There's currently no cure for migraines, although a number of treatments are available to help ease the symptoms.
It may take time to work out the best treatment for you. You may need to try different types or combinations of medicines before you find the most effective ones.
If you find you can't manage your migraines using over-the-counter medicines, your GP may prescribe something stronger.
During an attack
Most people find that sleeping or lying in a darkened room is the best thing to do when having a migraine attack.
Others find that eating something helps, or they start to feel better once they've been sick.
Many people who have migraines find that over-the-counter painkillers, such as paracetamol, aspirin and ibuprofen, can help to reduce their symptoms.
They tend to be most effective if taken at the first signs of a migraine attack, as this gives them time to absorb into your bloodstream and ease your symptoms.
It's not advisable to wait until the headache worsens before taking painkillers as it's often too late for the medication to work. Soluble painkillers (tablets you dissolve in a glass of water) are a good alternative because they're absorbed quickly by your body.
If you can't swallow painkillers because of nausea or vomiting, suppositories may be a better option. These are capsules that are inserted into the anus (back passage).
When taking over-the-counter painkillers, always make sure you read the instructions on the packaging and follow the dosage recommendations.
Children under 16 shouldn't take aspirin unless it's under the guidance of a healthcare professional. Aspirin and ibuprofen are also not recommended for adults who have a history of stomach problems, such as stomach ulcers, liver problems or kidney problems.
Taking any form of painkiller frequently can make migraines worse. This is sometimes called "medication overuse headache" or "painkiller headache".
Speak to your GP if you find yourself needing to use painkillers repeatedly or if over-the-counter painkillers aren't effective. Your GP may prescribe stronger painkillers or recommend using painkillers along with triptans (see below). If they suspect the frequent use of painkillers may be contributing your headaches, they may recommended that you stop using them.
If ordinary painkillers aren't helping to relieve your migraine symptoms, you should make an appointment to see your GP. They may recommend taking painkillers in addition to a type of medication called a triptan and possibly anti-sickness medication (see below).
Triptan medicines are a specific painkiller for migraine headaches. They're thought to work by reversing the changes in the brain that may cause migraine headaches.
They cause the blood vessels around the brain to contract (narrow). This reverses the dilating (widening) of blood vessels that's believed to be part of the migraine process.
Triptans are available as tablets, injections and nasal sprays.
Common side effects of triptans include:
- feelings of heaviness in the face, limbs or chest
Some people also experience nausea, dry mouth and drowsiness. These side effects are usually mild and improve on their own.
As with other painkillers, taking too many triptans can lead to medication overuse headache.
Your GP will usually recommend having a follow-up appointment once you've finished your first course of treatment with triptans. This is so you can discuss their effectiveness and whether you had any side effects.
If the medication was helpful, treatment will usually be continued. If they weren't effective or caused unpleasant side effects, your GP may try prescribing a different type of triptan since responses can be highly variable.
Anti-sickness medicines, known as anti-emetics, can successfully treat migraine in some people even if you don't experience nausea or vomiting. These are prescribed by your GP and can be taken alongside painkillers and triptans.
As with painkillers, anti-sickness medicines work better if taken as soon as your migraine symptoms begin. They usually come in the form of a tablet, but are also available as a suppository.
Side effects of anti-emetics include drowsiness and diarrhoea.
You can buy a number of combination medicines for migraine without a prescription at your local pharmacy. These medicines contain both painkillers and anti-sickness medicines. If you're not sure which one is best for you, ask your pharmacist.
It can also be very effective to combine a triptan with another painkiller, such as ibuprofen.
Many people find combination medicines convenient. However, the dose of painkillers or anti-sickness medicine may not be high enough to relieve your symptoms. If this is the case, it may be better to take painkillers and anti-sickness medicines separately. This allows you to easily control the doses of each.
Seeing a specialist
If the treatments above aren't effectively controlling your migraines, your GP may refer you to a specialist migraine clinic for further investigation and treatment.
In addition to the medications mentioned above, a specialist may recommend other treatments such as transcranial magnetic stimulation.
Transcranial magnetic stimulation
In January 2014, the National Institute for Health and Care Excellence (NICE) approved the use of a treatment called transcranial magnetic stimulation (TMS) for the treatment and prevention of migraines.
TMS involves holding a small electrical device to your head that delivers magnetic pulses through your skin. It's not clear exactly how TMS works in treating migraines, but studies have shown that using it at the start of a migraine can reduce its severity. It can also be used in combination with the medications mentioned above without interfering with them.
However, TMS isn't a cure for migraines and it doesn’t work for everyone. The evidence for its effectiveness isn't strong and is limited to people who have migraine with aura.
There's also little evidence about the potential long-term effects of the treatment, although studies into the treatment have so far only reported minor and temporary side effects, including:
- slight dizziness
- drowsiness and tiredness
- a muscle tremor that can make it difficult to stand
NICE recommends that TMS should only be provided by headache specialists in specialist centres, because of the uncertainty about the potential long-term side effects. The specialist will keep a record of your experiences using the treatment.
Treatment for pregnant and breastfeeding women
In general, migraine treatment with medicines should be limited as much as possible when you're pregnant or breastfeeding. Instead, trying to identify and avoid potential migraine triggers is often recommended.
If medication is essential, then your GP may prescribe you a low-dose painkiller, such as paracetamol. In some cases, anti-inflammatory drugs or triptans may be prescribed. Speak to your GP or midwife before taking medication when you are pregnant or breastfeeding.