Migraines are a complex set of disorders that cause throbbing, moderate-to-severe headaches that last from 4 to 72 hours.1,2 Unlike regular headaches, migraines have distinct phases that may include visual or sensory disturbances called auras.
Migraines are among the most common neurological disorders and more commonly affect women and younger people, although they can happen to anyone. The severe headaches of migraines can drastically affect daily life, causing physical, emotional, and financial pain.
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Are Migraines Curable?
Unfortunately, there is no cure for migraines.1,3 However, there are many treatment options that may provide symptom relief and make your migraines less frequent and painful.
How Are Migraines Treated?
There are several different treatments available for those suffering from migraines.2-4 Treatments for migraine fall into one of two categories: acute or preventative. Acute treatments are intended to provide immediate or fast-acting relief for migraine symptoms, depending on the medication. These therapies are generally taken either at the onset of a migraine headache or during the aura or prodrome phases.
In contrast, preventative treatments are intended to help prevent migraines, reduce their frequency, or make them less severe when they occur. Unlike acute treatments, preventative treatments must be taken regularly to work and do not provide relief if taken during a migraine headache.
Acute Therapies for Migraine
Anti-Inflammatory Drugs
Anti-inflammatory drugs are a broad class of drugs used for headaches, aches and pains, fevers, and migraines5. Non-steroidal anti-inflammatory drugs (NSAIDs) work by acting on molecules that trigger, worsen, or sustain inflammation, which can aggravate nerves that communicate pain signals to the brain. In migraines and other headaches, inflammation triggers pain signals in the head or amplifies them inside the brain6. By blocking or reducing inflammation, anti-inflammatory drugs can reduce the pain of headaches, including migraine headaches.
NSAIDs are the most commonly used drugs for migraines.5 However, they can have side effects for the gastrointestinal system and exacerbate bleeding, so not all patients can take them safely.
Anti-inflammatory drugs include:
- Acetaminophen
- Ibuprofen
- Naproxen
- Aspirin
- Ketoprofen
- Diclofenac
- Tolfenamic acid
- Piroxicam
- Ketorolac
Triptans
Triptans are a class of drugs primarily used to treat migraines that act by modifying the way the brain responds to serotonin. Serotonin is a chemical the brain uses to communicate between nerve cells and it affects how blood vessels in the brain open and close.7 Inappropriate electrical signals sweep over the brain during a migraine, partially regulated by serotonin. Triptans block molecules called receptors that react to serotonin, disrupting the process and providing pain relief.8 They are often combined with an NSAID to boost their effects.
Triptans include:
- Naratriptan
- Sumatriptan
- Zolmitriptan
- Eletriptan
- Rizatriptan
- Almotriptan
- Frovatriptan
Antiemetics
Nausea and vomiting are symptoms that occur during the headache phase of a migraine. Antiemetics are medications that treat nausea and vomiting.4 Antiemetics are given to patients alongside other drugs that target headache pain, most commonly an anti-inflammatory or a triptan.
Antiemetics include:
- Metoclopramide
- Prochlorperazine
- Chlorpromazine
Lasmiditan
Much like triptans, lasmiditan helps treat migraine headaches by affecting serotonin in the brain.9 Unlike triptans, it does not affect blood vessels in the brain. This makes it especially useful for people with cardiovascular conditions or those who are at increased risk of stroke.
Ergots
Ergots are a class of chemicals derived from a fungus that feeds on grain.10 Like other acute treatments for migraine, ergots target the serotonin system to provide quick-acting relief for headache pain. Ergots are commonly paired with caffeine for additional strength. Although ergots are effective, they are not as frequently prescribed as they were in the past, thanks to the development of newer triptans.
Ergots include:
- Ergotamine
- Dihydroergotamine
Preventative Treatments
Beta-Blockers
Beta-blockers are a class of drugs often used to treat heart conditions and anxiety. They reduce the activity of the sympathetic nervous system, often called the “fight or flight” system.4 Beta-blockers are the first-line preventative treatment for migraines.11 It is not entirely understood how they help reduce the occurrence of migraines, but they are effective at reducing their length, intensity, and frequency.
Beta-blockers include:
- Propranolol
- Timolol
- Atenolol
- Nadolol
- Bisoprolol
Antidepressants
Most antidepressants act by affecting serotonin in the brain. As a result, they are also used to help reduce the occurrence and severity of migraines.4
Antidepressants include:
- Amitriptyline
- Fluoxetine
Anticonvulsants
Anticonvulsants are drugs primarily used to treat epilepsy. They work by toning down the activity of nerves in the brain.4 Some anticonvulsants are used to effectively prevent migraines or reduce their frequency.
Anticonvulsants include:
- Topiramate
- Valproate
Calcium channel blockers
Calcium plays an important role in brain function. Calcium channel blockers affect the function of calcium in the brain, thereby affecting activity.4 These drugs are often prescribed for migraines in people who can get pregnant and people with Raynaud’s phenomenon, a circulatory condition affecting the extremities.
Anticonvulsants include:
- Flunarizine
- Verapamil
Calcitonin gene-related peptide antagonists:
Calcitonin gene-related peptide (CGRP) is a molecule that acts on the blood vessels in the brain, contributing to migraines.2-4 New antibody-based therapies can target this molecule and reduce the incidence of migraine episodes.
CGRP antagonists include:
- Fremanezumab
- Erenumab
- Galcanezumab
Alternative Medicines
Many people seek non-pharmaceutical remedies for their migraine symptoms.12 These are often based on plant-derived compounds called phytochemicals that may affect how the brain and blood vessels work. In addition, nutrients like B vitamins are also frequently used as a remedy for migraines. Note that these substances are not approved by the FDA to treat migraine disorders and should be used in combination with medication.
Alternative medicines include:
- Butterbur
- Magnesium
- Coenzyme Q10 (CoQ10)
- B vitamins
- Melatonin
- Vitamin D
- Ginger
- Omega-3 fatty acids
Nontraditional Therapies
In addition to medication, migraines can be treated with neurostimulation.1 In these procedures, specific nerves or parts of the brain are activated or suppressed by electrical stimulation. This can have profound effects on migraine symptoms.
Neurostimulation techniques include:
- Transcranial magnetic stimulation
- Transcutaneous supraorbital nerve stimulation
- Peripheral nerve blocking
- Nonpainful remote electric neurostimulation
Living with Migraines
Although there are many effective treatments for migraines, medication is only one part of the picture.3 There are several lifestyle changes that can help you manage your migraines. The first step is understanding your triggers. Whether it’s bright lights, loud noises, or a particular smell, knowing your triggers lets you minimize your chances of encountering them and having a migraine episode.
Future of Migraine Treatments
Significant research is currently being performed to develop new therapies or adapt existing treatments for migraines. This includes drugs like botox, supplemental therapies like probiotics, new indications for existing antibody treatments like galcanezumab, and new neurostimulation techniques.13-16 With further development, these and other treatments could help bring better and longer-lasting relief for people with migraines.
