How are migraines treated?

Migraine has no cure. But your migraines can be managed with your doctor’s help. Together, you will find ways to treat migraine symptoms when they happen, as well as ways to help make your migraines less frequent and severe. Your treatment plan may include some or all of these methods.
Medicine. There are two ways to approach the treatment of migraines with drugs: stopping a migraine in progress (called “abortive” or “acute” treatment) and prevention. Many people with migraine use both forms of treatment.
Acute treatment. Over-the-counter pain-relief drugs such as aspirin, acetaminophen, or NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen relieve mild migraine pain for some people. If these drugs don’t work for you, your doctor might want you to try a prescription drug. Two classes of drugs that doctors often try first are:

• Triptans, which work by balancing the chemicals in the brain. Examples include sumatriptan (Imitrex^®), rizatriptan (Maxalt^®), zolmitriptan (Zomig^®), almotriptan (Axert^®), eletriptan (Relpax^®), naratriptan (Amerge^®), and frovatriptan (Frova^®). Triptans can come as tablets that you swallow, tablets that dissolve on your tongue, nasal sprays, and as a shot. They should not be used if you have heart disease or high blood pressure.
• Ergot derivatives (ergotamine tartrate and dihydoergotamine), which work in the same way as triptans. They should not be used if you have heart disease or high blood pressure.

Most acute drugs for migraine work best when taken right away, when symptoms first begin. Always carry your migraine medicine with you in case of an attack. For people with extreme migraine pain, a powerful “rescue” drug might be prescribed, too. Because not everyone responds the same way to migraine drugs, you will need to work with your doctor to find the treatment that works best for you.
Prevention. Some medicines used daily can help prevent attacks. Many of these drugs were designed to treat other health conditions, such as epilepsy and depression. Some examples are:

• antidepressants, such as amitriptyline (Elavil^®) or venlafaxine (Effexor^®)
• anticonvulsants, such as divalproex sodium (Depakote^®) or topiramate (Topamax^®)
• beta-blockers, such as propranolol (Inderal^®) or timolol (Blocadren^®)
• calcium channel blockers, such as verapamil

These drugs may not prevent all migraines, but they can help a lot. Hormone therapy may help prevent attacks in women whose migraines seem to be linked to their menstrual cycle. Ask your doctor about prevention drugs if:

• your migraines do not respond to drugs for symptom relief
• your migraines are disabling or cause you to miss work, family activities, or social events
• you are using pain-relief drugs more than two times a week

Lifestyle changes. Practicing these habits can reduce the number of migraine attacks:

• Avoid or limit triggers.
• Get up and go to bed the same time every day.
• Eat healthy foods and do not skip meals.
• Engage in regular physical activity.
• Limit alcohol and caffeine intake.
• Learn ways to reduce and cope with stress.

Alternative methods. Biofeedback has been shown to help some people with migraine. It involves learning how to monitor and control your body’s responses to stress, such as lowering heart rate and easing muscle tension. Other methods, such as acupuncture and relaxation, may help relieve stress. Counseling also can help if you think your migraines may be related to depression or anxiety. Talk with your doctor about these treatment methods.