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How to treat a migraine

Woman lying on couch holding her head in pain
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Anyone who experiences migraines will know that they’re not just “bad headaches” – a migraine attack can cause very intense pain, nausea, vomiting and an upset tummy, as well as increased sensitivity to bright lights and loud noises. In other words, for some, it can be impossible to do anything while you’re having a migraine. The good news is, there are treatment options that can ease your symptoms during a migraine. There are also preventative options, which make you less likely to experience severe attacks. Read on to find out more.

Common treatments for migraines

Over-the-counter painkillers

Paracetamol, ibuprofen and aspirin are all good things to stock up on if you experience migraines.

To be most effective, these kind of painkillers, should be taken as soon as you feel a migraine coming on. If you wait until the pain has become more severe, it’s unlikely that you’ll feel any benefit. To speed up the process you can use soluble painkillers (i.e. ones that you dissolve in water) as these are absorbed by the body much quicker. Remember, although these painkillers may be available without a prescription but you’ll still need to take them as instructed on the pack. Don’t double up on doses or take anything that hasn’t been approved by your GP. You can always speak to a pharmacist for advice on the dose suitable for you.

What is an “overuse” or “painkiller” headache?

If you take painkillers frequently, there’s a risk that you’ll start having a ‘medication overuse headache’. To try and avoid this, it can be helpful to look for alternatives to standard pain relief, and to talk to your GP about migraine treatments that are more effective and which can bee taken less often.

Triptans for migraines

Triptans are the standard treatment for most people who have migraines. It’s thought that this medication works by narrowing the blood vessels around the brain, essentially reversing the effects of a migraine. As with over-the-counter painkillers, triptans should be taken at the beginning of a migraine attack, usually when your head begins to hurt. A second dose may be taken as per dosage guidelines on the pack. There can be some side effects associated with triptans, but these tend to be mild and improve with time. If the side effects are too strong or you don’t find the treatment effective, speak to your GP as they should be able to prescribe a different type of triptan.

Antiemetics for a migraine with nausea

Antiemetics are medicines that prevent sickness – specifically nausea and vomiting. This is a treatment prescribed to people with migraine who experience sickness as one of their main symptoms. Normally you’ll want to take antiemetics when your symptoms begin, often at the same time as a painkiller or triptan.

Natural remedies for migraines

There are plenty of drug-free and natural remedies for migraines that can be used to treat and prevent migraines. These don’t involve medication, which means there’s no risk of developing a ‘medication overuse headache’. You might find that your symptoms are easiest to manage when you combine over-the-counter painkillers and prescription medication with these kinds of lifestyle changes and pain management techniques.

TENS machines

A TENS (transcutaneous electrical nerve stimulation) machine is a device that uses small electrical impulses to block pain signals going to the central nervous system, and is thought to also stimulate the production of the body’s natural painkiller, endorphins.

Normally, a TENS machine is used for arthritis, joint pain, sports injuries and period pain. However, it can also be used to treat pain during a migraine attack, provided the electrodes on the device aren’t placed on the neck or temples, or near the eyes.

Here at LloydsPharmacy we’ve developed our own TENS machine specially for use during migraines. The device attaches directly to the forehead and helps to treat pain during a attack and reduce the likelihood of future episodes.

Turn off migraine pain with Migraine TENS

Acupuncture for migraines

Acupuncture is the practice of puncturing key areas of the body with thin needles to stimulate the nerves and relieve pain. It’s a technique that originated in ancient China, and today it is used in both traditional Chinese medicine and Western medicine.

The process can help relieve migraine pain and prevent migraines from recurring. Usually, you’ll need to have a course of up to 10 session across a period of five to eight weeks. This option can be considered if by healthcare professionals if migraine preventative treatments are unsuitable or ineffective.

During acupuncture, the insertion of the needles can create a tingling sensation or a dull ache, but the process shouldn’t be painful.

Supplements for migraines

Certain dietary supplements have been found to benefit people with migraine, helping to prevent the regularity and severity of attacks. The supplements that may be effective for migraines, according to The Migraine Trust, are:

  • Vitamin B2 (riboflavin) – 400mg/day
  • Magnesium – 400-600mg/day
  • Co-enzyme Q10 – 150mg/day

Avoiding migraine triggers

If you can, it’s really helpful to work out the things that trigger your migraines so you can try to avoid them. One way to do this is to keep a diary where you note down every migraine attack and key details about how you slept, what you ate and what you did that day.

Common migraine triggers include big changes to your routine (e.g. going to bed late or sleeping in), skipping meals, stress and having too much caffeine. With that in mind, lifestyle changes that might work for you include:

  • Going to bed and waking up at the same time each day
  • Eating regular meals
  • Relaxation techniques to deal with stress
  • Cutting back on tea and coffee – but not going cold turkey!

For more guidance on identifying and managing triggers, consult this page from The Migraine Trust.

Preventative medication for migraines

In addition to some of the remedies described above, there’s a long list of prescription medications that can be taken to prevent migraine attacks.

Topiramate for migraines

Topiramate was originally developed to treat epilepsy, but is now prescribed to people with migraine. It comes in tablet form and should be taken daily. This medication isn’t safe for everyone, particularly pregnant women, but it can be very effective in preventing migraines.

Propranolol for migraines

Propranolol is a tablet medicine used to treat angina, high blood pressure and anxiety. It can also effectively prevent migraines when taken every day – although it’s not suitable for people with asthma, COPD or certain heart problems.

Amitriptyline for migraines

Amitriptyline is a tablet medication used to treat depression, however it can also be helpful for those with migraines and who also have difficulty sleeping.

Botulinum toxin type A (“Botox”) for migraines

Botox injections can be an effective preventative for people who have chronic migraine i.e. you have headaches on at least 15 days of the month, and at least eight of these headache days are characterised as migraine symptoms.

To prevent migraines, botulinum toxin type A injections should be administered around the head and neck every 12 weeks.

Calcitonin gene-related peptide (CGRP) monoclonal antibodies CGRP monoclonal antibodies are a new treatment developed specially to prevent migraines. They work by targeting CGRP, a substance that is released during a migraine attack.

Monoclonal antibodies are administered by injection either intravenously (i.e. directly into a vein) or subcutaneously (under the skin), every few weeks or months, depending on the type medicine.

Hormonal contraception for migraines

Lots of women find that they experience migraines in the run-up to their period. To avoid this, your GP might recommend that you take hormonal contraception like the combined pill, the contraceptive injection or the implant.

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References

www.nhs.uk/conditions/migraine/treatment
https://migrainetrust.org/live-with-migraine/healthcare/treatments/acute-medicines
www.nhs.uk/conditions/transcutaneous-electrical-nerve-stimulation-tens
www.nhs.uk/conditions/acupuncture
www.nhs.uk/conditions/migraine/prevention
https://migrainetrust.org/live-with-migraine/healthcare/treatments/calcitonin-gene-related-peptide-monoclonal-antibodies
https://migrainetrust.org/live-with-migraine/healthcare/treatments/preventive-medicines