- When a migraine hits, you need to act quick.
- Migraines affect over 38 million Americans.
- There are several types of treatments including over-the-counter pain relievers, prescription medications, and lifestyle modifications.
If you suffer from migraines, you know all too well how important it is to treat these painful headaches aggressively, especially since they can really disrupt your quality of life. With so many options for treatment, it can be difficult to choose the right one for you. That’s why INSIDER asked several doctors to weigh in on how to treat different types of migraines, and here’s what they had to say.
What is a migraine?
Before we do a deep dive into the different types of treatments, let’s go over the basics about migraines. Dr. Evan Schloss, MD, neurologist, neuro-ophthalmologist, CareMount Medical, told INSIDER that a migraine typically has two parts: the headache, and the aura (if any).
“A migraine headache is usually a one-sided, severe, throbbing headache, and the headache is often associated with sensitivity to light, sensitivity to sound, and nausea,” he explained. “Most people just have the headache, however, in some people, the headache is preceded by an aura, which is often a visual disturbance which can look like a gradually expanding colourful shape in your vision, with a border that often looks like a zig-zag and has a shimmering quality to it,” he added. But some people just have the aura, and no headache.
Adding to the complexity of these headaches, are the different types of migraines. “There are several well-characterised sub-types of migraine including migraine with brainstem aura, hemiplegic migraine, retinal migraine, vestibular migraine, menstrual migraine, and chronic migraine,” Dr. Cara Pensabene, MD, EHE told INSIDER.
Over-the-counter pain relievers are an option.
There are several categories of migraine treatments. Schloss said that the most common is symptomatic treatment, which most people are familiar with. “You get a headache, and you take an over the counter pain reliever such as ibuprofen (NSAID) or acetaminophen,” he said.
Non-steroidal anti-inflammatory (NSAID) medications such as naproxen or ibuprofen can be helpful in treating migraines. Dr. Robert Carson, MD, Ph.D. assistant professor of neurology at Vanderbilt and advisor to Remedy Review told INSIDER these are most helpful when taken as soon as a migraine is noted, so for those with an aura, as soon as the aura is detected, then you should take something.
While caffeine can trigger migraines, Carson said that some individuals respond well to a combination of NSAIDs with caffeine. “Please note that taking NSAIDs more than two to three times per week for treatment of migraines can lead to chronic daily headaches, a notoriously difficult type of headache to treat which is best avoided,” he warned. “If you are taking something two to three times per week, you might strongly think about more lifestyle changes or a prophylactic treatment of some type,” he added.
Prescription medicine can be prescribed for preventative measures.
If OTC products don’t work, you might want to consider preventative prescription medicines. “Preventive treatment refers to prescription medicines you can take on a regular (usually daily) basis to prevent headaches in the future,” explained Pensabene.Dr. Janette Nesheiwat, medical director at CityMD told INSIDER that prescription medications such as “triptans” and nausea medications are two types of medications doctors will use to treat the symptoms of migraines.
Schloss also said that recently, a new type of migraine medication was approved by the FDA, called CGRP inhibitors. “These are powerful new medications which are capable of providing headache relief for patients with chronic migraine for which no medication has been successful, including Aimovig, Ajovy, and Emgality,” he added.
Abortive treatment should be taken right when the aura is beginning.
Another category of migraine treatment is abortive treatment with medications. “These intend to stop the migraine before it even starts,” explained Schloss. For example, he said Sumatriptan(Imitrex) is a common medication used for this type of treatment. “For it to work, you must take it as soon as you get an aura or the beginning of the headache,” he added.
Botox as treatment is an option when medication doesn’t work.
If someone does not respond to medications and supplements and still has many headaches per month, Schloss said that Botox injections are a good option for migraine relief. You can get more information on finding a safe provider via the American Migraine Foundation.
Sleep treatment with antihistamines can help treat migraines.
For acute therapy for a bad migraine, Carson said the best treatment is sleep. “This may be encouraged with use of medications such as diphenhydramine, an over the counter antihistamine, which helps make people sleepy,” he explained. “Other sedating medications which also help with nausea are often prescribed by physicians for those with migraines,” he added.
Sleep is his preferred method for treating migraines. That said, he also explained that this does not work for everyone, and that is when NSAIDs come into play.
Environmental modifications are a quick fix.
When a migraine hits, you want to act quick. And for many people, that means finding somewhere dark and quiet to help alleviate some of the pain. Nesheiwat said some natural remedies that are tied to your environment include avoiding loud noises and bright lights. She said it’s also helpful to turn off lights, rest in a dark quiet room, and wear sunglasses.
Lifestyle modifications are a long-term treatment.
Learning to live with and manage the severity and frequency of migraines requires you to take a preventative approach to treatment. Pensabene said her patients practice “headache hygiene,” which means taking care of yourself in a way that will reduce the likelihood, frequency, intensity, and severity of headaches. Here are the lifestyle changes she recommended to practice headache hygiene.
- Maintain regular sleep patterns. Go to sleep and wake up at the same time each day.
- Exercise regularly. For example, aerobic exercise for at least 30 minutes three times a week will help reduce the frequency or severity of a migraine.
- Eat regular meals, do not skip meals, and eat a good, healthy breakfast.
- Reduce stress. Limit stress by avoiding conflicts and resolving disputes calmly. Some people find it helpful to take a daily “stress break.”
- Avoiding known triggers, including dietary triggers such as aged cheese, alcohol, and caffeine that increase the likelihood of developing a migraine. By keeping a headache diary, you will be able to identify some triggers for your particular headaches. Once you have identified triggers, it will be easier for you to avoid them and reduce your chances of having a migraine attack.
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