How to get rid of a migraine

Learn your migraine early warning signs

“One of the most important things you can do is learn the early warning signs of an attack,” says Dr. Ann Nainan, doctor and Healthily expert. “There are 3 key things about the signs that mean they’re crucial for you to get help with migraines.”

1. Know the common early warning signs of a migraine attack. Around 20-25% of people will get aura. These symptoms include:

   • blurred vision
   • seeing flashing lights
   • hearing noises such as music or ringing
   • burning pain or tingling
   • jerking movements

   If you don’t get aura, there are other more subtle signs called a ‘prodrome’ that might tell you a migraine is coming. This happens in up to 77% of people and signs can include:

   • yawning
   • mood changes, such as feeling irritable
   • gut issues such as constipation
   • food cravings
   • muscle stiffness, particularly in your neck

   And there are others – read more about the early warning signs of migraine in our article, Get control of migraine.

2. Know your own personal signs. Everyone has different mixtures of warning signals. It’s a good idea to get familiar with your usual signs to help you identify patterns with your migraine. The best way to keep track of your migraine warning signs is by using a migraine diary. You can do this in a notebook or on your smartphone.

3. Use your warning signs to take action. “The faster you take your medication, the quicker it works,” says Dr. Ann.

Treatments for migraines

“Depending on how severe your symptoms are, and what type of migraine you get, you will need different treatments because everyone’s symptoms are individual,” says Dr. Ann. “You may be able to use over-the-counter medicine for migraine pain, or you might need to see your doctor for prescription-only treatments.”

• There’s no cure for migraines but there are acute treatments to help ease pain and reduce symptoms, like nausea and vomiting. Read on to find out more about the main types of treatment when your migraine has taken hold

• There are prevention treatments you can take regularly to make your migraines less severe, and/or reduce how often you get them – read more here about migraine prevention

How your pharmacist can help

You can buy some treatments for migraines from your pharmacy. “It’s handy to have a stockpile of over-the-counter medicine for migraine pain at home or at work, so you can take them as soon as you feel an attack coming on,” says Dr. Ann.

Combination medications – for mild pain

Some over-the-counter migraine medications, such as Excedrin Migraine, combine caffeine, aspirin and acetaminophen. But for some people, caffeine can be a migraine trigger – find out more in ‘Your questions answered.’ Talk to your pharmacist to check if these medicines are safe for you.

Painkillers for migraines – for mild to moderate pain

You can get painkillers from your pharmacy to help deal with the pain of mild to moderate migraines. Check with your pharmacist which ones might be best for you. These include:

• nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
• aspirin
• acetaminophen

Anti-nausea drugs for migraines – even if you’re not nauseous

It may be helpful to take anti-nausea medication (sometimes called antiemetics) alongside painkillers when you feel a migraine coming on, even if you don’t get nausea and vomiting. This is because your gut absorption slows down when you have a migraine and some antiemetics can help your body to absorb painkillers.

Alternative migraine treatments

Neuromodulation devices are non-invasive and drug-free. They use electrical currents or magnets to change activity in your brain – and possibly reduce migraine symptoms when one is underway.

• while most of these devices are prescription-only, currently 1 device is approved by the U.S. Food and Drug Administration (FDA) to be sold over-the-counter in pharmacies

• this device stimulates your trigeminal nerve (which is involved in most migraines) using an electrode which you stick to your forehead. The electrode sends out micro-impulses which stimulate your trigeminal nerve, producing a calming effect during a migraine

• you might want to try these non-invasive devices as an alternative to medication. But they can be expensive and the scientific evidence on how effective they are is limited – so it’s a good idea to talk to your doctor before buying one

Home remedies to help with migraines

“Some of these self-care tips may help ease your migraine as it’s happening, and they can be helpful alongside your migraine medication,” says Dr Ann. Ideas to try include:

• as soon as your migraine kicks in, head to a quiet, darkened room – this is because light and sound can make your migraine pain worse
• close your eyes and rest or nap, if you can
• if you can’t get to a quiet room, wear earplugs
• use a heated pad or ice pack on your head, neck or shoulders to dial down pain and tension
• massage your scalp
• gently apply pressure to your temples in a circular motion
• stay hydrated by drinking plenty of water
• try relaxation techniques such as yoga and meditation
• sip a caffeinated drink – in small amounts, caffeine may relieve migraine in the early stages of an attack. But don’t go overboard as too much caffeine can give you withdrawal headaches later on

Migraine treatments from your doctor

If OTC painkillers and self care aren’t helping your migraines enough, make an appointment to see your doctor. You may be prescribed:

Triptans for migraines

• triptans are a type of painkiller specifically for migraines. They work by reversing the widening of the blood vessels around your brain, which is thought to be part of what happens during a migraine. They also block the pain messages to your brain
• drugs such as sumatriptan and rizatriptan are both types of triptan – there are others though, and if one type doesn’t work for you, your doctor may prescribe a different triptan
• you may be able to take triptans alongside painkillers and antiemetics
• triptans can be taken as tablets, sprays or injections
• you shouldn’t use them if you have a history of certain types of heart disease, strokes or severe liver disease
• common side effects of triptans are usually mild and clear up on their own. They can include:
  • warmness
  • tightness in your face, arms, legs or chest
  • tingling
  • flushing
  • feeling ‘heavy’ in your face, limbs or chest
  • nausea
  • dry mouth
  • feeling drowsy

CGRP antagonists

A newer type of medication called CGRP antagonists (sometimes called ‘gepants’) can be used to treat a migraine attack if you don’t respond well to triptans, or if triptans aren’t suitable for you.

• during a migraine attack your nerves and blood vessels release substances called calcitonin gene-related peptides (CGRP) – these play a part in the pain you feel during a migraine. CGRP antagonist treatments work to stop these substances affecting you
• rimegepant and ubrogepant are 2 types of CGRP antagonist that can be used to treat migraines when they’re happening. Other CGRP antagonists can also be used to prevent migraine in the first place

Other prescription migraine medications

• anti-nausea medications – such as prochlorperazine
• dihydroergotamine – available as a nasal spray or injection, this drug works by tightening the blood vessels in your brain and stopping the release of substances in your brain that cause swelling. It’s usually used if triptans haven’t helped, but it can’t be used together with them. You might get your first dose of dihydroergotamine in your doctor’s office so they can monitor your reaction and check you’re using it properly. You may then be able to administer it yourself when you have a migraine attack
• lasmiditan – a newer oral tablet which you may be prescribed if you get migraine with or without aura. Unlike some other migraine medications, it doesn’t narrow your blood vessels, so it might be suitable if you can’t take triptans because you have a history of cardiovascular conditions, such as heart disease or high blood pressure
• opioids – for people who can't take other migraine medications, opioid medications might help. But they can be highly addictive, so they’re usually only used as a last resort

Prescription medical devices

There are FDA-approved non-invasive devices for treating a migraine in progress right now that your doctor can prescribe. Experts say these devices could be helpful for people who get frequent migraines and don’t want to take too many medications. And scientific studies are underway to find out if devices could work if you’re pregnant, because migraine treatment options can be limited during pregnancy.

The devices include:

• single pulse transcranial magnetic stimulator – this generates a magnetic impulse that affects the electric signalling in your brain
• transcutaneous vagus nerve stimulator – uses electrical stimulation to target the vagus nerve in your neck
• transcutaneous supraorbital neurostimulator – uses electrical stimulation to stimulate nerves in your head
  If your migraines are happening frequently or your symptoms are really affecting you, your doctor may recommend medication to stop them from happening in the first place. Find out more in our migraine prevention article.

Is there a natural cure for migraine?

Here’s the latest evidence on natural remedies. “If you decide you want to try one of these, always talk to your doctor first,” says Dr. Ann.

• green light therapy – there’s limited evidence that this therapy may reduce the intensity of migraine attacks. You’re exposed to a narrow band of green light from a special lamp. The thinking is that green light increases pain-relieving chemicals in your brain, or it could be that green light is less painful than other colors
• magnesium – although it’s been studied more as a preventative treatment for migraine, some studies have looked at whether the mineral magnesium might help people with severe, difficult-to-treat migraines. In research, magnesium sulfate given as an injection worked best for people with a history of migraine with aura. In those without aura, there was no difference in immediate pain relief or nausea relief, but there was less light and noise sensitivity after the magnesium injection

Treating ocular migraine

• aspirin and antiepileptic drugs can reduce how bad your migraine attack is
• triptans aren’t suitable because of the risk of permanent vision loss
• because ocular migraine attacks are usually short (5–60 minutes), your doctor will usually focus on treatment that prevents your migraine from coming in the first place, rather than treating it as it happens

To find out more about ocular migraine, also called retinal migraine, read our article get control of migraine.

Treating vestibular migraine

• you’d usually be recommended standard migraine treatments such as triptans, NSAIDs and/or painkillers
• if you get vertigo with your vestibular migraine attack, you may be prescribed a short course of the anti-sickness medicine, prochlorperazine, or other anti-sickness drugs such as ondansetron or domperidone

Find out more about vestibular migraine in our article on getting control of migraine.

Treating abdominal migraine

• the usual migraine treatments are recommended for abdominal migraine, including painkillers and possibly triptans, plus self-help techniques such as lying in a darkened room

Read more about abdominal migraine in our article, get control of migraine.

Your questions answered

Does caffeine help migraine?

“Maybe. You’ll find caffeine in lots of migraine medications, such as Excedrin and Anacin as caffeine is believed to make the painkillers in those combination drugs work better. Some people with migraine also find that a strong cup of coffee can stop a migraine in its tracks.

But on the flipside, caffeine is also a common migraine trigger for some people. Until we know more about the caffeine-migraine connection, it’s probably wise to listen to your body. If you find your migraines are worse when you drink coffee, it’s better to cut back,” says Dr. Ann.

I’m planning to get pregnant – will I have to come off my migraine medication?

“If you’re pregnant, or you’re trying for a baby, you may need to avoid migraine medication. Your doctor will go through options with you on how to manage your migraines,” says Dr Ann.

What you need to know:

• many women find their migraines become less severe and less frequent during pregnancy, particularly during the second or third trimester. “This may be because of more stable estrogen levels in pregnancy, an increase in endorphins, your body’s ‘natural’ painkillers, plus muscle relaxation and changes in your body’s sugar balance,” says Dr Ann. So it may be that you don’t need as much medication as usual, or you can control migraines by avoiding triggers and with non-drug treatment
• but there is a chance your migraine attacks will continue through pregnancy, especially if you get migraine with aura
• if you do need treatment, acetaminophen is usually the medication of choice in pregnancy, but speak to your doctor first. There may also be other options if this isn’t helping enough – your doctor can discuss the risks and benefits of triptans and NSAIDs, depending on which trimester you’re in

What is medication overuse headache?

Medication overuse headache (MOH) is when you get a headache from frequently using medications to treat a migraine attack. The medicines – such as painkillers, triptans and NSAIDs – can cause ‘rebound’ headaches. “If this happens to you a lot, preventative treatment for migraines is usually recommended. This is because they can reduce the number of attacks you have and get your migraines under better control, meaning you need to use fewer painkillers,” says Dr Ann.