Migraine treatment options

A migraine is a type of headache that is usually severe and 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 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 right 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. Relpax, 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 as tablets as well as nasal sprays, wafers that dissolve on the tongue and self-injection devices, which are helpful if you have nausea and vomiting with your migraines and can't keep tablets down.

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 month) 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 also being used to prevent migraines. Some examples of medicines used to prevent migraines include amitriptyline, pizotifen (Sandomigran), propranolol (e.g. Inderal), sodium valproate, topiramate (e.g. Topamax, Epiramax) and verapamil. 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.

Botulinum toxin type A (Botox) can be used to help prevent migraine headaches in certain people with chronic migraine. Botox is injected into specific head and neck muscle areas. Repeat injections may be needed after 12 weeks.

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: 2 November 2011
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References

1. Migraine (revised June 2011). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2011 Jul. http://online.tg.org.au/complete/ (accessed Oct 2011).
2. National Institute of Neurological Disorders and Stroke (NINDS). NINDS Migraine information page (updated 2009, Dec 21). Available at: http://www.ninds.nih.gov/disorders/migraine/migraine.htm (Accessed 2010, Jan 21)
3. Silberstein SD. Practice Parameter: Evidence-based guidelines for migraine headache (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2000; 55: 754-62. Available at: http://www.neurology.org/cgi/reprint/55/6/754
4. MayoClinic.com. Migraine (updated 2009, Jun 6). Available at: http://www.mayoclinic.com/health/migraine-headache/DS00120 (accessed 2010 Jan 21)
5. Maxalt Prescribing Information. Merck, Sharp & Dohme. Accessed via eMIMS. Date of TGA approved information: 29/06/2009
6. Dihydergot Prescribing Information. Novartis. Accessed via eMIMS. Date of TGA approved information: 30/04/2008
7. Botox Prescribing Information. Allergan. Accessed via eMIMS. Date of TGA approved information: 24/3/11
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