Six ways to cope with migraine

Prescription and over-the-counter drugs

Various over-the-counter and prescription drugs can help manage migraine.

Nonsteroidal anti-inflammatory drugs

These medications are available over the counter.

They include:

• aspirin (acetylsalicylic acid)
• ibuprofen
• diclofenac (Voltaren)
• naproxen (Aleve)

They are easily available and relatively inexpensive. They can help manage mild and moderate attacks of migraine.

Triptans

Triptans are serotonin receptor agonists. This means they selectively activate serotonin receptors to boost serotonin levels.

Some researchers suggest that low serotonin levels may play a role in migraine attacks. Studies have not confirmed this, but triptans appear to help manage migraine.

Examples include:

• eletriptan (Relpax)
• rizatriptan (Maxalt)
• sumatriptan (Imitrex)
• zolmitriptan (Zomig)
• almotriptan (Axert)

The authors of a 2016 review conclude that eletriptan and rizatriptan are more effective at relieving pain than sumatriptan, zolmitriptan, ibuprofen, and aspirin. However, other researchers note that they are not effective in all cases.

It is of note that triptans can have adverse effects, such as:

• pain in the neck, jaw, or chest
• chest pressure
• skin irritation
• numbness
• nausea
• flushing

Ergotamine

Ergotamine features in some migraine treatments.

Ergotamine tartrate combines ergotamine and caffeine. It has approval from the Food and Drug Administration (FDA) to treat headaches that may have links with the vascular system, including migraine.

Experts do not know precisely how this combination works.

Ergotamine is a vasoconstrictor, which means it causes blood vessels to become narrower. It may also help boost dopamine levels and reduce levels of calcitonin gene-related protein (CGRP), which tend to be high in people with migraine.

CGRP plays a role in pain signaling and the widening and narrowing of blood vessels. Migraine medications often aim to reduce levels of CGRP.

Caffeine may help by making ergotamine easier to absorb and reducing the risk of acidity in the stomach. It may also enhance mood and alertness.

However, this combination can have adverse effects, including:

• nausea
• vomiting
• cramps
• muscle pain

For this reason, doctors prefer to prescribe another drug, unless a person has frequent attacks or attacks that last longer than 48 hours.

Antiemetics

Antiemetics can help manage nausea and vomiting, which often affect people with migraine.

Examples include metoclopramide (Reglan) and ondansetron (Zofran), which also help the body absorb other drugs. A person should take antiemetics before or with pain relief medication for migraine.

They are available on prescription.

Preventive medications

Doctors sometimes prescribe drugs that target other conditions to help prevent migraine.

These may include:

• antihypertensives, such as beta-blockers and calcium channel blockers, which target high blood pressure
• anticonvulsants, for instance, topiramate (Topamax), a treatment for both seizures and migraine
• antidepressants, such as amitriptyline and nortriptyline, which can help prevent migraine, but there is a risk of withdrawal symptoms if a person stops using them abruptly
• CGRP inhibitors, such as erenumab (Aimovig), which aim to reduce levels of CGRP in the body

Experts have linked high CGRP levels with migraine attacks.

Lasmiditan (Reyvow) is a new type of drug with FDA approval for treating acute migraine without aura in adults. It works by targeting the 5-hydroxytryptamine receptor.

In trials, over one-third of people who took it when they already had moderate to severe pain had no more pain after 2 hours. Adverse effects include a mild feeling of intoxication. People should not drive within 8 hours of taking it.

Dietary supplements

Some people use supplements to prevent migraine, although there is not enough evidence to show they are all effective.

A person should always check with a doctor before using supplements, as they may not be safe for everyone. They can also interact with other drugs.

Coenzyme Q10

In a small study, people with migraine took 100 milligrams of coenzyme Q10 per day, alongside their usual medication.

It appeared to reduce the severity, length, and frequency of attacks and did not produce adverse effects.

Riboflavin

Research suggests that riboflavin, or vitamin B2, can act as a neuroprotective agent, safeguarding brain function and structure. It may also help reduce the pain of a migraine headache.

However, there is not enough evidence to confirm its usefulness for migraine.

Magnesium

Magnesium plays a key role in metabolism, regulating blood pressure, and other functions.

According to some research, magnesium supplementation may help reduce migraine frequency, although not all researchers agree.

Melatonin

Melatonin is a hormone that helps regulate the sleep-wake cycle.

Some research indicates it may be beneficial for migraine and have fewer side effects than other drugs. However, more studies are necessary to confirm its effectiveness and safety.

Butterbur

Butterbur refers to extracts from the root of the butterbur plant (Petasites hybridus).

There is evidence that butterbur may help prevent migraine. However, some experts urge caution due to the risk of liver damage.

Feverfew

The National Center for Complementary and Integrative Health notes that feverfew may help manage migraine.

It also says feverfew may reduce:

• the frequency of attacks
• pain
• nausea and vomiting
• light sensitivity

However, results have not been consistent.

Neuromodulation therapy

Neuromodulation therapy works by stimulating the brain or spinal cord to promote or suppress various functions of the central nervous system. Sometimes, implanted devices deliver the stimuli.

Various devices have FDA approval for treating migraine. Here are two options:

Single-pulse transcranial magnetic stimulation

This device stimulates the brain through magnetic impulses. A device placed over a person’s head generates these impulses.

The FDA has approved single-pulse transcranial magnetic stimulation for preventing migraine and treating acute migraine from the age of 12 years.

Experts claim it may be a “valuable addition” to other treatments for both occasional and chronic migraine.

Transcutaneous supraorbital nerve stimulation

A device placed on a person’s forehead generates magnetic impulses. The impulses stimulate the supraorbital nerve, which allows them to travel through the forehead to the scalp, eyes, and sinus.

Evidence suggests it may be a safe and effective way to prevent migraine, and it has FDA approval as a preventive option.

Vagus nerve stimulation

gammaCore is a vagus nerve stimulation device that received FDA approval for treating migraine in 2018.

To use the device, a person will need to do the following:

1. Locate the vagus nerve on the neck.
2. Apply a gel.
3. Switch on the device and apply it to the neck.

It may help those who experience frequent attacks and wish to avoid using drugs due to concerns about medication overuse headaches, according to the American Headache Society.

Transcutaneous electrical nerve stimulation

People use transcutaneous electrical nerve stimulation (TENS) machines to relieve pain from various sources. The machine delivers low voltage electrical currents across the surface of the skin. The current stimulates the nerves under the skin, and this helps relieve pain.

Nerivio Migra is one TENS device that has FDA approval for treating migraine. It is a wearable device that provides electrical pulses to the upper arm. Each treatment lasts 45 minutes. The person controls the device through an app on their cellphone.

A 2018 review concludes that TENS may be effective at treating migraine, with few adverse effects. However, the review authors were not able to confirm this due to low quality of evidence.

Meditation

Meditation may help relieve stress and pain, and research suggests it can improve tolerance to pain in the case of migraine.

In the study, the researchers randomly assigned people living with migraine to practice one of several relaxation techniques. Those who practiced spiritual meditation had fewer migraine attacks and a stronger pain tolerance threshold, according to the study.

A 2021 study concludes that both mindfulness-based stress and education about migraine helped reduce the frequency of migraine attacks.

Acupuncture

The author of a 2017 article found that acupuncture reduced both the frequency and intensity of migraine without aura. This type of migraine does not involve visual disturbances or temporary cognitive impairment.

A 2020 review concludes that acupuncture could be a safe and effective way of treating migraine. It notes, however, that some of the evidence is not high quality.

Botox

A type of Botulinum toxin, or Botox, called onabotulinumtoxinA (OBTA) can help reduce the number of migraine attacks in people with chronic migraine.

A specially trained professional will inject OBTA under the skin or into the muscles in the head, neck, and forehead. A person will need 31 or more small injections every 3 months.

Tips for managing migraine

Tips for managing a migraine attack include:

• sleeping or lying in a darkened room
• for some people, eating something, if they are not vomiting
• taking medication as soon as symptoms appear
• using soluble pain relief medication, which dissolves in water, as the body will absorb it more quickly
• using suppositories for pain relief if a person has nausea or vomiting

These tips are unlikely to make the migraine disappear, but they may help individuals feel more comfortable.

Frequently asked questions

Below, we answer some questions people often ask about migraine.

How can I get rid of migraine fast?

It is not always possible to get rid of migraine quickly.

However, taking medication as soon as symptoms appear may prevent a severe attack. Pain relief medication that dissolves in water may work more quickly than tablets.

What causes migraine?

Experts do not know what causes migraine. Factors in the nervous system appear to play a role.

In individuals who tend to experience migraine, triggers include stress, hormonal changes, and lack of sleep.

How long can migraine last?

A migraine attack usually lasts 4–72 hours. Symptoms that last longer than 72 hours may indicate status migrainosus, a complication of migraine.

How do I know whether I have migraine?

Migraine usually involves an intense headache and other symptoms. Changes such as visual disturbances may occur before the headache.

The headache usually starts around one eye — often the left — and then radiates to the rest of the head. Many people are unable to continue with their daily routine during a migraine attack.

Summary

Migraine involves an intense headache and often also nausea and vomiting. It is a chronic condition, which means a person is likely to have more than one episode.

Ways of treating migraine include medication to manage pain and vomiting. Some drugs may help prevent migraine attacks or reduce the severity of symptoms.

A doctor can help a person decide on the options, or a combination of options, that suit them best.