Jumping on treatment quickly can prevent a migraine from setting in. Here are your options.

Jessica Migala
July 02, 2021
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If you get migraines, you know the debilitating affect they have on your day. "A migraine is more than just a headache," says Alex Feoktistov, M.D., Ph.D., director of the Synergy Integrative Headache Center in Northfield, Illinois. "A migraine is a result of complex chemical changes in the central nervous system that impact blood vessels and nerves of the brain," he explains.

Migraines differ from headaches because they involve a throbbing on one or both sides of the head that can be intense and are accompanied by other symptoms such as nausea and sensitivity to light and sound, according to the American Migraine Foundation. When the symptoms first start is when you should take action to stop them. Yes, the sooner you stop the pain the less time you have to live with it, but earlier treatment gives patients a better chance of stopping an ongoing migraine attack, Dr. Feoktistov says.

Wait too long, and the migraine becomes more difficult to treat. And unfortunately, left untreated, a migraine lasts anywhere from 4 to 72 hours, notes the National Headache Foundation. So, rather than trying to wait it out or thinking the pain will go away soon, take action now.

woman with her hands on her head because of a migraine
Credit: Getty Images / Cavan Images

1. Take medication as soon as you feel it coming on

When it comes to medication, you have several options, and the one that's right for you depends on your own history with migraine, as well as other health concerns. The goal for treatment is to clear the headache completely in one or two hours, meaning the pain does not come back, says Dr. Feoktistov. "We consider successful treatment one where the medication provides pain freedom and allows the patient to get back on their feet and function well," he says.

NSAID: Some people find that taking anywhere from 200 to 600 mg of ibuprofen (like Advil) or naproxen (like Aleve) works. Unfortunately, it's actually not common for patients to be able to successfully use an over-the-counter NSAID for migraine relief. "For about 80% of patients, NSAIDs will take the edge off the pain but not stop the attack," he says.

A medication like Excedrin, which combines two pain relievers—acetaminophen and aspirin (an NSAID)—plus caffeine is a slightly better option but patients usually still need something more, he says.

Acute Prescriptions: Medications such as triptans, dihyroergotamines, and gepants are commonly used to stop a migraine attack. A newer class of medications is called ditans (such as Lasmiditan), which are anti-migraine drugs. These all work in different ways. For example, triptans target serotonin receptors, which are involved in migraine development and constrict blood vessels, and gepants block receptors of a neuropeptide chemical called CGRP that's released in the brain that contributes to migraine, explains Dr. Feoktistov. "Each type of medication has its pros and cons, and you should discuss which one is right for you with your healthcare provider," he says.

Rescue medications are available in different formulations, such as oral pills, nasal sprays or injectables, but Dr. Feoktistov says that nasal sprays or injectables tend to be faster acting, which can be helpful for migraine pain that rapidly develops, if you wake up in the morning with a migraine or if you also experience significant nausea or vomiting, which may delay absorption of an oral pill.

Something you'll want to be aware of: Frequent use of both NSAIDs and these acute migraine medications can cause a migraine overuse headache (also called a rebound headache), which means that taking the medication actually triggers the attack. If you notice that you're taking these medications to treat a migraine 10 to 12 days or more per month, you'll want to talk to your doctor about preventive medications, he advises. Preventives are taken throughout the month in order to lessen the number, duration, or intensity of headache days.

Regardless of the number of migraine days you have, however, if yours are particularly disabling or resistant to acute medication, you're also a good candidate for preventive medication, he notes.

2. Try to relax in a dark, quiet space

Untreated, it's likely your migraine will evolve and the throbbing pain may progressively get worse. In addition to medication, there are other things you can do. "I do recommend patients take medication as soon as they can and then take it easy," Dr. Feoktistov says. Here are 4 things you can do:

  • Lay down in a dark, quiet room for 30 minutes.
  • Take a power nap for 30 to 40 minutes. (Avoid taking naps longer than that, which can disrupt your sleep later that night, something that's a migraine trigger.)
  • Eliminate other irritants or migraine triggers such as bright lights or loud noises. "Migraine patients almost universally become sensitive to light and sound. It's important to control these factors as best you can," he says.
  • Stay hydrated. Drinking a lot of water can help you recover from an episode more quickly, he adds.

Another option to ask your doctor about? A device that delivers non-invasive neuromodulation. "These are handheld portable electric devices that patients can use to stimulate specific nerves to stop or prevent migraine from happening," Dr. Feoktistov says. Most of the devices, which are FDA-cleared are available by prescription, such as gammaCore Sapphire, though one—Cefaly—can be purchased over-the-counter, notes the American Migraine Foundation. While expensive, insurance may help cover the cost of this device and if you're someone who regularly suffers from migraines, you may find the benefits well worth the cost.

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