How to Treat a Migraine
If you need to treat a migraine and over-the-counter pain relievers aren't helping, find a quiet, dark place where you can relax. Try meditation or deep breathing exercises to help you relax, since stress and muscle tension can make your migraine worse. You can also try placing an ice pack or a warm compress on your forehead or at the base of your neck. If you get migraines regularly, you can ask for a prescription such as an ergot or triptan medication, which may alleviate your symptoms.
Distinguish migraine symptoms from other headaches. Before trying to treat a migraine, you want to be sure you really do have a migraine and not another type of headache. Migraines generally occur as throbbing pain on one side of your head along with nausea or vomiting, and/or noise and light sensitivity, though it is possible to have a migraine and experience no head pain. You may experience forewarning signs an hour or two before the migraine, such as blind spots, auras, flashing lights, weakness, tingling, or even difficulty speaking. They usually last from four to 72 hours and feel worse when you're being active. Know the basic features of other types of headaches, and consider whether your symptoms seem more like a migraine: Tension headaches feel like a tight band around your head or a weight on your head, often with neck and/or shoulder tension. They occur without throbbing, nausea, or vision changes. They are the most common type of headache, causing mild to moderate pain. Cluster headaches cause extreme pain usually over one eye, temple , or forehead; pain tends to come on quickly, last five to 60 minutes, then disappears for a time before returning. Sometimes your eye will water or nose will run on the same side as the headache. These are the least common types of headache. Visit your doctor for a referral to a neurologist. If you suffer from frequent or severe headaches, your family doctor can refer you to a specialist called a neurologist. This doctor can diagnose your headaches by doing a physical exam, talking to you about your symptoms, and discussing your family history. This is usually enough to diagnose migraines or other types of headaches. If your headaches are severe or abnormal, they may rarely have you do more testing such as: An MRI (magnetic resonance imaging) or CT (computerized tomography) to rule out tumors, bleeding, or other problems inside your brain A blood test to check for toxins or infection in your body A lumbar puncture (or spinal tap) to check the pressure in your skull and rule out other problems Know the warning signs of an emergency. Even if you get migraines frequently, don't ignore the warning signs of a more serious problem. Some types of headaches can indicate dangerous medical conditions. See your doctor right away or visit the emergency department if you experience any of these symptoms: A severe headache that comes on suddenly and feels like the worst headache you've ever had Headaches with stiff neck, fever, confusion, seizures, weakness, or difficulty speaking A headache after you injure your head, especially if it worsens over time A headache that doesn't really go away and gets worse if you move quickly, cough, or strain You develop headaches for the first time after age 50 Take your medication as early as possible. As soon as you recognize you are having a migraine, take your medication. Lie down in a dark room after you take your medicine to potentially improve your migraine symptoms more. Try over-the-counter pain relievers. If your migraine is mild try aspirin, or ibuprofen products like Advil or Motrin; for some people, acetaminophen (Tylenol) helps, as well. For moderate migraine pain, try an OTC medication marketed for migraine headaches, such as Excedrin Migraine which contains aspirin, acetaminophen, and a small amount of caffeine. Talk to your doctor before taking any medications. Long-term or overuse of some OTC pain medicines (non-steroidal anti-inflammatories, or NSAIDs) can cause stomach bleeding, ulcers, and other problems. Always follow the dosing instructions on the packaging. Get a prescription for indomethacin. Indomethacin (Indocin or Tivorbex) is an NSAID like aspirin and ibuprofen; however, it is available in suppository form (instead of swallowing a pill, you place it in your rectum). This may be helpful if you experience severe nausea or vomiting when you have a migraine. See your doctor and ask about getting a prescription. Try prescription triptan medications. Triptans like sumatriptan (Imitrex) and zolmitriptan (Zomig) are by prescription to take when you have a migraine. Triptans help migraine pain by blocking pain pathways in the brain and constricting blood vessels, and can be taken as a pill, nose spray, or injection. Your doctor can prescribe these medications if you have severe or frequent migraines. You shouldn't take triptans if you've had a heart attack or stroke. Taking triptans and SSRIs (selective serotonin reuptake inhibitors) or SNRIs (serotonin norepinephrine reuptake inhibitors) together may cause a serious medical problem called serotonin syndrome. If you take an antidepressant like Zoloft or Cymbalta, talk to your doctor about taking triptans. It's possible to take the two together if you know what symptoms to look out for, but your doctor may want to prescribe you something different. The medication Treximet combines two different pain relievers called sumatriptan and Naproxen, and seems to be very effective. Try ergot medications. Also by prescription, ergot medications seem to be somewhat less effective than triptans, but are good if your migraines last over 2 days. Ergotamine is the usual choice, though it can worsen nausea for some people. It's usually combined with some caffeine, like in the medicines Migergot and Cafergot. Migranal is a similar medicine with fewer side effects available as a nasal spray or injection. Take your ergot medication as soon as possible after your migraine symptoms start to improve its efficacy. Treat your nausea. Ask your doctor about anti-nausea medications if nausea and vomiting are frequent migraine symptoms for you. Chlorpromazine, metoclopramide (Reglan), and prochlorperazine are often prescribed. Ask your doctor about opioids or steroids as your last option. Opioid medications are sometimes used to treat severely painful migraines, but because they contain narcotics they can be dangerously habit-forming and are only used if nothing else works. Your doctor might give you glucocorticoids like prednisone or dexamethasone in combination with other medication to improve pain relief, but these aren't good to use often because of the side effects. Opioids are prescribed as little as possible because they can be addictive or easily abused, and you have to slowly wean off of them. Steroid medicines also must be stopped gradually, not all at once. Recognize warning signs of an impending migraine. Some people who get migraines experience an “aura,” which often appear as flashes of light or altered vision before a migraine begins. You may also experience blind spots, tingling on one side of your face, arm, or leg, weakness, or difficulty speaking. If you recognize a migraine early, you can try to prevent it from worsening or alleviate symptoms. Some people even experience what's called a “prodrome” phase up to a day or two before the headache. This might be a change in mood (sadder or happier than usual), food cravings, constipation, yawning a lot, stiff neck, or more frequent urination and increased thirst. Minimize the sensory stimuli around you. Bright lights, strong scents, and loud noises often worsen migraine symptoms. When you first recognize signs that you may have a migraine approaching, shut off as much sensory stimuli as possible. Lie down in a quiet, dark room and rest. Use relaxation techniques. Stress and muscle tension can worsen migraines, and being stressed a lot is a possible trigger for migraines. Use relaxation techniques on a regular basis to reduce your stress level and during your migraine to ease discomfort. Try meditation or deep breathing exercises during your headache, while resting in a dark place. Regularly practice mindfulness , go for walks in nature, listen to music – whatever helps you relax. Try hot or cold packs. Put an ice pack or cold compress on your neck or head to help numb the pain. If you don't own an ice pack, fill a plastic baggie with ice and wrap it in a thin towel; this helps prevent damage to your skin from having ice directly on it. You can also try a heating pad, which can relax tense muscles and possibly alleviate migraine pain. Try massage. The effect massage has on muscle tension and stress may help reduce the frequency you get migraines. More studies are needed to prove its efficacy, but some people have found relief through massage therapy. If you can't get a professional massage, try some self-massage. Use light pressure with your fingertips to massage in gentle circles or a back-and-forth motion on your temples and scalp; don't let your fingers slide over your skin, try to rub the muscles underneath. Consider learning biofeedback treatment. Biofeedback may be effective in decreasing the pain of migraines. A professional uses specialized equipment during this relaxation exercise to teach you to recognize and control some physiological responses your body has to stress. Learning to recognize stressors that trigger migraines can be help you avoid or change these situations. If your migraine has a slow onset, you may be able to use biofeedback to avoid a full attack. Check out cognitive behavioral therapy. Cognitive behavioral therapy, or CBT, is a psychiatric tool that teaches you how to change your patterns of thinking and behavior. A professional therapist can work with you to learn CBT. It works similarly to biofeedback, except using mental processes rather than physical. CBT may help alleviate or prevent migraine symptoms. Try acupuncture. Studies have shown that acupuncture may be a helpful therapy in treating migraines. A professional will insert small needles into your skin at special points with the goal of minimizing pain. Consider trying a session if you hope to treat your migraines naturally. Try the herb feverfew with caution. Some studies show that feverfew might reduce the severity of migraines or help prevent them, though this isn't scientifically proven. Feverfew may be available as capsules containing dried leaves of the herb at a pharmacy or health food store. Ask your doctor before using herbal remedies. Do not take feverfew if you are pregnant or breastfeeding, and do not give it to children under 2 years old. Avoid food triggers and eat regular meals. Fasting or skipping a meal can trigger a migraine in some people. Aged cheese and salty and processed food may also be triggers. Decrease salt in your diet by avoiding potato chips and other snack aisle foods, and seasoning your meals with spices and herbs instead of table salt. Avoid frozen and pre-packaged meals, as well as fast food. Food additives , like aspartame (an artificial sweetener) and MSG in various foods, can trigger migraines in some people. Avoid these products by using natural sweeteners and asking restaurants if they use MSG – request your meal be MSG-free! Nitrates are also a common trigger, and can be found in processed meats like pepperoni, hot dogs, and lunch meat. Minimize your alcohol intake. Drinking alcohol, especially wine, can trigger migraines. Stop drinking alcohol or limit your intake to moderate amounts – 1 glass a day for women and men over 65, and 2 glasses a day for men under 65 is considered “moderate.” Avoid drinking lots of caffeine. Highly caffeinated beverages like espresso drinks and energy drinks may trigger migraines due to the “caffeine crash” a few hours later. A sudden drop in caffeine level is potentially a migraine trigger. If possible, drink tea instead of coffee, and try to keep your caffeine to a minimum to avoid the crash. If you drink a lot of caffeine now, don't stop all at once – that can cause headaches and other withdrawal effects. Taper down. For instance, if you currently drink 2 cups of coffee a day, drink 1 cup for a week or two, then drink half-caff (half regular, half decaf). Set a regular sleep schedule. For some people, migraines are triggered when they change their sleep habits and get too little, or even too much, sleep. If you're prone to migraines, set a regular bedtime and wake time for yourself so you get approximately 8 hours of sleep nightly. Jet lag can also be a trigger. If you are travelling into a very different time zone, try to minimize the disruption to your sleep schedule as much as possible. Ask your doctor about your birth control pills and heart medicine. Vasodilator medications like nitroglycerin can make migraines worse, as can oral contraceptive pills. Of course, these medications are important, so do not just stop taking them if you have migraines. Talk to your doctor, and they may be able to switch your medication to something different that is less likely to worsen migraines. Keep a headache journal. It can be difficult to determine your triggers unless you pay careful attention and write things down. Keep a journal, and when you have a headache note what you did that day, what you ate in the last 12 hours, and any other stimuli you encountered (someone's strong perfume, only getting five hours of sleep, etc.). This may help you recognize patterns so you can avoid triggers in the future. Ask your doctor if you’re eligible for preventive migraine medicine. Preventive medicines are reserved for severe and hard-to-treat cases because of their side effects. However, if migraines plague you often and affect your quality of life, talk to your doctor. Preventive medicines can make your attacks shorter, less frequent, or less intense. You may be eligible for preventive medicines if: Your migraines regularly last longer than 12 hours. You get four or more migraines per month. Your pain isn't improved by medications. You get a prolonged aura with numbness or weakness. Consider heart medicines. Cardiovascular drugs that usually treat high blood pressure are sometimes used to prevent migraines. Beta-blockers like metoprolol and others, the calcium-channel blocker verapamil, and the ACE inhibitor lisinopril are most commonly used. These are not good options for you if you have a heart condition, smoke cigarettes, or are over 60 years old. Your doctor will take a thorough history and discuss the risks and benefits of other medications with you. Try a tricyclic antidepressant. The medication amitriptyline is proven to help prevent migraines. Other tricyclics are used sometimes because they have fewer side effects (dry mouth, constipation, tiredness, and weight gain are associated with amitriptyline). Your doctor will help you weigh the risks and benefits of using such a medication to prevent migraines. Venlafaxine (Effexor XR) is an SNRI that may help prevent migraines. Look into anti-seizure drugs. Anticonvulsants like valproate and topiramate (Topamax) may cause migraines to occur less frequently. However, these medications can have serious side effects. Valproate cannot be taken if you're pregnant. Inquire into botox injections. Botox, or onabotulinumtoxinA, has been shown effective in helping to prevent migraines in adults. Botox is injected into the muscles of the neck and forehead about every 12 weeks in order to work well. If you have chronic migraines, consider discussing this option with your healthcare provider. 
Distinguish migraine symptoms from other headaches. Visit your doctor for a referral to a neurologist. Know the warning signs of an emergency. Take your medication as early as possible. Try over-the-counter pain relievers. Get a prescription for indomethacin. Try prescription triptan medications. Try ergot medications. Treat your nausea. Ask your doctor about opioids or steroids as your last option. Recognize warning signs of an impending migraine. Minimize the sensory stimuli around you. Use relaxation techniques. Try hot or cold packs. Try massage. Consider learning biofeedback treatment. Check out cognitive behavioral therapy. Try acupuncture. Try the herb feverfew with caution. Avoid food triggers and eat regular meals. Minimize your alcohol intake. Avoid drinking lots of caffeine. Set a regular sleep schedule. Ask your doctor about your birth control pills and heart medicine. Keep a headache journal. Ask your doctor if you’re eligible for preventive migraine medicine. Consider heart medicines. Try a tricyclic antidepressant. Look into anti-seizure drugs. Inquire into botox injections. 