Migraine Headaches
Treatment Overview
Although there is no cure for migraines, you can often reduce and possibly prevent some migraines. Drugs are available to prevent or treat migraines. There is some evidence that taking aspirin along with a drug that helps with nausea, such as metoclopramide (for example, Reglan), may help reduce migraine symptoms.4
You may also reduce the number of migraines you have by identifying and avoiding triggers that lead to migraines, such as drinking red wine or getting too much or too little sleep.
Initial treatment
At first you may use pain relievers that you can buy without a prescription, such as acetaminophen (for example, Tylenol), and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, or naproxen sodium, to reduce migraine symptoms. Some doctors recommend that you first try an NSAID to see whether it reduces pain before trying abortive or preventive drugs, which may have more side effects.5
Initial treatment depends on how severe your migraine attacks are and how often they occur, but usually includes drugs to stop a headache (abortive) or drugs to prevent a headache (preventive), along with treatments that may reduce stress.
The most commonly used abortive drugs are:
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, some of which you can buy without a prescription.
- Triptans (serotonin receptor agonists). These are usually the first type of prescription medicines tried to quickly stop a migraine attack.
- Ergotamine derivatives, such as Cafergot, although these medications may not be as effective as triptans for treating migraines.
- Midrin, which is a combination of the drugs isometheptene, acetaminophen, and dichloralphenazone.
The most commonly used preventive drugs—used to avoid or reduce the frequency of migraine attacks—include:
- Beta-blockers, which relax blood vessels.
- Calcium channel blockers, which reduce the amount of narrowing (constriction) of the blood vessels.
- Antidepressants, such as amitriptyline, a tricyclic antidepressant, which has been shown to be effective in preventing migraines.5
- Anticonvulsants, such as topiramate, which is approved by the U.S. Food and Drug Administration (FDA) for preventing migraines.
Some small studies suggest that the angiotensin-converting enzyme (ACE) inhibitor lisinopril and the angiotensin receptor blocker (ARB) candesartan reduce the frequency of migraine headaches. But more research is needed.6
Antinausea drugs (such as Compazine or Reglan) are sometimes prescribed along with abortive drugs to relieve symptoms of nausea and vomiting. Antinausea drugs may also be prescribed alone to treat migraine symptoms.
Complementary therapies may be added to drug treatment to reduce or prevent migraine symptoms. Be sure to ask your doctor before you try these therapies—to make sure they are safe for you.
- Acupuncture, which involves putting very thin needles into the skin at certain points on the body to produce energy flow along the body's meridians. Current evidence suggests that acupuncture can help with headaches. But more research is needed.2
- Biofeedback, a relaxation method for learning to control a body function that is not normally under conscious control, such as muscle tension.
- Relaxation techniques to reduce stress and tension.
- Feverfew, which is an herb that in the past was thought to help prevent migraines. We now have enough research to say that a benefit has not been proven. Feverfew doesn't appear to work any better than placebo at preventing migraines.7
- Butterbur, which is an herb that has been shown to help prevent migraines in some people.8
- Riboflavin (vitamin B2) and coenzyme Q10, which in small studies have both been shown to help prevent migraines.9
If you have recently been diagnosed with migraines, see:
You may also want to learn about drugs that can prevent migraines before they start. For more information, see:
Ongoing treatment
It is important to develop a treatment plan for ongoing migraines. This may involve finding the right drug for your type of migraine, identifying and avoiding migraine triggers, and avoiding rebound headaches that are caused by overusing migraine drugs. You and your doctor will work together to find the best treatment to relieve or prevent your migraines.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, may be helpful in reducing migraine symptoms. If NSAIDs stop your migraines, they may be your best treatment because they have fewer side effects than migraine drugs.
The most commonly used abortive drugs, used to stop a headache, are:
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, some of which you can buy without a prescription.
- Triptans (serotonin receptor agonists). These are usually the first type of prescription medicines tried to quickly stop an acute migraine attack.
- Ergotamine derivatives, such as Cafergot, although these medications may not be as effective as triptans for treating migraines.
- Midrin, which is a combination of the drugs isometheptene, acetaminophen, and dichloralphenazone.
The most commonly used preventive drugs—used to avoid or reduce the frequency of migraine attacks—include:
- Beta-blockers, which relax blood vessels.
- Calcium channel blockers, which reduce the amount of narrowing (constriction) of the blood vessels.
- Antidepressants, such as amitriptyline, a tricyclic antidepressant, which has been shown to be effective in preventing migraines.5
- Some anticonvulsants—such as topiramate—that are approved by the U.S. Food and Drug Administration (FDA) for preventing migraines.
Some small studies suggest that the angiotensin-converting enzyme (ACE) inhibitor lisinopril and the angiotensin receptor blocker (ARB) candesartan reduce the frequency of migraine headaches. But more research is needed.6
Antinausea drugs (such as Compazine or Reglan) are prescribed along with abortive drugs. Antinausea drugs may also be prescribed alone to treat migraine symptoms.
Complementary therapies may be added to drug treatment to try to reduce or prevent migraine symptoms. Be sure to ask your doctor before you try these therapies—to make sure they are right for you.
- Acupuncture, which involves putting very thin needles into the skin at certain points on the body to produce energy flow along the body's meridians. Current evidence suggests that acupuncture can help with headaches. But more research is needed.2
- Biofeedback, a relaxation method for learning to control a body function that is not normally under conscious control, such as muscle tension.
- Relaxation techniques to reduce stress and tension
- Feverfew, which is an herb that in the past was thought to help prevent migraines. We now have enough research to say that a benefit has not been proven. Feverfew doesn't appear to work any better than placebo at preventing migraines.7
- Butterbur, which is an herb that has been shown to help prevent migraines in some people.8
- Riboflavin (vitamin B2) and coenzyme Q10, which have both been shown to help prevent migraines in small studies.9
If you have recently been diagnosed with migraines, see:
You may also want to learn about drugs that can prevent migraines before they start. For more information, see:
Treatment if the condition gets worse
If you continue to have migraines while receiving treatment, you and your doctor may want to change your abortive or preventive headache drugs or try a different type of migraine drug. If you have already tried several different types of migraine drugs, your doctor may seek additional testing (such as MRI or CT scan) to rule out other causes for your recurring headaches.
It is possible you have been misdiagnosed with migraines when you really have another type of headache. It can be difficult to distinguish migraines from other types of headaches such as sinus, tension, or cluster headaches, as symptoms can be similar or overlap. Different types of headaches require different treatment.
What To Think About
Even with treatment, you may continue to have migraines. The goal of treatment is to reduce the frequency of attacks and relieve your symptoms as quickly as possible with the fewest drug side effects. For mild to moderate migraines, you may first want to try a nonprescription pain reliever that has fewer side effects and is less expensive than other drugs. However, if this treatment is not effective or if you have frequent or severe headaches, prescription drugs may be needed.
Finding an effective medicine may require some time and patience.
Overuse of abortive headache drugs or pain relievers can cause rebound headaches. Rebound headaches are different from migraine headaches. They are usually triggered after pain medicine has worn off, prompting you to take another dose. Eventually you get a headache whenever you stop taking the drug. Be sure to take your migraine medicine only as prescribed by your doctor.
If you think your recurring headaches could be associated with depression or anxiety, be sure to let your doctor know. You may be able to eliminate or reduce some headaches with proper treatment of these conditions.
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| Author: | Monica Rhodes | Last Updated: July 3, 2007 |
| Medical Review: | Anne C. Poinier, MD - Internal Medicine Colin Chalk, MD, CM, FRCPC - Neurology | |
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