Treatment of migraine involves several approaches that may be used alone or together.  These approaches include:

• Identifying and controlling triggers.
• Encouraging healthy behaviors and lifestyles.
• Medications to prevent attacks of migraine (prophylaxis).
• Medications to treat an individual migraine attack (acute treatment).

Acute Migraine Treatments

Specific migraine drugs are:

• Triptans.  They are more than seven drugs in this category in one or more may be tried.  Examples of these drugs include Amerge, Axert, Frova, Imitrex, Maxalt, Relpax, and Zomig.  Failure to respond to one of these drugs does not necessarily mean that the other ones won't work.
• Ergots.  DHE 45 (dihydroergotamine) is the best-known medication in this category.
• Midrin

Other pain medications that are commonly used for acute migraine treatment include:

• Over-the-counter pain medications like aspirin, ibuprofen (Advil, Motrin), or acetaminophen (Tylenol).
• Prescription pain medications.  The use of these medications on a regular basis may increase headache frequency, called rebound headache or analgesic headache (please see our section on rebound headaches for details).
• Anti-inflammatory medications that are also known as non-steroidal or arthritis medications.

Preventative Headache Medications

These medications are taken on a regular daily basis to prevent migraine attacks much as blood pressure medications are taken regularly to prevent hypertension.

• Antidepressants such as Amitriptyline, Nortriptyline, and Zoloft.
• Beta-blockers such as Propranolol, Atenolol, and Metoprolol.
• Calcium channel blockers such as Verapamil, and Amlodipine.
• Anticonvulsants such as valproic acid (Depakote), gabapentin (Neurontin), pregabalin (Lyrica), topiramate (Topamax), and levitiracetam (Keppra).
• Vitamin B1, magnesium, hormones.
• Botulinum toxin (Botox®).

Other preventative approaches may not use medication at all but include relaxation training, biofeedback, acupuncture, and stress management.

Additionally smoking, large amounts of caffeine, and poor sleep can make headaches worse.  Therefore it is strongly recommended to quit smoking, and to avoid the frequent consumption of caffeinated beverages. 

If poor sleep is an issue and one complains of excessive daytime sleepiness (as demonstrated by easily falling asleep during watching TV, driving a car is a passenger, or even during conversation) this could be a sign of a sleep disorder like obstructive sleep apnea.  It is therefore recommended to seek evaluation by a sleep specialist.  Sleep apnea for example can cause a chronic daily headache and also increases one's cardiovascular risk for stroke and heart attacks.  Treatment of this disorder by a specialist is therefore highly recommended.

If you have questions or comments regarding this topic that you would like for us to address here in the future please don’t hesitate to email us at Headache@Wisedoctors.com.