Migraine treatment options
A migraine is a type of (usually) severe headache that is characterised by one-sided pain (although both sides of the head can be affected), often accompanied by nausea and/or vomiting and sensitivity to light or sound. It can be debilitating, and can have you out of action for a few hours or even a day or more.
Avoiding migraine triggers
Knowing what triggers migraines for you, and avoiding these triggers, can help you to manage your migraines. Keeping a food and pain diary can be helpful for working out which foods, if any, trigger your migraines.
Common migraine triggers include:
- stress;
- missing a meal;
- lack of sleep;
- certain odours;
- alcohol;
- certain foods including cured meats, chocolate, caffeine, nuts, pickled foods, monosodium glutamate (MSG), aged cheese, yogurt, onions, brown vinegar, chicken livers, among many others;
- hormone fluctuations;
- some medicines used to treat other conditions; and
- overuse of pain-relieving medicines.
Migraine treatment medicines
To be most effective, medicines to treat a migraine are best taken as soon as migraine symptoms are noticed.
Most usual over-the-counter headache medicines are only helpful for people who have mild or moderate, rather than severe, migraine pain. Mild migraine pain may be helped by anti-inflammatory medicines such as ibuprofen or by aspirin. However, when taken at the onset of symptoms, aspirin can relieve even severe migraines.
Some people find that taking caffeine, for example, by drinking a cup of strong coffee, helps stop a mild migraine progressing. This is thought to be because caffeine causes the blood vessels in your brain to narrow, which counteracts the dilation of blood vessels that is thought to partly cause the pain of migraine.
As nausea and vomiting are common with migraines, and may prevent absorption of oral migraine medicines, it is often recommended to take an anti-nausea medicine such as metoclopramide (e.g. Maxolon), domperidone (Motilium) or prochlorperazine (Stemetil) along with other migraine medicines.
No migraine medicine is effective for all people, and those who do not respond to over-the-counter preparations may need special migraine medicines prescribed by their doctor.
These medicines include the triptans (e.g. Imigran, Naramig, Zomig and Maxalt), ergotamine (e.g. Cafergot, a brand which also includes caffeine) and dihydroergotamine (Dihydergot, given as an injection). The triptans are available in a range of delivery modes such as nasal sprays, wafers that dissolve on the tongue and self-injection devices, which is helpful if you get vomiting with your migraines.
All migraine medicines are best given at the first sign of a migraine. People who have severe or frequent migraines (more than 2-3 times a week) may need to be prescribed preventive medicine.
Preventive medicines for migraine
Medicines that are more commonly associated with treatment of other conditions, such as depression, high blood pressure or convulsions, are now being used to prevent migraines. Some examples of medicines used to prevent migraines include amitriptyline, pizotifen (Sandomigran), propranolol (e.g. Inderal), sodium valproate and topiramate (e.g. Topamax, Epiramax). This type of preventive medicine is usually taken every day and is useful for people who have frequent, severe migraines or who have a condition that prevents them from taking any of the migraine treatment medicines.
Other treatments for preventing migraines
Other treatments that may be useful in preventing migraines include acupuncture, cognitive behavioural therapy (a type of psychological therapy), relaxation exercises and stress management training. Cutting down on your caffeine intake may also help prevent migraines.
Although these therapies may be useful on their own, they are usually used together with preventive medicines for migraine.
When to see your doctor
If you get severe headaches that are not helped by the usual over-the-counter pain medicines, see your doctor. If you are having regular migraines, ask your doctor if preventive medicine is suitable for you.
Last Reviewed: 29 January 2010
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