Migraines Overview

How to Treat Migraines

An injection is the fastest way to get migraine pain relief.
An injection is the fastest way to get migraine pain relief.
©iStockphotoIvan Ivanov

There are two ways to treat a migraine: before they start (preventive), or after symptoms begin (acute). Acute treatment is something you do or take, usually a medication, after symptoms start. Preventive treatments are for people who experience frequent migraines who want to avoid getting them.

Acute treatments are most often known by their common names: Tylenol and Advil (ibuprofen). These are non-steroidal anti-inflammatory drugs, or NSAIDs. These medications work best early in the migraine symptom cycle, before head pain begins. Many of these are effective for headaches without intense pain. A study has recently shown that, for migraines, an effective treatment is the combination of aspirin, acetaminophen and caffeine. Some brands, such as Excedrin, have begun implementing this combination in their migraine medications.

Other acute treatments include triptans, a serotonin-mimicking drug that some people with migraine pain call a miracle drug. Sumatriptan (Imitrex) can be taken in pill form or as a nasal spray, which acts more quickly and is good if you have problems with nausea and vomiting. If you have severe migraines with vomiting and end up in the hospital, the doctor might give you Imitrex in an injection form. However, if you purchase your very own Imitrex injector, you'd be able to give yourself the same injection without the added steps (and extra time) involved in scheduling a doctor's office visit. Nasal and subcutaneous (under-the-skin injection) treatments get into the blood stream faster to help relieve pain more quickly.

Preventive treatments are treatments used by people who have chronic migraines. Doctors have found that prescribing some medications for off-label use (using medications for something other than what they were made for) are very effective in helping with migraine symptoms.

Antidepressants are a very common preventive treatment. There seems to be a connection between serotonin, a brain chemical that regulates your mood, and migraines. An antihistamine called cyproheptadine is also known for helping to regulate serotonin levels. Using a drug that increases serotonin seems to be very effective in regulating migraines as well as mood. Because serotonin is a vasoconstrictive chemical, meaning it makes your blood vessels and tissues shrink, doctors think that antidepressant drugs that increase your serotonin levels help to prevent the inflammation of the brain vessels and tissues. Because of this, however, people with vascular disease, high blood pressure and coronary disease should not take these drugs because they can narrow the coronary arteries.

Beta-blockers are drugs you might think of taking if you have cholesterol problems or other heart conditions, but they have found a place in migraine treatment. Other cardiovascular drugs are also effective, such as calcium-channel blockers and blood pressure medication. Doctors don't know exactly why these seem to help -- it might be because they lessen pressure on blood vessels -- but they've been proven in helping people have fewer and less painful migraines. These are especially helpful if you have heart problems as well as migraines and can't take drugs that raise serotonin levels.

Antiseizure medications are another treatment possibility, although they are usually saved for treatment until some others are ruled out. These work by blocking the neurotransmitters that start migraine attacks.