by relaxing blood vessels and reducing inflammation.
Antidepressants of several different classes may be used to help prevent migraine. Effexor (Venlafaxine), a member of the serotonin-norepinephrine reuptake inhibitor (SNRI) class, is one of antidepressants most frequently prescribed to help prevent migraines. Tricyclic antidepressants that may be prescribed for people with migraine include Elavil (Amitriptyline) and Pamelor (Nortriptyline). Drugs in the selective serotonin reuptake inhibitor (SSRI) class include Prozac (Fluoxetine) and Zoloft (Sertraline). Antidepressants are believed to work in cases of migraine by changing the balance of neurotransmitters in the brain.
Anticonvulsant (also called anti-seizure or anti-epileptic) drugs are believed to help prevent migraine by inhibiting nerve signals. Anticonvulsants prescribed for the prevention of migraine attacks include Topamax (Topiramate), Neurontin (Gabapentin), and Depacon (Valproate sodium).
Calcium channel blockers such as Verapamil (sold under the brand names Calan, Covera-HS, and Verelan) may be prescribed for preventative use in those with migraine. Calcium channel blockers are believed to work by suppressing the action of serotonin, which constricts blood vessels in the head and lowers pain tolerance.
Angiotensin-converting enzyme (ACE) inhibitors such as Zestril (Lisinopril) may help prevent migraine by relaxing the blood vessels.
Aimovig (Erenumab-aooe) is a newer drug approved by the FDA to prevent migraine in adults. Aimovig is a biologic drug – a genetically engineered antibody, or protein used by the immune system to identify and neutralize substances. Aimovig is also the first member of a new class of drugs called calcitonin gene-related peptide receptor (CGRP-R) antagonists. Aimovig is believed to work by interfering with CGRP, a substance that dilates blood vessels and contributes to pain signals and inflammation. Aimovig is taken by injection once a month.
Acute treatment medications
Some drugs are prescribed to be taken when a migraine attack begins. Most acute treatments work best when taken as early as possible in the attack. Generally, acute migraine treatments work best when taken in one large, single dose rather than spaced out in smaller doses.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first treatment most people try for relieving migraine pain. Some NSAIDs such as Aspirin, Advil (Ibuprofen) and Aleve (Naproxen) are available over the counter (OTC), while others such as Naprosyn (Naproxen), Indocin (Indomethacin), Celebrex (Celecoxib), and Voltaren (Diclofenac) require a prescription. NSAIDs are believed to work by inhibiting the production of chemicals that promote inflammation and blood clot formation in the body. Taken regularly at high doses, some NSAIDs can cause gastrointestinal problems and abnormal bleeding.
Tylenol (Acetaminophen) is an OTC analgesic (pain reliever) and antipyretic (fever reducer). Tylenol is believed to work by altering the body’s perception of pain. Some OTC products such as Excedrin Migraine and Excedrin Tension Headache combine Acetaminophen and caffeine. Caffeine is a stimulant and a vasoconstrictor – drug that causes the blood vessels to constrict. Caffeine is believed to work in migraines by narrowing the blood vessels in the brain. Excedrin Migraine also contains Aspirin.
Triptans are a class of drugs approved specifically for use in acute migraine. Triptans are believed to work by constricting blood vessels and reducing inflammation. Triptans include Imitrex (Sumatriptan), Maxalt (Rizatriptan), Relpax (Eletriptan), Zolmig (Zolmitriptan), Amerge (Naratriptan), Axert (Almotriptan), and Frova (Frovatriptan).
Treximet (Sumatriptan/Naproxen) combines a triptan drug with an NSAID.
Ergot alkaloids are also approved for the treatment of acute migraines. Ergot alkaloids are believed to work by constricting blood vessels in the brain and inhibiting the transmission of brain signals. Migranal (Dihydroergotamine) is an ergot alkaloid. Cafergot combines an ergot alkaloid and caffeine.
Corticosteroids such as Prednisone or Dexamethasone may be prescribed in combination with other medications to treat migraine in some cases. Corticosteroids work by suppressing inflammation. Corticosteroids are relatively safe for short-term use, but long-term use causes serious side effects such as high blood glucose, bone problems, mood swings, and weight gain.
For migraine pain that is not controlled with other treatments, some may require opioids such Codeine, Norco (Hydrocodone/Acetaminophen) and Vicodin (Hydrocodone/Acetaminophen) may be prescribed. Opioids are believed to work on the brain by altering the body’s ability to perceive pain. According to the National Institute on Drug Abuse, regular use of opioids – even as prescribed by a doctor – can lead to dependence. If misused, opioids can cause overdose and death.
In addition to any side effects specific to each drug, medications used to treat acute migraine have the potential to cause medication overuse headache, also known as rebound headache. Researchers also believe that overusing these drugs can raise the risk for progressing to chronic migraine – migraine that occurs 15 or more days out of each month. The risks of overuse are believed to be highest with aspirin/acetaminophen/caffeine combinations and opioids. Discuss with your doctor how to use acute migraine treatments safely.
Non-drug treatments for migraine
For those in whom migraine medications are not effective, or who cannot tolerate migraine medications, there are several types of non-drug treatments that can be effective for treating or preventing migraine.
Nerve block injections
Botox (OnabotulinumtoxinA) is approved by the FDA to help prevent migraine attacks in people with chronic migraine. Botox is an injectable form of the neurotoxin produced by the bacterium Clostridium botulinum. Botox is believed to work by inhibiting the release of certain molecules, such as acetylcholine, and preventing the movement of some nerves and muscles. Other nerve blocking techniques are used to treat some people with chronic migraine, including sphenopalatine ganglion block.
Nerve stimulation devices
Some people with migraine find neurostimulation (nerve stimulating) devices effective for treating acute migraine pain. Cefaly, SpringTMS, gammaCore, and transcutaneous electrical nerve stimulation (TENS) are four different types of neurostimulation devices. Most neurostimulation devices are believed to work by interfering with pain signals. The electricity prevents the nerves from carrying pain messages to the brain.
Cognitive behavioral therapy (CBT) or other forms of psychotherapy can help people with migraine better manage stress, which can be a major trigger for migraine. CBT is goal-oriented, focusing on specific problems and how to improve them. Studies show that CBT offers small but significant improvements in pain and disability and moderate improvements for mood in those with chronic pain over six to 12 months.
Tracking diet, sleep, activity, and headaches in a journal can allow you to identify your migraine triggers. Making changes to your lifestyle may help you avoid these migraine triggers and reduce the frequency of attacks. Some people with migraine feel better when they improve their nutrition in general or try a specific diet such as the anti-inflammatory diet.
Natural and complementary treatments
Complementary and alternative medicine therapies are popular with many people who get migraines. Natural or complementary treatments for migraines may include acupuncture, acupressure, herbal or nutritional supplements, biofeedback, chiropractic, and daith piercing. Some alternative or natural therapies have been studied in clinical trials, but in many cases, there is limited or inconsistent evidence that they are beneficial for migraines. A few natural treatments can worsen migraines or cause dangerous interactions with migraine medications. Let your doctor know if you try any natural or complementary treatments for migraine.
Some people with migraine participate in clinical trials. Clinical trials may test new drugs, new procedures, new dosages of existing drugs, or new combinations of existing drugs. Other clinical studies test the safety and efficacy of alternative treatments such as herbal supplements or ketamine.
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