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 everyone. It is therefore important to discuss treatment methods with healthcare professionals to find the best individual treatment. There are many variants of the same type of medication, 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, sleep deprivation, and alcohol. There is also evidence for other non-medical treatment methods for migraine prevention1 - it is worth noting that what one experiences as 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 and quiet room with a cooling compress on the forehead can relieve mild attacks, but often this is not enough. Pain-relieving medication, such as ibuprofen, naproxen, paracetamol, and aspirin, can be effective, and possibly also in combination with metoclopramide or domperidone to relieve nausea1. However, it is important to avoid overuse of pain medication, as it can lead to more headaches, what we call 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 regular pain medication is not sufficient, doctors often recommend triptans. These drugs relieve pain by briefly narrowing the blood vessels in the brain.
Triptans are a medication specifically developed to treat migraine. Triptans are available both over-the-counter and by prescription. Triptans can be combined with anti-nausea and/or pain medication to achieve better effect if you do not feel that a triptan is effective enough. 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 have the "migraine form" 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 occurs. The period from the end of the aura phase until a potential headache occurs can last anywhere from 5 to 60 minutes. Not everyone gets 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 commonly used first-line treatment 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 documented good effect. Botulinum toxin is administered via 31 injections into 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 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 the medical consultation.
A holistic approach that combines medication, lifestyle changes, and non-medical methods can provide the best control over migraine and improve quality of life.
"It is recommended to get the right treatment as soon as possible so that you minimize the risk of the migraine progressing and you can improve your quality of life."
- Neurologist, Signe Bruun Munksgaard, Hemi Headache Clinic
The article is based on the standard for treatment 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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