Acute Migraine Treatment
The goal of abortive, or acute, treatment for migraines is to relieve headache pain once it has begun. In some cases, mild, infrequent migraines can be relieved using over-the-counter (OTC) medication, but severe headaches and migraines with accompanying symptoms usually require prescription medication. Generally, acute medications are more effective if they are taken as soon as possible after symptoms develop.
During a migraine headache, it may help to rest or sleep alone in a dark, quiet room. Applying cold packs to the head or pressing on the bulging artery in front of the ear on the painful side of the head may provide temporary pain relief.
Medications to Treat Migraines
- OTC analgesics (e.g., aspirin, ibuprofen, acetaminophen) provide symptomatic relief from headache pain and should be taken at the first sign of a migraine. They are most effective for infrequent migraines (less than 3 a month) and breakthrough headaches (i.e., headaches that occur despite using prophylactic medications).
Frequent use of analgesics (i.e., more than 4 times a week) can cause rebound headaches and may interfere with prophylactic migraine treatment. Acetaminophen is sometimes combined with other drugs to form an analgesic compound (e.g., Midrin, Fioricet).
Side effects caused by aspirin and ibuprofen (e.g., Advil, Motrin) include gastrointestinal upset and bleeding. These drugs should be taken with food and used only as directed. Ibuprofen is available in suppository form, which can be useful if the migraine is accompanied by severe nausea and vomiting.
- Serotonin receptors (e.g., Imitrex, Amerge, Axert, Zomig), are fast-acting, usually well- tolerated medications commonly used to treat migraines. They are available in oral, injectable, and nasal spray forms and can be taken any time during the headache. Side effects of these medications include dizziness, drowsiness, flushing, discomfort, tingling, and nausea. Overuse also may lead to headache exacerbationdaily headaches or more frequent migraine attacks requiring detoxification.
- In January 2013, the U.S. Food and Drug Administration (FDA) approved Zecuitythe first transdermal delivery system (patch) to treat migraines. This battery-powered patch delivers sumatriptan (Imitrex) through an 8-inch long, 4-inch wide patch that wraps around the arm or thigh like an elastic bandage.
The dosage is regulated by a small battery and a computer chip and is administered over the course of 4 hours. A weak electrical current moves the medication through the skin.
The migraine patch provides an additional option for patients who, for example, have difficulty swallowing oral medication or don't like the unpleasant aftertaste of nasal spray. Side effects include a painful sensation and redness at the site of application.
- Ergots (e.g., Cafergot, Mioranal) may be administered orally, intranasally, or as a suppository and is often combined with antinausea drugs, such as prochlorperazine (Compazine). This medication should be taken at the first sign of a migraine and may not be effective if the headache has moved into the throbbing stage.
Side effects include gastrointestinal upset, dizziness, stroke, and high blood pressure (hypertension). Ergots should not be taken by patients with heart, vascular, liver or kidney disease.
Approved Medical Devices to Treat Migraines
Adults with migraines who do not tolerate drug treatments well, or for whom medications are ineffective, may be treated using the Cerena transcranial magnetic stimulator or the Cefaly transcutaneous electrical nerve stimulation deviceprescription medical devices approved by the U.S. Food and Drug Administration (FDA) to treat migraines. These devices, which have been shown in studies to be effective, pose few risks/side effects.
Cerena is approved for adults who experience migraine with aura and should be used at the start of a migraine headache. The device emits a short magnetic pulse at the back of the head to stimulate a part of the brain called the occipital cortex. Cephaly can be used daily to help prevent migraines. Worn across the forehead for 20 minutes, electrical current from the device stimulates the trigeminal nerve.
Side effects of these devices include pain, discomfort, and irritation at the application site; dizziness; and sleepiness. Safety of Cerena and Cefaly has not been established in children, women who are pregnant, and people with pacemakers.