Migraine treatment often involves a combination of medication and non-medical methods. Medical treatment can be divided into acute treatment, initiated to relieve or stop an attack, and preventive treatment, which aims to provide milder or fewer attacks.
It is important to understand that there is no cure for migraine, but with timely and appropriate treatment, quality of life can be significantly improved. This article describes evidence-based treatment that can relieve or prevent migraine attacks.
What works for one person does not necessarily work for another. It is therefore important to discuss treatment methods with healthcare professionals to find the best individual treatment. There are many variations of medication within the same type, where one variant may work for some but not for others, which is why close follow-up from your healthcare professional is important for you as a patient.
Read more about what migraine is and the symptoms of migraine here.
To prevent migraine attacks, it can be crucial to try to avoid trigger factors such as stress, lack of sleep, and alcohol. There is also evidence for other non-medical treatment methods for migraine prevention1 – it is worth noting that what one finds effective is individual:
When these measures are not sufficient to prevent and relieve attacks, both over-the-counter migraine medication and prescription medication are available as alternatives.
It is crucial to have a plan for the acute treatment of a migraine attack. Resting in a dark, quiet room with a cold compress on your forehead can relieve mild attacks, but it is often not enough. Pain-relieving medication, such as ibuprofen, naproxen, paracetamol, and aspirin, can be effective, potentially in combination with metoclopramide or domperidone to relieve nausea1. However, it is important to avoid overusing pain medication, as this can lead to more headaches, known as medication-overuse headache. Therefore, do not use pain medication for migraine attacks more than 9 days per month or on average 2 days per week.
For migraine attacks where standard pain medication is not sufficient, doctors often recommend triptans. These medications relieve pain by briefly narrowing the blood vessels in the brain.
Triptans are medications specifically developed to treat migraines. Triptans are available both over-the-counter and by prescription. Triptans can be combined with anti-nausea and/or pain-relieving medication to achieve a better effect if you do not feel that a triptan alone is sufficient. It is important to limit the use of triptans to a maximum of twice a day and no more than nine days per month1.
Many people have the type of migraine called migraine with aura. In the case of aura (visual disturbances, sensory disturbances, and/or speech difficulties), triptans should not be taken until the aura has passed and the headache begins. The period from the end of the aura phase until a potential headache occurs can last anywhere from 5 to 60 minutes. Not everyone experiences a headache after an aura.
Preventive treatment1 should be considered if:
First-line treatment includes blood pressure-lowering medication such as beta-blockers (metoprolol and propranolol) and the angiotensin II receptor blocker candesartan. Another first-line treatment frequently used is antidepressant medication such as amitriptyline. Treatment is highly individual, and it may be necessary to try different preparations before the right treatment is found.
A new step in migraine treatment is CGRP inhibitors, which have shown positive results in preventing migraine attacks. These drugs inhibit a substance called calcitonin gene-related peptide, which plays a role in a migraine attack.
Treatment with Botulinum toxin type A, often referred to as Botox, has also been documented to have a good effect. Botulinum toxin is administered via 31 injections at specific points in the forehead, temples, back of the head, base of the skull, and neck every 12 weeks.
CGRP inhibitors and Botulinum toxin type A are only prescribed to people with chronic migraine, which means you must have at least 15 days of headache per month, of which at least 8 days must be with migraine.
Many of the types of medication used for both preventive and acute treatment cannot be used during pregnancy and breastfeeding, either because they are harmful to the fetus or child, or because they are relatively new types of medication and we therefore do not yet know if they are actually harmful. Read more here.
We are all different and respond differently to medication. Therefore, some are lucky enough to find a good and effective treatment after the first attempt, while others have to try more than one preparation before they experience an effect.
It is important to consult a doctor to get a correct diagnosis and develop an individually tailored treatment plan based on symptoms, health history, and any underlying causes of migraine. It is therefore also important that you prepare for your doctor's appointment.
A holistic approach that combines medication, lifestyle changes, and non-medical methods can provide the best migraine control and improve quality of life.
"It is recommended to get the right treatment as soon as possible to minimize the risk of your migraine progressing and to improve your quality of life."
- Neurologist, Signe Bruun Munksgaard, Hemi Headache Clinic
This article is based on the standard of care in Denmark, last reviewed and presented in the 2020 Reference Program by the Danish Headache Society.
Read about migraine treatment at Hemi Headache Clinic here.
1. Danish Headache Society 2020, Reference Program 2020, https://dhos.dk/wp-content/uploads/2020/06/2932-Referenceprogram_2020_final_web-24.06.20.pdf
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