Migraine - Treatment 

Treating migraine 

Video: pain clinic

Patients with chronic pain conditions such as migraines are sometimes referred to a pain clinic by their GP. A consultant in chronic pain management explains what chronic pain is, different types of pains and what treatments and procedures may be offered at the pain clinic

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Menstrual migraines

Menstrual migraines usually occur within two days either side of the first day of a woman’s period. If menstrual migraines are a problem, they can be prevented using either non-hormonal or hormonal treatments.

The non-hormonal treatments that are recommended are:

  • non-steroidal anti- inflammatory drugs (NSAIDs) - a widely used type of medication that helps reduce pain
  • triptans - medicines that reverse the widening (dilation) of blood vessels, which is thought to be a contributory factor in migraines

Hormonal treatments that may be recommended include:

During an attack

Most people find that sleeping or lying in a darkened room is the best thing to do when having a migraine attack.

Others find that eating something helps, or they start to feel better once they have been sick.

There is currently no cure for migraines. However, a number of treatments can be used to ease the symptoms.

It may take time to work out which is the best treatment for you. You may need to try different types or combinations of medicines before you find the most effective ones.

If you find that you cannot manage your migraines using over-the-counter medicines, then your GP can help.

Painkillers

Many people who have migraines find that over-the-counter painkillers, such as paracetamol and aspirin, can help to reduce their symptoms.

When taking paracetamol or aspirin, always make sure you read the instructions on the packaging and follow the dosage recommendations. Children under 16 should not take aspirin unless it is under the guidance of a healthcare professional. Aspirin is also not recommended for adults who have, or have had in the past, stomach problems, such as a peptic ulcer, liver problems or kidney problems.

Some people find that the painkiller codeine makes migraine worse. This can be because it increases the nausea associated with the migraine.

Taking any form of painkiller frequently can make migraine worse. This is sometimes called 'medication overuse headache'.

Painkillers are usually the first treatment for migraine. They tend to be more effective if taken at the first signs of a migraine attack. This gives them time to absorb into your bloodstream and ease your symptoms.

Some people only take painkillers when their headache becomes very bad. However, this is not advisable because it is often too late for the painkiller to work. Soluble painkillers (tablets that dissolve in a glass of water) are a good option because they are absorbed quickly by your body.

If you cannot swallow painkillers because of nausea or vomiting, suppositories may be a better option. These are capsules that are inserted into the anus (back passage).

If over-the-counter painkillers are not effective, your GP or specialist may prescribe you a stronger painkiller.

Triptan medicines

If ordinary painkillers are not helping to relieve your migraine symptoms, triptan medicines might be the next option. Some triptan medicines, such as sumatriptan, are available without prescription over the counter. Others require a prescription from your GP.

Triptan medicines are not the same as painkillers. They cause the blood vessels around the brain to contract (narrow). This reverses the dilating (widening) of blood vessels that is believed to be part of the migraine process.

Triptans are available as tablets, injections and nasal sprays.

Triptan medicines only work for some people. If one type of triptan medicine does not seem to work, ask your GP about other types.

Anti-inflammatory medicines

Some people find that anti-inflammatory medicines such as ibuprofen are effective in treating the symptoms of migraine.

You can buy ibuprofen over the counter at a pharmacy, and it is available on prescription. However, do not take ibuprofen if you have, or have had in the past, stomach problems, such as a peptic ulcer, or if you have liver or kidney problems.

Diclofenac, naproxen and tolfenamic acid are anti-inflammatory medicines that are only available on prescription.

Anti-sickness medicines

Anti-sickness medicines can successfully treat migraine in some people, even if nausea is not a symptom. These are prescribed by your GP and can be taken alongside painkillers.

As with painkillers, anti-sickness medicines work better if taken as soon as your migraine symptoms begin. They usually come in the form of a tablet, but are also available as a suppository.

Combination medicines

You can buy a number of combination medicines for migraine over the counter at your local pharmacy. These medicines contain both painkillers and anti-sickness medicines. If you are not sure which one is best for you, ask your pharmacist.

Many people find combination medicines convenient. However, the dose of painkillers or anti-sickness medicine may not be high enough to relieve your symptoms. If this is the case, you may prefer to take painkillers and anti-sickness medicines separately. This will allow you to easily control the doses of each.

Ask your GP or pharmacist if you are not sure which medication is most suitable for you.

Transcranial magnetic stimulation

In January 2014, the National Institute for Health and Care Excellence (NICE) approved the use of a treatment called transcranial magnetic stimulation (TMS) for the treatment and prevention of migraines.

TMS involves holding a small electrical device to your head that then delivers magnetic pulses through your skin. It is not clear exactly how TMS works in treating migraines, but studies have shown that using it at the start of a migraine can reduce its severity. It can also be used in combination with the medications mentioned above without interfering with them.

However, TMS is not a cure for migraines and it doesn’t work for everyone. There is also little evidence about the potential long-term effects of the treatment, although studies into the treatment have so far only reported minor and temporary side effects, including:

NICE recommends that TMS should only be provided by headache specialists, because of the uncertainty about the potential long-term side effects. The specialist will keep a record of your experiences using the treatment.

For more information, see 'NICE approves migraine magnet therapy'.

Migraine clinics

If you are not responding to treatment or your migraines are not being well managed, your GP may refer you to a specialist migraine clinic for further investigation. Reasons for being referred include:

  • doubt over the diagnosis of migraine
  • a rarer form of migraine is suspected
  • other headaches besides migraine are present
  • treatment is not working well for you
  • your migraines or headaches are getting worse and/or more frequent

Treatment for pregnant women

In general, migraine treatment with medicines should be limited as much as possible when you are pregnant or breastfeeding.

If medication is essential, then your GP may prescribe you a low-dose painkiller, such as paracetamol. In some cases, anti-inflammatory drugs or triptans may be prescribed. Speak to your GP or midwife before taking medication in pregnancy.

Page last reviewed: 14/05/2012

Next review due: 14/05/2014

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The 5 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Colin187 said on 17 December 2013

As soon as the aura starts I take two aspirin and a glass of water, or two aspirin and a glass of milk, then go somewhere quiet and not bright. It helps me if I do this the minute the aura starts. This has eased my suffering a great deal. It took me years to work out this was the best plan.

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malcolmdodge said on 02 October 2013

I have suffered from migraines for about 10 yrs starting after a car accident. It has taken these past ten years to convince doctors and specialists that the migraine originates from my Neck - I have taken every tablet known to my doctor but now I am having treatment on trapped nerves in my neck there is hope and results.

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lucky lucy said on 19 March 2012

some times when my head feels as though it will explode as it is so hot, an ice pack over my head is the only relief.

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SuperMutantsUnited said on 20 December 2011

I find splashing my face with cold water then sitting down with my face in a warm towel to be quite an effective treatment. I try not to depend on pain killers too much, they're not as effective after a while. The splashing technique works for me about 9/10 times.

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k718 said on 24 August 2009

I find that sometimes drinking a large glass or two of cold water can help relieve the pressure felt inside the head. Maybe this is to do with dehydration, which I've found can initiate a migraine. I'd say it's probably best to do this as soon as you start to get a headache.

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