Migraine Treatment
Migraine treatment is not one single treatment. It may involve treating an attack, reducing future attacks, supporting recovery and adapting care to the person’s wider health needs.
Treat the migraine — and look at the whole person
Effective migraine management often combines treatment for attacks, prevention, everyday supports and management of other conditions that may be adding to the overall burden.
What works for one person may not suit another. Migraine type, attack frequency, other medical conditions, medication tolerance, pregnancy or hormonal factors, age and individual preferences can all affect treatment choices.
Migraine is a neurological condition — treatment does not depend on finding and avoiding every possible trigger.
Reducing avoidable load can be useful, but treatment can also focus on making the migraine system less vulnerable and reducing the frequency, severity or impact of attacks.
Three parts of migraine management
Treat the attack
Acute or rescue treatment is used when a migraine attack begins or is underway.
Acute TreatmentReduce future attacks
Preventive treatment aims to reduce migraine frequency, severity, duration or overall disability.
PreventionSupport the whole system
Sleep, meals, hydration, sensory load, pacing, recovery and treatment of other conditions can form another part of care.
Everyday SupportAcute migraine treatment
Acute medicines are intended to stop an attack or reduce symptoms such as headache, nausea and vomiting.
Simple pain medicines
Depending on the person, medicines such as paracetamol or anti-inflammatory medicines may be considered for some migraine attacks.
They are not suitable for everyone, and individual health conditions and medication risks need to be considered.
Triptans
Triptans are migraine-specific medicines used to treat attacks. Several different triptans and formulations are available.
A person who does not respond well to one triptan may sometimes respond differently to another.
Newer migraine-specific treatments
CGRP-targeting acute medicines, including gepants, provide another treatment approach for some people.
Availability and suitability vary, so these are best discussed with a doctor or migraine specialist.
Nausea and vomiting
Anti-nausea medicines may form part of an acute migraine plan, particularly when nausea or vomiting makes attacks difficult to manage.
Different formulations may sometimes be considered when swallowing or absorbing tablets during an attack is difficult.
Frequent use of some acute migraine medicines can contribute to medication-overuse headache. If acute treatment is needed very frequently, it is worth discussing the pattern with a healthcare professional rather than simply trying to manage increasingly frequent attacks.
Preventive treatment
Prevention may be considered when migraine is frequent, disabling, prolonged, difficult to treat acutely or having a substantial effect on everyday life.
Traditional preventive medicines
A number of medicines originally developed for other conditions are also used to prevent migraine.
Depending on the individual, these can include medicines from groups such as:
- beta blockers
- some anticonvulsant medicines
- some antidepressant medicines
- some blood-pressure medicines
Choice depends on the person’s other conditions, possible benefits, side effects and contraindications.
CGRP-targeting preventive treatment
CGRP is involved in migraine biology. Treatments that target CGRP or its receptor have been developed specifically for migraine.
These include injectable monoclonal antibodies and, in some settings, oral CGRP-targeting medicines.
Eligibility, availability and cost vary by country and healthcare system.
Botox for chronic migraine
OnabotulinumtoxinA — commonly known as Botox — can be used as a preventive treatment for appropriately diagnosed chronic migraine.
Treatment involves injections at multiple sites around the head and neck and is generally administered by an appropriately trained clinician.
Neuromodulation and devices
Some migraine treatments use electrical or magnetic stimulation of parts of the nervous system rather than medication.
Different devices have different indications and availability, and evidence varies by device.
Migraine Devices — Coming SoonSupporting a less vulnerable migraine system
Everyday supports do not replace appropriate migraine treatment, but they may form an important part of the overall management plan.
Sleep
Aim for sleep that is as regular and restorative as reasonably possible, while also identifying sleep disorders that may require treatment.
Food & fluids
Long gaps without food and inadequate hydration can be problematic for some people. Individual medical, gastrointestinal and autonomic needs also matter.
Sensory load
Light, sound, smell, movement and busy environments can become difficult during migraine. Sensible adaptations can reduce unnecessary load.
Movement
Appropriate physical activity can be helpful for many people, but the type and amount need adapting for conditions such as ME/CFS, POTS, pain and hypermobility.
Stress & regulation
Stress is one of many factors that can influence migraine. Regulation strategies can be useful without implying that migraine is caused by psychological weakness or negative thinking.
Recovery
Migraine may have a prodrome and a postdrome as well as the main attack. Recovery needs can therefore extend beyond the period of headache.
Hormonal patterns may change treatment needs
Migraine can change around menstruation, pregnancy, postpartum periods, perimenopause and menopause.
Menstrual migraine
Some people experience attacks that reliably occur around menstruation. These may sometimes require a treatment strategy tailored to that pattern.
Menstrual Migraine — Coming SoonPerimenopause & menopause
Hormonal fluctuations during perimenopause can change migraine frequency or severity in some people.
Migraine history — particularly whether migraine aura is present — can also be relevant when discussing hormonal treatment with a healthcare professional.
Migraine, Perimenopause & Menopause — Coming SoonA good migraine treatment may still need adapting
Standard migraine advice can be useful — but it does not automatically fit every person.
Other ALPIMS conditions may affect medication choice, exercise advice, hydration, sensory strategies, treatment tolerance and what is realistically manageable.
Treatment often involves some trial and adjustment
A treatment does not necessarily need to eliminate migraine completely to be worthwhile.
Useful changes might include fewer migraine days, milder attacks, shorter attacks, better response to acute treatment, less nausea, better function or shorter recovery.
Keep the treatment plan manageable
Complicated plans can become difficult when migraine itself causes brain fog, fatigue or executive-function problems.
Written instructions, simple routines, medication organisers, reminders or help from another person may make a plan easier to use.
Track enough — but not everything
A simple record of migraine days, severe days, medication use and major changes can help evaluate treatment.
Tracking does not need to become a search for every possible trigger.
Simple Migraine Tracker — Coming SoonReview rather than simply keep adding treatments
Periodic review can help identify what is helping, what is causing side effects, what is no longer needed and whether the diagnosis or treatment plan needs reconsidering.
Build a treatment plan that fits the person
A GP, neurologist or headache clinician can help confirm the diagnosis, consider whether further investigation is needed and discuss acute and preventive treatment.
Other healthcare professionals may be useful when sleep, hormones, autonomic symptoms, pain, rehabilitation, mental health or other conditions are significant parts of the picture.
Choose what is useful now
You might start with treatment for attacks, explore prevention, look at everyday supports or consider how your other ALPIMS conditions change what is appropriate.
General information only. This page does not provide individual medical advice or recommend a particular medication or treatment. Migraine treatment should be discussed with an appropriately qualified healthcare professional, particularly when other health conditions, pregnancy, medication sensitivities or significant changes in symptoms are present.