How are migraine headaches treated?

Self-care at home

Most migraineurs can deal with mild-to-moderate migraine attacks at home. The following measures may help relieve migraine headache pain:

• Using a cold compress to the area of pain
  
  
• Resting with pillows comfortably supporting the head or neck
  
  
• Resting in a dark, quiet place
  
  
• Avoiding odors
  
  
• Withdrawing from stressful surroundings
  
  
• Sleeping
  
  
• Drinking a moderate amount of caffeine
  
  
• Taking certain over-the-counter headache remedies: Note that none of the following (with the exception of acetaminophen, aspirin, and caffeine combinations) has been clearly shown to relieve migraine headache pain.

• Nonsteroidal anti-inflammatory drugs (NSAIDs): Examples of NSAIDs include aspirin, ibuprofen (Motrin, Advil), naproxen (Naprosyn, Aleve), and ketoprofen (Orudis). These medicines sometimes cause stomach ulcers and bleeding; therefore, anyone with a history of stomach bleeding should not take them. Even people without such history should not take NSAIDs over a long period. The doctor or pharmacist should be asked about possible drug interactions if other medications are also being taken.
  
  
• Acetaminophen (Tylenol): Acetaminophen may be safely taken with an NSAID or other pain medicine for an additive effect. Taking acetaminophen by itself is usually safe, even for people with a history of stomach ulcers or bleeding, but it should not be taken if a person has liver problems. Taking large amounts of acetaminophen is associated with liver and kidney damage. Patients should always tell their doctor how much acetaminophen they take each day.
  
  
• Combination medications: Some over-the-counter pain relievers have been approved for use with migraine, including Excedrin Migraine, which contains acetaminophen, aspirin, and caffeine.

Medical treatment

Despite advances, migraines can be difficult to treat. About half of migraineurs stop seeking medical care for their headaches because they are dissatisfied with treatment results. This is unfortunate because the right drug or combination of drugs will eventually be found if the migraineur keeps visiting his or her doctor for follow-up visits.

Migraines can be treated with 2 approaches: abortive and preventive.

• Abortive: The goal of abortive therapy is to prevent a migraine attack or to stop it once it starts. The prescribed medications stop a headache during its prodrome stage or once it has begun and may be taken as needed. Some can be administered as a self-injection into the thigh; others, as a wafer that melts on the tongue. These forms of medication are especially useful for people who vomit during a migraine, and they work quickly.

Abortive treatment medications include the triptans, which specifically target serotonin. They are all very similar in their action and chemical structure. The triptans are used only to treat headache pain and do not relieve pain from back problems, arthritis, menstruation, or other conditions.

• Sumatriptan (Imitrex)
  
  
• Zolmitriptan (Zomig)
  
  
• Eletriptan (Relpax)
  
  
• Naratriptan (Amerge, Naramig)
  
  
• Rizatriptan (Maxalt)
  
  
• Frovatriptan (Frova)
  
  
• Almotriptan (Axert)

The following drugs are also specific and affect serotonin, but they affect other brain chemicals. Occasionally, one of these drugs works when a triptan does not.

• Ergotamine tartrate (Cafergot)
  
  
• Dihydroergotamine (D.H.E. 45 Injection, Migranal Nasal Spray)
  
  
• Acetaminophen-isometheptene-dichloralphenazone (Midrin)

The following drugs are mainly used for nausea, but they sometimes have an abortive or preventive effect on headaches:

• Prochlorperazine (Compazine)
  
  
• Promethazine (Phenergan)

The next drugs are weak members of the narcotic class. They are not specific for migraine, but they can help relieve almost any kind of pain. Since they are habit forming, they are less desirable than the specific headache drugs listed above. These drugs should be used primarily as a "backup" for the occasions when a specific drug does not work.

• Butalbital compound (Fioricet, Fiorinal)
  
  
• Acetaminophen and codeine (Tylenol With Codeine)
  
  

• Preventive: This type of treatment is considered if a migraineur has more than 1 migraine per week. The goal is to lessen the frequency and severity of the migraine attacks. Medication to prevent a migraine can be taken daily. Preventive treatment medications include the following:
  
  
  • Medications used to treat high blood pressure - Beta-blockers (propranolol [Inderal]), calcium channel blockers (verapamil [Covera])
    
    
  • Antidepressants - Amitriptyline (Elavil), nortriptyline (Pamelor)
    
    
  • Antiseizure medications - Gabapentin (Neurontin), valproic acid (Depakote), topiramate (Topamax)
    
    
  • Some antihistamines and anti-allergy drugs, including diphenhydramine (Benadryl) and cyproheptadine (Periactin)
  
  

Migraineurs must see their doctor regularly. Keeping a "pain journal" is often helpful to track how often attacks happen and what drugs were used to treat them. Sometimes it takes several doctor visits before an effective treatment plan is found.

Some migraineurs have been helped by alternative or complementary therapies such as chiropractic, acupuncture, osteopathic manipulation, and herbal remedies, though none of these treatments is supported by reliable scientific evidence.