Treating and preventing migraine - Migraine

There is no cure for migraine but treatment can help to ease the symptoms.

You may need to try different medicines before you find what works best. This can take time.

Talk to your GP if medicines you can buy without a prescription do not help.

Treatment during a migraine attack

During an attack, it may help to:

• sleep
• lie in a dark room
• eat something
• drink water
• use a cold pack or heat pack

Some people start to feel better after they vomit.

Medicines you can take during an attack can include:

• painkillers
• triptan medicines
• anti-sickness medicines
• combination medicines

Some people use acupuncture.

Painkillers for migraine

Painkillers you can buy without a prescription can help to reduce symptoms. For example, paracetamol, aspirin or ibuprofen. Avoid painkillers that contain codeine.

Take the painkiller at the first sign of a migraine attack. It takes time for your body to absorb the painkiller. If you wait until the headache gets worse, it may be too late for the medicine to work.

You can take painkillers as:

• tablets you swallow
• tablets you dissolve in a glass of water (soluble painkillers) - these may work faster
• capsules you put in your bottom (suppositories) - if you feel sick and cannot swallow anything

Taking painkillers

When you take painkillers, always:

• read the instructions on the packaging
• take the correct dose

Do not give aspirin to children under 16 without advice from your GP.

Do not take aspirin and ibuprofen if you have a history of stomach problems. For example, liver problems, kidney problems or stomach ulcers.

If you take painkillers too often, it may make migraine attacks worse. This is called a medication overuse headache, painkiller headache or rebound headache.

Triptan medicines

Your GP may recommend triptan medicines if other painkillers do not work.

Triptans can help to:

• narrow blood vessels in the brain that get wider during a migraine attack
• block pain signals in the brain

You can take triptans as tablets, injections or nasal sprays. Your GP can recommend the best type for you based on your symptoms.

You take the triptan as soon as headache symptoms start. They may not work if you take them too early. For example, when warning signs start.

You may need to try different types of triptan. You can take triptans with other painkillers or anti-sickness medicines.

Side effects of triptans

Common side effects of triptans include:

• tightness
• tingling
• flushing
• warm sensations
• feelings of heaviness in the face, arms, legs or chest

Some people also feel sick or have a dry mouth and drowsiness.

These side effects are usually mild and improve on their own.

Taking too many triptans can cause a medication overuse headache.

Anti-sickness medicines

Your GP may prescribe anti-sickness medicines. They are also called anti-emetics.

Anti-sickness medicines can help:

• if you have symptoms of nausea or vomiting
• improve how your body absorbs other medicines, such as painkillers

You take anti-sickness medicines as soon as symptoms start. You can take them as a tablet or a suppository.

Side effects of anti-sickness medicines include drowsiness and diarrhoea.

Combination medicines

You can buy some combination medicines without a prescription at a pharmacy.

These medicines contain a painkiller and an anti-sickness medicine. A pharmacist can help you choose one.

Combination medicines are convenient. But the dose of painkillers or anti-sickness medicine may not be high enough to relieve your symptoms.

If combination medicines do not work, you can:

• take painkillers and anti-sickness medicines separately to better control the doses
• ask your GP about taking triptan with a painkiller, such as ibuprofen.

Acupuncture

If medicines do not suit you or do not help to prevent migraines, you can try acupuncture.

A course of up to 10 sessions over 5 to 8 weeks may help.

Migraine clinic

If medicines to treat or prevent migraine do not help, your GP may refer you to a migraine clinic.

Treatment at a clinic depends on your symptoms, general health and how often you have migraine attacks.

The clinic will tell you what treatments are available that may work for you.

But some treatments include:

• botulinum toxin type A (Botox)
• calcitonin gene related peptide (CGRP) therapies
• non-invasive neuromodulation devices - devices that stimulate the nerves
• psychology support
• physiotherapy

Treatment for pregnant and breastfeeding women

Limit using medicines to treat migraine when you're pregnant or breastfeeding. Try to identify and avoid potential migraine triggers instead.

If medicine is essential, contact your GP for advice. They may prescribe a low-dose painkiller. In some cases, they may prescribe anti-inflammatory medicine or triptans.

Preventing migraine attacks

To reduce your chances of having migraine attacks, you can:

• identify and avoid triggers
• take medicines that prevent migraine attacks

Identifying and avoiding triggers

The best way to prevent migraine attacks is to find out things that trigger an attack and try to avoid them.

For example, you may find you have a migraine attack after eating a certain food. If you can avoid the food, you can reduce the chances of having an attack.

Possible migraine triggers

Migraine diary

Keeping a migraine diary can help you identify possible triggers and how well medicines work.

Note in your diary:

• the date of the attack
• the time of day the attack began
• any warning signs or aura
• your symptoms
• what medicine you took
• when the attack ended

Medicines to prevent migraine attacks

Your GP may prescribe medicines to prevent attacks if you:

• avoid triggers but you still have migraine attacks
• have severe migraine attacks
• have frequent migraine attacks

Medicines include:

• topiramate
• propranolol
• amitriptyline

You may need to take a medicine for a few months before you can see if it works.

Topiramate

Topiramate was made to prevent seizures in people with epilepsy. It is now more often used to prevent migraine attacks.

You usually take it as a tablet every day.

Tell your GP if you have kidney or liver problems.

Topiramate and pregnancy

Topiramate can:

• reduce the effectiveness of hormonal contraceptives
• harm an unborn baby if taken during pregnancy

Your GP may recommend other forms of contraception if they prescribe topiramate.

Side effects of topiramate

Side effects of topiramate can include:

• decreased appetite
• feeling sick (nausea)
• vomiting
• constipation or diarrhoea
• dizziness
• drowsiness
• problems sleeping

Propranolol

Propranolol is used to treat angina and high blood pressure. It also prevents migraines. You take it every day as a tablet.

Propranolol is not suitable for everyone.

Tell your GP if you have:

• asthma
• chronic obstructive pulmonary disease (COPD)
• some heart problems
• diabetes

Side effects of propranolol

Side effects of propranolol can include:

• cold hands and feet
• pins and needles
• problems sleeping
• tiredness

Amitriptyline

Amitriptyline is a medicine to treat depression. But it can also help to prevent migraine attacks.

You take it as a tablet every day. It's best to take it in the evening or before you go to bed. This is because amitriptyline can make you feel sleepy.

It may take up to 6 weeks before you feel the full benefit of the medicine.

Amitriptyline for pain and migraine

Side effects of amitriptyline

Other side effects include:

• constipation
• dizziness
• a dry mouth
• difficulty peeing
• headache

Preventing attacks related to your period

These migraine attacks usually happen from 2 days before the start of your period, to 3 days after. They are fairly predictable.

It may be possible to prevent them with:

• non-steroidal anti-inflammatory medicines (NSAIDs) - such as ibuprofen
• triptans - medicines that reverse the widening of blood vessels

You take the medicines as tablets 2 to 4 times a day from either the start of your period or 2 days before. You take them until your last day of bleeding.