Migraine - Treating migraines

There is currently no cure for migraines, although a number of treatments are available to help ease the symptoms.

It may take time to work out which is 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 that you cannot manage your migraines using over-the-counter medicines, your GP may prescribe something stronger.

Painkillers

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 is not advisable to wait until the headache worsens before taking painkillers because by this point it is often too late for the medication to work. Soluble painkillers (tablets that dissolve in a glass of water) are a good alternative because they are absorbed quickly by your body.

If you cannot swallow painkillers because of nausea or vomiting, suppositories may be a better option. These are capsules that are inserted into the anus (back passage).

Cautions

When taking over the counter painkillers, always make sure you read the instructions on the packaging and follow the dosage recommendations.

Children under 16 should not take aspirin unless it is 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 are not 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.

Triptans

If ordinary painkillers are not 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 not the same as painkillers. They are thought to work by reversing the changes in the brain that may cause migraines. 

They cause the blood vessels around the brain to contract (narrow). This reverses the dilating (widening) of blood vessels that is believed to be part of the migraine process.

Triptans are available as tablets, injections and nasal sprays.

Common side effects of triptans include warm-sensations, tightness, tingling, flushing, and 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.

Your GP will usually recommend having a follow-up appointment when you have finished your first course of treatment with triptans, so you can discuss whether they were effective and whether you had any side effects.

If the medication was helpful, treatment will usually be continued. If they were not effective or caused unpleasant side effects, your GP may try prescribing a different type.

Anti-sickness medicines

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.

Combination medicines

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 are not sure which one is best for you, ask your pharmacist.

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 will allow you to easily control the doses of each.

Seeing a specialist

If the treatments above are not 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 then delivers magnetic pulses through your skin. It is 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 is not a cure for migraines and it doesn’t work for everyone. The evidence for its effectiveness is not strong and is limited to people who have migraine with aura.

There is 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
• irritability

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.

For more information, see NICE approves migraine magnet therapy.

Treatment for pregnant and breastfeeding women

In general, migraine treatment with medicines should be limited as much as possible when you are 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.