Treatment options for migraine

Did you know that many patients with chronic migraine go undiagnosed?1 One reason for this is that people with migraine do not always consult a doctor for their symptoms.2 Why? For some people, it may be lack of faith in treatment options.2 Maybe you anticipate that the doctor will not be able to manage your migraines effectively. Or you think that no helpful treatments are available. Or maybe you have been unhappy with previous treatments.2

While there is no cure for Chronic Migraine, there are different types of treatment strategies or medications to manage migraine,3 and people with migraine should likely be on both types.4,5 Talk to a doctor who has expertise in treating and diagnosing headaches to find out how acute, preventive and alternative treatments may benefit your type of migraine.

  • Acute medications (Symptomatic Treatment)

    These medications are taken as needed once you have a migraine. The idea is to stop the pain once it has begun.

    LEARN MORE
  • Preventative Treatments

    People who suffer from more frequent migraines may need to take steps to prevent migraines before they start, and reduce how often they happen or how severe they are.

    LEARN MORE
  • Alternative Treatments

    There are many non-medication preventative options that can help reduce the severity and frequency of migraines. These alternative treatments can be used instead of medication treatments or in addition to them.

    LEARN MORE

Acute medications for migraine are administered as needed to relieve symptoms, especially pain, after a migraine starts.

Treatment Options Possible Side Effects
Analgesics
  Ibuprofen6(e.g., Advil®Liqui-Gels) Show Details
  • Abdominal pain
  • Nausea or vomiting
  • Diarrhea or constipation
  • Allergic reactions (hives, shortness of breath, facial swelling)
  • Bloody or black stools
  • Gastrointestinal discomfort
  • Ringing or buzzing in the ears
  • Fluid retention
  • Dizziness
  • Skin rash or itching
  • Change in vision
  • Nervousness
  • Sleeplessness
  Aspirin Extra Strength7 Show Details
  • Nausea or vomiting
  • Stomach irritation
  • Gastrointestinal Bleeding and/or ulceration
  • Ringing or buzzing in the ears or pain
  • Bruising
  • Allergic reaction
  Acetaminophen (e.g., Tylenol)8 Show Details
  • Allergic reaction (hives, facial swelling, itchy skin, wheezing)
  • Taking more than the maximum daily dose may cause severe or possibly fatal liver damage. Excessive alcohol consumption may also increase this risk.
  Analgesic + Caffeine (e.g., Tylenol Ultra)9 Show Details
  • Allergic reaction (hives, rash, wheezing)
  • Rapid heart rate
  • Nervousness
  • Sleeplessness
  • Taking more than the maximum daily dose may cause severe or possibly fatal liver damage. Excessive alcohol consumption may also increase this risk.
  Barbituate/Analgesic Compounds (e.g., Fiorinal)10 Show Details
  • Nausea, vomiting, indigestion and/or stomach pain
  • Drowsiness, lightheadedness and dizziness
  • Constipation and gas
  • Skin rash and itching
  • Small pupils
  • Fast or irregular heart beat
  • Irritability
  • Tremor
  • Lack of coordination
  • Difficulty thinking
  • Poor memory and judgement
  • Decreased attention
  • Mood swings
  • Exaggeration of personality traits
  • Drug dependence can develop
Serotonin (5-HT) Receptor Agonists (commonly referred to as Triptans)
  Sumatriptan (Imitrex®)11 Show Details
  • Pain, pressure or tightness in any part of the body (including chest and throat)
  • Sensations of heaviness
  • Unusual sensations including numbness, tingling,
  • Heat/burning or cold
  • Flushing (redness of the face lasting for a short time)
  • Nausea or vomiting
  • Dizziness
  • Drowsiness
  • Tiredness
  • Weakness
  • Irregular or rapid heart beat
  Zolmitriptan (Zomig®)12 Show Details
  • Sensations of pain, pressure, or tightness in the chest, neck, throat, jaws, arms or leg
  • Sensation of tingling, heat, heaviness, or pressure
  • Nausea or vomiting
  • Dizziness
  • Drowsiness
  • Tiredness
  • Muscle weakness
  • Muscle aches and pains
  • Difficulty swallowing
  • Dry mouth
  • Headache
  • Stomach pain
  • Discomfort inside the nose (nasal spray)
  • Nose-bleed (nasal spray)
  • Irregular or rapid heart beat
  Rizatriptan (Maxalt®)13 Show Details
  • Dry mouth
  • Sensations of pain, pressure or tightness in the chest, neck, throat, jaw, arms or legs
  • Sensations of tingling, heat, heaviness or pressure
  • Headache
  • Dizziness
  • Tiredness
  • Muscle pain
  • Nausea or vomiting
  • Drowsiness
  • Irregular or rapid heartbeats
  Almotriptan (Axert)14 Show Details
  • Nausea
  • Sleepiness
  • Dizziness
  • Tingling sensation
  • Headache
  • Dry mouth
  Eletriptan (Relpax®)15 Show Details
  • Sensations of pain, pressure or tightness in the chest, neck, throat, jaw or arms.
  • Shortness of breath; wheezing; heart throbbing; swelling of face, lips, eyelids; skin rash; skin lumps; or hives
  • Feeling weak, dizziness, feeling sleepy or drowsy, tingling, difficulty swallowing, nausea and stomach pain/cramps
  • Drowsiness
  Frovatriptan (Frova®)16 Show Details
  • Sensations of pain or pressure in the chest, throat, neck, or jaw
  • Dizziness
  • Tiredness
  • Headache (other than a migraine headache)
  • Feeling of tingling
  • Numbness
  • Feeling hot or cold
  • Allergic reaction
  Naratriptan (Amerge®)17 Show Details
  • Dizziness
  • Drowsiness
  • Ear, nose and throat infections
  • Nausea and vomiting
  • Headache
  • Dry mouth
  • Sensation of numbness, tingling, feeling hot, pain in any part of the body including chest, neck, jaw and throat
Opioids
  Butorphanol Nasal Spray18 Show Details
  • Drowsiness and sleepiness
  • Dizziness
  • Nausea and vomiting
  • Confusion
  • Weakness
  • Nervousness
  • Drug dependence can develop
  • Blurred vision
  • Unpleasant taste
Ergot Derivatives
  Dihydroergotamine (Migranal®)19 Show Details
  • Nasal irritation or congestion, excessive sneezing, runny nose, taste disturbance, application site reactions
  • Nausea and vomiting
  • Numbness or tingling in your fingers and toes
  • Pain, tightness or discomfort in your chest
  • Muscle pain or cramps in your arms and legs
  • Weakness in your legs
  • Temporary speeding or slowing of your heart rate
  • Swelling or itching

This is not an exhaustive list; please consult your doctor to find out if the product is right for you.

Natural Health Products

There are also several natural health products that can be used for the treatment of migraines.

Treatment Options Possible Side Effects
Natural Health Products
  Homeopathic Remedies20, (e.g., Head On; Hyland’s Migraine Headache Relief) Show Details
  • Skin irritation or allergic reaction (for topical products)
  • Allergic reactions and side effects may occur. Talk to your doctor before using.
  • Muscle stiffness
  • "Morning Sluggishness"
  • Nausea
  Chinese Medicines21,22 (e.g., Qingxuan Pian; Xiongju Shangqing Wan) Show Details
  • Allergic reactions and side effects may occur.
  • Talk to your doctor before using.

Should you add preventive therapy to your acute therapy?

More than 1 in 4 people with migraines are candidates for preventive therapy.5 Are you one of them?

Talk to your doctor to ask if you may benefit from preventive therapy.

Preventive (also referred to as prophylactic) treatment for migraine can be considered for people who:3,23

  • Are not responding to acute medications
  • Experience a substantial impact on their lives due to migraines
  • Have a high frequency of migraine attacks

Could you benefit from preventive therapy?

Talk to your doctor about what’s right for you.

Unlike treatments used at the start of a migraine, preventive medications are taken on a regular basis. These medications are only considered to be effective when taken long term.24

The goals of preventive therapy are to: 3,24

  • Prevent headaches from occurring
  • Reduce migraine and headache frequency, severity, and duration

Which in turn may help to: 3

  • Improve function, reduce disability and improve health-related quality of life
Preventative Options Dosing Frequency Possible Side Effects
Beta-blockers
Propranolol25 Daily Show Details
  • Congestive heart failure
  • Slow heart beat
  • Bronchospasm (spasms of the bronchiole tubes in the lungs)
  • Anorexia (weight loss)
  • Nausea and vomiting
  • Diarrhea
  • Abdominal pain
  • Fatigue
  • Cold extremities
  • Dizziness or lightheadedness
Timolol26 Daily Show Details
  • Congestive heart failure
  • Slow heart beat
  • Diarrhea
  • Difficulty sleeping
  • Dizziness or lightheadedness
  • Drowsiness
  • Dry eyes
  • Headache
  • Nausea or vomiting
  • Unusual tiredness or weakness
  • Cold extremities
  • Shortness of breath
  • Ringing in the ears
Calcium Channel Blockers
Flunarizine27 Daily Show Details
  • Drowsiness (sedation or fatigue)
  • Weight gain, increased appetite
  • Depression
  • Restlessness, trembling or uncontrolled movements of the face, arms and legs
  • Slow movement, stiffness in older individuals
Anticonvulsant
Topiramate28 Daily Show Details
  • Co-ordination problems
  • Difficulty concentrating
  • Slow thinking
  • Confusion and forgetfulness
  • Dizziness
  • Tiredness
  • Tingling
  • Headache
  • Upper respiratory tract infection (e.g. colds, bronchitis
  • Drowsiness
Botulinum toxin
Botox®(Onabotulinumtoxin A for injection) 29 Every 3 months (12 weeks) Show Details
  • Headache
  • Facial muscle weakness
  • Drooping of the eyelids
  • Muscle spasm
  • Muscle tightness
  • Injection pain and rash

This is not an exhaustive list; please consult your doctor to find out if the product is right for you.

Natural Health Products

There are also several natural health products that can be used for the prevention of migraines.

Preventative Options Dosing Frequency Possible Side Effects
Coenzyme Q1030, 31 (e.g., Trophic -Coenzyme Q10, 80 mg; Coq10, Co-Q10;Clear-q; Bpt Ubidecarenone Capsules Usp 100 mg) Daily Show Details
  • Stomach upset
  • Vomiting
  • Nausea
  • Diarrhea
  • Appetite suppression
  • Allergic skin rashes
5-HTP (L-5 Hydroxytryptophan)32 (e.g., L-5-Htp Capsules; Westcoast Naturals L-5-Htp Capsules; Cifolia) Daily Show Details
  • Drowsiness
  • Diarrhea
  • Nausea
  • Vomiting
  • Stomach pain
Tanacetum Parthenium33,34 (e.g., Migrelief; Feverfew 125 mg; Extra Strength Feverfew 400 mg) Daily Show Details
  • Gastrointestinal discomfort
  • Sore mouth
  • Mouth ulcers
Petasites hybridus (butterbur)35 (e.g., Sisu Petadolex; Petadolex; Migranon Ii) Daily Show Details
  • Burping
  • Headaches
  • Drowsiness
  • Constipation
  • Upset stomach
  • Hair loss
  • Depression
  • Skin or eye discoloration
  • Skin and allergic reactions
  • Fatigue
  • Difficulty breathing or exhaling
  • Itchy eyes
  • Bad breath
  • Itching
  • Discolored stool

This is not an exhaustive list; please consult your doctor to find out if the product is right for you

If you think you could benefit from starting preventive therapy—or from a change in your preventive treatment—talk to your doctor.

Behavioural treatments Show Details

For many who suffer from intermittent migraine and tension-type headaches, the consistent practice of behavioral methods can actually reduce the intensity and frequency of attacks. For others, behavioral treatment may serve as a means for coping with the stress created by the headache, or helping the headache sufferer continue to function.36

For individuals experiencing frequent and severe headaches, behavioral methods are usually combined with drug therapy. This may lead to better headache control than would be the case with either type of treatment alone.36

Examples of behavioral treatments that have been proven to be effective include:24

  • Biofeedback
    • In biofeedback, an instrument monitors the body’s stress response (e.g. muscle tension/skin temperature) whilst you try to modify your response37
    • This form of treatment is potentially useful if the person suffering migraines needs to avoid treatment with medications
    • Examples of biofeedback include:38
      • Hand-warming (temperature)
        • When you experience stress your blood vessels in your hands and fingers tend to narrow, making them feel cooler. Hand-warming biofeedback training helps teach those affected to reduce their stress and thereby improve the blood flow in their hands, making them feel warmer.39
        • Findings from research suggest that headache patients that have learned to raise their hand temperature using biofeedback had fewer and less severe headaches.39
      • Electromyogram (EMG)
        • EMG biofeedback has been used as an approach to help prevent tension-type headaches. In EMG biofeedback, an EMG machine monitors muscle tension. Using the feedback from the EMG machine helps a person identify when their muscles are becoming tense. In addition, using the feedback can help one figure out effective ways of reducing this muscle tension.39
      • Temporal pulse amplitude
        • To perform this biofeedback technique, one is taught ways to restrict blood flow in the areas of the head experiencing the pain due to the headache.40
  • Relaxation training
    • Involves learning how to achieve a physical and mental state of calm and relaxation, following a systematic set of procedures to reduce stress37
    • Can be helpful when pharmacotherapy is contraindicated
    • Examples include:38
      • Meditative (abdominal breathing exercises) – meditating and using breathing techniques such as slowing breathing in through the mouth and out through the nose can be relaxing and help reduce tension.
      • Visualization/guided imagery – visualizing a positive tranquil image or a particular image may be helpful for some in reducing tension.
      • Autogenics training may also be referred to as progressive muscle relaxation. This technique teaches one to experience a feeling of warmth and heaviness throughout the body, thereby producing a sense of physical relaxation.41
  • Cognitive-behavioral therapy
    • Stress management can be considered to be a major focus of cognitive-behavioural therapy38

Other behavioural treatments that are supported by clinical experience include:36

  • aerobic exercise
  • sleep regulation
  • dietary regulation
  • smoking cessation

Alternative Pain Management Strategies Show Details

For those looking for pain management, there are a wide variety of possible treatments to choose from including:24

  • acupuncture
  • chiropractic
  • massage
  • body work
  • Reiki
  • magnets

Talk to your doctor about which treatment is best for you.

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