How Is Migraine Treated?

Migraine is a severe type of headache that causes debilitating symptoms, such as throbbing head pain, nausea, and light or noise sensitivity. If you have experienced migraine before, you are not alone. In fact, 12% of Americans have migraine episodes.

There is no one-size-fits-all treatment for everyone who experiences migraine—mostly because migraine affects each person differently. There are several effective treatments that you can use to manage your condition, reduce symptoms, and prevent episodes from occurring.

Options for treatment include medications, therapies, lifestyle modifications, and home remedies. Your healthcare provider may suggest a combination of treatments that are best suited for your symptoms, migraine triggers, lifestyle, and overall health.

Medications for Acute Migraine 

Acute migraine occurs when you are actively experiencing a migraine attack. Medications for acute migraine look different from medications that prevent migraine episodes from happening.

There are a variety of medication options you can use to treat acute migraine. These medications include:

• Pain medications: Pain medications are typically the first line of treatment. These medications are usually available over the counter. However, your healthcare provider can prescribe stronger pain medications, depending on the severity of your condition. Tylenol (acetaminophen) and non-steroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) and Bayer (aspirin) are common types of pain medication.
• Triptans: For moderate to severe migraine episodes, you may consider triptan medication—a type of anti-migraine drug that can reduce headache symptoms. Triptans can come in the form of oral pills or nasal sprays. These medicines include Imitrex (sumatriptan) and Zomig (zolmitriptan), among others.
• Ergot alkaloids: Ergot alkaloids are another class of drugs that your healthcare provider might suggest if you have severe migraine episodes. This medication is only available via a prescription from your healthcare provider. One of the most common ergot alkaloid drugs is Migranal (dihydroergotamine).
• Antiemetic drugs: During acute migraine, you may experience nausea or vomiting. You may consider using antiemetic drugs to help treat nausea-related symptoms. Medications that help manage these symptoms include Reglan (metoclopramide) and Compro (prochlorperazine).

Medications to Prevent Migraine 

If you experience severe and frequent migraine episodes, you may have chronic (or, recurring) migraine. A diagnosis of chronic migraine can be made if you experience 15 days or more of headaches per month for over three months, with at least eight of those days being migraines. You also have chronic migraine if each month you experience four to eight headaches or more that are hemiplegic (cause paralysis on one side of the body) or cause other severe migraine symptoms. Your healthcare provider may recommend treatments to prevent chronic migraine episodes from happening.

Medications to prevent migraine include:

• Calcitonin gene-related peptide (CGRP) inhibitors: This is a class of drugs that help block the CGRP protein, which is involved in pain signaling. Several types of CGRP inhibitors have been approved by the Food and Drug Administration (FDA) for the prevention of chronic migraine. Some of these drugs are administered as injections, including Aimovig (erenumab), Ajovy (fremanezumab), Emgality (galcanezumab), and Vyepti (eptinezumab). Others are oral pills or tablets, such as Ubrelvy (ubrogepant), Nurtec ODT (rimegepant), and Qulipta (atogepant).
• Anticonvulsive drugs: These medications often help treat seizures, but in some cases, healthcare providers can recommend anticonvulsive drugs for chronic migraine. A commonly used medication option is Topamax (topiramate).
• Antihypertensive drugs: Antihypertensive drugs usually help treat high blood pressure, but can also help prevent migraine attacks. A variety of hypertensive drugs exist, including beta blockers like Inderal (propranolol) and angiotensin receptor blockers like Atacand (candesartan).
• Certain antidepressants: Some antidepressant drugs may also help lower the frequency of migraine episodes. Your healthcare provider may select Amitriptyline (tricyclic antidepressants) or selective serotonin-norepinephrine reuptake inhibitors like Effexor (venlafaxine).
• Botox: Your healthcare provider can also suggest Botox (onabotulinumtoxinA) injections. These injections can help reduce the frequency of chronic migraine episodes, but the treatment isn’t permanent. Your provider may recommend getting injections every three months, or as needed for your condition.
  

Neurostimulation

Neurostimulation uses electric currents or magnetic waves to help treat chronic migraine. This is a noninvasive treatment (or, a treatment that doesn’t use a medical instrument to cut into the skin) that works by stimulating the parts of your brain that are associated with pain.

There are several stimulation options that affect different nerves. These include:

• Vagus nerve stimulation (VNS): The vagus nerve helps regulate your heart rate, digestion, and blood pressure. To electrically stimulate the vagus nerve, a medical professional will deliver treatment to your neck using a hand-held device.
• Transcranial magnetic stimulation (TMS): This treatment uses magnetic waves to deliver a pulse to the back of your head. TMS can be helpful to treat an active episode and prevent future migraine attacks.
• Supraorbital stimulation (SONS): The supraorbital nerve is connected to your eyelids, forehead, and scalp. SONS uses electrodes or a wearable headband to send electrical signals to your temples.
• Sphenopalatine ganglion (SPG) stimulation: The sphenopalatine ganglion (SPG) is a bundle of nerve cells that plays a role in headache pain, nasal congestion, and the formation of your tears. SPG stimulation sends electrical signals to your mouth, just above the upper jaw area.

Behavioral Treatments

Behavioral factors such as stress, lack of sleep, and not eating enough can all trigger migraine episodes. Aside from medication or stimulation therapy, behavioral treatments can also help ease migraine symptoms.

These treatment approaches include:

• Cognitive behavioral therapy (CBT): CBT is a form of talk therapy that involves speaking with a mental health professional or clinician, such as a psychologist, therapist, or clinical social worker. Your clinician can help you change negative thought patterns, incorporate healthy lifestyle changes, and manage stress.
• Biofeedback: This mind-body therapy uses electrical sensors that are attached to a feedback tone to help you become more aware of how your body is feeling and what it needs. During a biofeedback session, your healthcare provider can place sensors on different parts of your body to measure physiological signs, such as your heart rate, muscle tension, and skin temperature. Your provider can use mental techniques (e.g., relaxation training or deep breathing) that help you reduce your heart rate, relax your muscles, and lower your temperature.

Lifestyle Recommendations

You can also manage migraine through lifestyle adjustments. Lifestyle factors can often trigger migraine episodes. Learning how to manage these triggers can help you prevent episodes. Your healthcare provider can recommend the following lifestyle changes:

• Having a regular exercise routine
• Drinking at least eight glasses (or, 64 ounces) of water each day
• Getting at least seven hours of uninterrupted sleep per night
• Limiting your alcohol and tobacco use
• Going outside to get fresh air
• Reducing food triggers, such as chocolate, cured meats, and aged cheeses
• Lowering your stress levels by spending time with your loved ones or doing activities that you enjoy

A Quick Review 

Migraine is a neurological disorder that produces painful headache symptoms. The condition can be hard to treat and manage—especially because migraine affects each person differently.

While there is no sole cure for treating migraine, your healthcare provider can recommend a combination of medications, stimulation therapies, behavioral treatments, and lifestyle recommendations to help you better manage your condition.