Migraine Treatment Overview

When to see a healthcare provider

If you think you have migraine headaches but have never been diagnosed, consider seeing a healthcare provider. Some headaches may be caused by other conditions like eye strain, sinus problems, high blood pressure, or, rarely, more serious issues like a brain tumor. A doctor can help you get an accurate diagnosis.

Also see a doctor if you have a migraine that doesn’t get better after 3 days of home care, or if you have chronic migraines (more than about 8–10 days per month) or if your migraines interfere with your regular activities (including school or work).

Your doctor may refer you to a neurologist or pain doctor who specializes in migraines. They will be able to help you figure out medical and lifestyle treatments that can help reduce the frequency and severity of your migraines.

If you have had migraines in the past but develop a new headache that is somehow different—more severe, more frequent, longer lasting, doesn’t respond to usual treatments—check in with your doctor. Any new severe headache should be evaluated by a doctor.

Getting diagnosed

Migraines are diagnosed based on your symptoms. Sometimes additional tests are needed to check for more serious causes of your headache. This may include a CT scan or MRI. Blood tests could help detect inflammation or infection.

What to expect from your doctor visit

Your doctor can help you create a treatment plan that includes medications and lifestyle changes. If your migraines are occasional, your doctor will recommend OTC and prescription medications to take at the first sign of a migraine (these are called rescue medications).

If your migraines are more frequent, occurring about 10 or more days a month, your doctor may recommend medications you take preventively to reduce the frequency and intensity of the migraines. These include some antidepressants, anti-seizure medications, and a new class of medications called CGRP blockers. You may need to try a few medications before you find the one that’s right for you.

Prescription medications to take during a migraine

• Triptans or ditans to stop (abort) a current headache
  • Sumatriptan (Imitrex)
  • Rizatriptan (Maxalt)
  • Lasmiditan (Reyvow)
• Anti-nausea medications, including:
  • Metoclopramide (Reglan)
  • Ondansetron (Zofran)
• Selective serotonin reuptake inhibitor (SSRI)
  • Lasmiditan (Reyvow)
• Calcitonin gene-related peptide blocker for treatment
  • Ubrogepant (Ubrelvy)

Prescription medications to help prevent migraines

• Some antidepressants
  • Amitriptyline (Elavil)
• Anti-seizure medications
  • Valproic acid (Depakote)
  • Topiramate (Topamax)
• Blood pressure medications called beta blockers
  • Propranolol (Inderal)
  • Metoprolol (Toprol XL)
  • Timolol (Blocadren)
• Calcitonin gene-related peptide (CGRP) blockers are a newer class of medication used to migraines
  • Some CGRP blockers are given by self-injection, usually at home
    • Erenumab (Aimovig)
    • Fremanezumab (Ajovy)
    • Galcanezumab (Emgality)
    • Eptinezumab (Vyepti) is given by IV, usually at a clinic
  • Rimegepant (Nurtec ODT) for prevention as well as acute treatment

Your doctor will also discuss evidence-based recommendations that may help reduce how often you get migraines. It may include:

• Improving your sleep habits
• Diet changes
• Exercise
• Discussing possible triggers to avoid

Other treatments your doctor may consider include Botox injections in your head and magnetic or electrical nerve stimulation.

• Botox: A doctor injects Botox into multiple trigger points in the head or neck to block the neurotransmitters that send pain signals to your brain. The injections can be painful.
• Electrical nerve stimulation: A device that sends an electrical signal to stimulate your nerves, interrupting pain pathways related to migraine, is placed on your forehead or neck. You may feel a tingling sensation, but it should not be painful.

Types of migraine providers

• A primary care physician for mild or moderate migraines that don’t respond to home treatment after about 3 days
• A neurologist is a doctor specializing in brain and nerve conditions. They often are trained in treating migraines.
• Pain specialist, a doctor who focuses on pain conditions including migraines
• An emergency medicine physician (ER doctor), if you have a severe or unusual headache that needs to be evaluated right away.

How to manage migraines at home

Migraines can often be treated at home with either OTC migraine medicine or prescription medications from your doctor. It may be more effective to take the medication at the first sign of a migraine. If you get an aura (a visual or other symptom), take it then, before the headache hits.

If your symptoms last more than 3 days, consider seeing a healthcare provider.

OTC medications

Over-the-counter migraine medicine can help your headaches. In general, you should not take them more than about 2–3 times a week. More frequent use can lead to medication overuse headache.

• Acetaminophen (Tylenol)
• NSAIDs
  • Ibuprofen (Advil, Motrin)
  • Naproxen (Aleve)
• Aspirin
• Combination medications such as acetaminophen, aspirin, and caffeine (Excedrin)

Home remedies for migraine like vitamins and supplements help some people with migraine symptoms, though scientific evidence is limited. Always tell your doctor if you’re taking vitamins or supplements.

• Vitamin B2
• Magnesium
• Riboflavin
• Coenzyme Q10

Tips for helping a migraine at home

Along with taking OTC or prescription medications, these tips can help lessen the pain.

• Close your eyes and rest in a cool, dark room.
• Avoid bright lights and loud noises.
• Take a break from phone, computer, and television screens.
• Drink plenty of water. Dehydration can worsen migraine symptoms.
• It may help to start a headache journal to record symptoms and possible triggers. Track habits or events that seem to be linked to migraine headaches. If you are menstruating, keep track of your cycles.

Wellness and prevention:

A healthy lifestyle may help reduce the frequency and severity of migraine headaches.

• Most adults need 6–8 hours of uninterrupted sleep. If you have insomnia or are not well rested, try to improve your sleep habits and talk to a healthcare provider about what you can do to improve your sleep.
• Get regular aerobic exercise.
• Eat regular meals, following a well-rounded diet.
• Increase your fluid intake, focusing on water (at least 8 glasses every day).
• Be aware of your caffeine use. Caffeine is sometimes used to treat headaches, but heavy use can make them worse.
• Consider reducing how much alcohol you drink.
• Look for ways to reduce stress and increase relaxation. Some people are helped by yoga and meditation.