Migraine - Treatment 

Treating migraines 

Migraine: Debbie's story

Debbie has experienced migraines since she was a child. See how alternative therapies and relaxation techniques brought her some relief.

Media last reviewed: 20/08/2013

Next review due: 20/08/2015

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, although a number of treatments are available to help 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, your GP may prescribe something stronger.

Painkillers

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

They tend to be most effective if taken at the first signs of a migraine attack, as this gives them time to absorb into your bloodstream and ease your symptoms.

It is not advisable to wait until the headache worsens before taking painkillers because by this point it is often too late for the medication to work. Soluble painkillers (tablets that dissolve in a glass of water) are a good alternative 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).

Cautions

When taking over the counter painkillers, 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 and ibuprofen are also not recommended for adults who have a history of stomach problems, such as stomach ulcers, liver problems or kidney problems.

Taking any form of painkiller frequently can make migraines worse. This is sometimes called "medication overuse headache" or "painkiller headache".

Speak to your GP if you find yourself needing to use painkillers repeatedly or if over the counter painkillers are not effective. Your GP may prescribe stronger painkillers or recommend using painkillers along with triptans (see below). If they suspect the frequent use of painkillers may be contributing your headaches, they may recommended that you stop using them.

Triptans

If ordinary painkillers are not helping to relieve your migraine symptoms, you should make an appointment to see your GP. They may recommend taking painkillers in addition to a type of medication called a triptan and possibly anti-sickness medication (see below).

Triptan medicines are not the same as painkillers. They are thought to work by reversing the changes in the brain that may cause migraines. 

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.

Common side effects of triptans include warm-sensations, tightness, tingling, flushing, and feelings of heaviness in the face, limbs or chest. Some people also experience nausea, dry mouth and drowsiness. These side effects are usually mild and improve on their own.

Your GP will usually recommend having a follow-up appointment when you have finished your first course of treatment with triptans, so you can discuss whether they were effective and whether you had any side effects.

If the medication was helpful, treatment will usually be continued. If they were not effective or caused unpleasant side effects, your GP may try prescribing a different type.

Anti-sickness medicines

Anti-sickness medicines, known as anti-emetics, can successfully treat migraine in some people even if you don't experience nausea or vomiting. These are prescribed by your GP and can be taken alongside painkillers and triptans.

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.

Side effects of anti-emetics include drowsiness and diarrhoea.

Combination medicines

You can buy a number of combination medicines for migraine without a prescription 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, it may be better to take painkillers and anti-sickness medicines separately. This will allow you to easily control the doses of each.

Seeing a specialist

If the treatments above are not effectively controlling your migraines, your GP may refer you to a specialist migraine clinic for further investigation and treatment.

In addition to the medications mentioned above, a specialist may recommend other treatments such as transcranial magnetic stimulation.

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. The evidence for its effectiveness is not strong and is limited to people who have migraine with aura.

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 in specialist centres, 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.

Treatment for pregnant and breastfeeding women

In general, migraine treatment with medicines should be limited as much as possible when you are pregnant or breastfeeding. Instead, trying to identify and avoid potential migraine triggers is often recommended.

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 when you are pregnant or breastfeeding.

Page last reviewed: 14/04/2014

Next review due: 14/04/2016

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The 7 comments posted are personal views. Any information they give has not been checked and may not be accurate.

trulys said on 05 September 2014

I suffer with headaches and migraines, and usually, once its got really bad, there's not a lot can help apart from a good sleep. I have, however, today had a headache which has gradually got worse as the morning progressed, but I didn't have any tablets with me. I bought some Solpadeine Max Soluble tablets (with paracetamol, codeine and caffeine) and I have to say, an hour after taking them, my headache has got so much better. When I came back to the office, I felt I couldn't do any work because my head hurt so much, and all I wanted to do was put my head down on the desk and fall asleep. I now feel a lot better, and am stuck with the task of getting 3 reports typed up and out by 5pm, so a big thumbs up for Solpadeine Max today!

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Southpaw said on 28 August 2014

I've had migraines for about 30 years now, and has been chronic for quite a few years now, barely a day goes by without one. So far I've tried pizotifen, amitriptyline, epilim, gabapentin, topiramate, probably something else that I've forgotten about and various triptan tablets I'm now on a nasal spray. So far none of the preventatives have worked. I keep being promised Botox for the last 3 years by the consultant which I'm still waiting to try. I've been told that there is nothing left for me to try, so I've resigned myself to the fact that unless it spontaneously resolves itself I will be stuck with these horrible migraines probably till I die like another family member.

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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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