Migraines can occur frequently and may be triggered by certain lifestyle factors. The two main approaches to migraine care are to stop migraine attacks after they start (acute treatment) and to prevent them before they start (preventive treatment). Many people with migraine use both acute and preventive treatments.
Migraines are a type of headache that causes head pain and other symptoms, such as dizziness, fatigue, and nausea.
This article covers acute and preventive migraine treatment, including medications, home remedies, and devices to relieve the pain when a migraine occurs, and preventive lifestyle approaches, medications, devices, and supplements.
Table of Contents
How Are Migraines Treated?
Migraines are treated with a number of different therapies. Migraine medications can stop migraine symptoms during the episodes. Other treatments—which include lifestyle strategies, medical interventions, or medications—are helpful for preventing migraine episodes.
Treatments for migraine symptoms can include at-home care, such as using an ice pack or avoiding bright lights. Medical therapy may include over-the-counter (OTC) medication or prescription treatments. Rarely, medical interventions or injections are needed to treat an ongoing migraine attack.
Everybody who experiences migraines can benefit from paying attention to contributing lifestyle factors and avoiding triggers. For some people, preventive medication or interventional procedures can be beneficial as well—this depends on the migraine frequency and severity.
Medications to Prevent a Migraine
Migraine prevention is an important aspect of living with this condition. Recurrence is a characteristic of migraines. Certain lifestyle strategies and medical treatments are known to be effective at preventing repeated migraines.
When your migraines are too frequent, they can severely impact your quality of life. This is when medical treatment for migraine prevention is needed. Some medications to prevent migraine are taken on daily. These medical therapies are available by prescription only.
Some of the medications that are commonly prescribed to prevent migraines include:
Lifestyle Approaches to Prevent Migraine
Lifestyle approaches that can help prevent migraine include:
- Getting enough exercise and physical activity
- Getting enough sleep (including treating sleep disorders such as sleep apnea)
- Drinking enough non-caffeinated beverages to stay hydrated
- Avoiding alcohol
- Avoiding smoking
- Managing stress
- Keeping a diary to identify triggers and that you are taking your medications appropriately
For some people, caffeine or certain foods or food ingredients (such as chocolate, monosodium glutamate, and nitrates) can trigger migraines. If you regularly consume caffeinated beverages, decreasing your intake can lead to caffeine withdrawal, which usually triggers severe migraines.
Abortive Drugs for Migraines
The term “abortive drugs” describes migraine treatments that are used during an episode. This is because they can abort (stop) the migraine attack. These medications can include OTC treatments, but you may need prescription therapies if the OTC options don’t work or are not well tolerated.
Common acute migraine treatments include:
- Tylenol (acetaminophen)
- Advil, Motrin (ibuprofen)
- Aleve (naproxen)
- Excedrin (caffeine, aspirin, acetaminophen)
- Fiorinal (butalbital, aspirin, caffeine)
- Fioricet (butalbital, acetaminophen, caffeine)
- Antiemetics (antinausea medication), such as Reglan (metoclopramide)
- Triptans, includes Imitrex (sumatriptan), Relpax (eletriptan), Maxalt (rizatriptan), Zomig (zolmitriptan)
- Gepants, includes Ubrelvy (urbrogepant), Nurtec (rimgepant)
- Reyvow (lasmiditan), in a new drug category called ditans
Each treatment category can have side effects, but they are usually mild. Nevertheless, it’s important to pay attention to your migraine symptoms and potential side effects and discuss them with your healthcare provider, especially when starting a new medication.
A migraine episode can include any combination of the following stages:
- Prodrome: This is a feeling that you might get before a migraine begins. Its symptoms can include irritability, hunger, fatigue, or muscle aches. Most people start to recognize their prodromal symptoms and can sometimes take medication before the head pain begins.
- Aura: This stage can occur during either the prodrome or the headache phase of the migraine. An aura is a neurological symptom, such as loss of sight in one visual field or numbness or weakness of one arm on one side of the body.
- Headache: This is the most recognizable part of a migraine. It usually feels like one-sided head pain, neck and shoulder pain, nausea, photophobia (discomfort induced by lights), phonophobia (discomfort induced by sound), and irritability.
- Postdrome: This is the stage after the headache, and it may include a feelings of fatigue, muscle aches, and relief. Generally, it’s best to rest during this stage, and migraine medication is typically not beneficial at this point.
Antinausea Drugs for Migraines
Antiemetics prevent nausea and vomiting. These medications are also effective for treating migraines. Antiemetics for migraines have pros and cons, and they are not used as often as other migraine treatments.
Advantages of antiemetics for migraine treatment include:
- Safe to use during pregnancy (most of the other common acute migraine treatments are not safe to use during pregnancy)
- Can treat nausea, along with other migraine symptoms
- Some are given by injection, which is an advantage if you are too nauseated to take medication by mouth
A disadvantage of antiemetics for migraine treatment is that they may cause focal muscle dystonia, a rare but distressing side effect in which you have muscle spasms or stiffening.
Because of their potential for dystonia, antiemetics are not typically prescribed for migraine treatment. They are commonly given in a hospital setting.
When to Take Migraine Medication
Treating a migraine episode is usually more effective when medication is taken at the first sign of a migraine or shortly after the first symptoms begin.
Sometimes, even after you feel better, you might need to take a repeat dose 12 to 24 hours after the first dose.
However, even if you don’t take your medication immediately at the beginning of your migraine, you can feel better by taking your medication at any time while you are still experiencing migraine symptoms.
Noninvasive devices have been approved for use in migraine treatment. These are relatively new and are considered safe.
However, they might not always be covered by health insurance. Ask your healthcare provider if a device is worth purchasing. You could also consider asking whether there is a research trial that you could enroll in so that you could lower your out-of-pocket costs.
Devices that have been used for migraine treatment include:
- SpringTMS by eNeura is approved by the Food and Drug Administration (FDA) for both the acute and preventive treatment of migraine. It is a device that's held to the back of the head.
- Cefaly is a device placed on the forehead. It is approved for prevention or acute treatment. It provides electrical stimulation to the trigeminal nerve, which controls sensation in parts of the forehead.
- Nerivio is placed on the upper arm and provides electrical pulses, which are adjustable with an app. It is approved for migraine prevention or acute treatment.
- Relivion is a headband that electrically stimulates branches of the trigeminal and occipital nerves for acute migraine relief.
Supplements for a Migraine
A few supplements are commonly used for preventing or treating migraines. There is some evidence that supplements may be effective for controlling or treating migraines, but many people do not experience adequate relief from using supplements.
If you are interested in considering a supplement to help prevent or treat your migraines, discuss it with your healthcare provider and pharmacist. Supplements may interact with other medications. They may also be contraindicated (advised against) if you have certain underlying health problems.
Supplements that are sometimes used as part of migraine therapy:
- Magnesium: This mineral is available as an over-the-counter supplement.
- Ginger: This spice may be recommended for the treatment of acute migraine. It has anti-inflammatory and antinausea effects. You can find it in the form of ginger ale, ginger tea, ginger candies, ginger pills, and more.
- Feverfew (Tanacetum parthenium): This herb might help reduce inflammation.
- Vitamin B2 (riboflavin): This vitamin can help maintain the energy stores in the body.
Other complementary and alternative medicine (CAM) therapies that have been recommended for both migraine treatment and prevention include breathing exercises, meditation, gentle exercises (such as yoga and swimming), and OTC acupressure devices.
Preventing Medication Overuse Headaches
Taking too much pain medicine or migraine medication or taking these drugs too often can lead to medication withdrawal headaches (also called medication overuse headaches). One of the reasons why preventive medication is recommended for people who have very frequent migraines is that prevention can reduce your need for acute migraine treatment.
Home Remedies for Migraine Relief
When you have a migraine, use home remedies that have been effective for you in the past.
Home remedies you might consider include:
- Using an ice pack on your shoulders, face, or forehead
- Using a heating pad on your shoulders, face, or forehead
- Staying cool, possibly with a fan or air-conditioning
- Wrapping up in a warm blanket
- Sipping a warm drink
- Listening to soothing music
- Taking a walk
- Stretching your muscles
- Avoiding bright lights
- Avoiding loud or unpleasant noises
- Resting or sleeping
It’s best to learn which at-home therapies and medications work best for your migraines and to stick to the routine that works for you.
Migraine treatment includes preventive strategies, as well as treatment for an acute migraine. Preventive strategies include lifestyle modifications, devices, medication, and procedures.
Migraine episodes can usually be treated with OTC medication or prescription therapies, but at-home care is also an important part of getting relief from your migraine. Usually, treating a migraine episode right at the beginning—or even before it starts—is more effective than waiting it out.
In some situations, the medication that’s recommended for you might not work, and you may need to seek emergency care. Emergency treatments may include antiemetics or an injection of migraine-specific medication.
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