Migraine Treatments: Prevention & Relief Options

What Is a Migraine?

A migraine is a neurological condition characterised by moderate to severe throbbing head pain, typically on one side of the head, lasting between 4 and 72 hours. Migraines affect approximately 1 in 7 people globally, making them one of the most common neurological disorders worldwide.

Migraines are not simply "bad headaches." They involve changes in brain chemistry and nerve signalling that produce a cascade of symptoms beyond head pain.

Treatments for Migraine

Treatments for migraine fall into two broad categories: acute treatments, used to stop or reduce a migraine attack once it begins, and preventive treatments, used regularly to reduce the frequency and severity of future attacks. Mool Health recommends that individuals work with a healthcare provider to determine which combination of migraine treatments is most appropriate for their specific pattern of attacks.

Acute Treatments for Migraine

Acute treatments for migraine, also called abortive treatments, work best when taken as early as possible at the first sign of an attack.

Over-the-Counter (OTC) Medications

For mild to moderate migraines, OTC options may provide adequate relief:

• Non-steroidal anti-inflammatory drugs (NSAIDs) — Ibuprofen (400–600 mg) and naproxen sodium are commonly used first-line options
• Paracetamol (acetaminophen) — Effective for mild attacks, particularly when combined with caffeine
• Aspirin — May reduce migraine pain, especially in combination formulas
• Combination analgesics — Products containing aspirin, paracetamol, and caffeine together have shown greater efficacy than single-ingredient options in clinical observations

Important: Using OTC pain medications too frequently can lead to medication overuse headache (MOH), which can make headaches more frequent over time.

Prescription Acute Treatments for Migraine

For moderate to severe migraines or attacks that do not respond to OTC options, prescription medications are typically recommended:

Triptans are among the most widely prescribed classes of acute migraine treatment. They act on serotonin receptors involved in migraine pain pathways.

• Sumatriptan (available as tablet, nasal spray, and injection)
• Rizatriptan
• Zolmitriptan
• Eletriptan
• Almotriptan

Studies suggest that triptans can be effective for many migraine attacks. They are generally used once the migraine headache begins and work best when taken early in the attack according to the treatment plan prescribed by a healthcare professional.

Gepants — A newer class of migraine treatments that block the calcitonin gene-related peptide (CGRP) pathway. Unlike triptans, gepants do not cause vasoconstriction.

• Ubrogepant
• Rimegepant (also used for prevention in some treatment plans)

Ditans — Lasmiditan is a serotonin 5-HT1F receptor agonist used for acute migraine treatment in some regions. It can cause dizziness and sedation, so driving restrictions may apply after a dose.

Anti-nausea medications — Medicines such as metoclopramide or prochlorperazine may be used when nausea or vomiting accompanies migraine and can sometimes be combined with acute pain treatment.

Ergot derivatives — Ergotamine and dihydroergotamine (DHE) are older migraine treatments that may still be used in selected patients, particularly for prolonged or difficult-to-treat attacks.

Preventive Treatments for Migraine

Preventive treatments for migraine may be considered when:

• Migraines occur on several days each month
• Attacks are severely disabling even when infrequent
• Acute medications are being used too frequently
• Acute treatments are ineffective or poorly tolerated
• Migraine substantially interferes with work, school, sleep, or everyday activities

Preventive treatment often requires several weeks or months of consistent use before its full effect can be assessed. The aim is usually to reduce migraine frequency, severity, duration, or disability rather than necessarily eliminate every attack.

Oral Preventive Medications

Beta-blockers — Propranolol and metoprolol are established preventive treatments for migraine and may be considered depending on the individual's health profile.

Antidepressants — Amitriptyline is widely used for migraine prevention, particularly when sleep disturbance or certain mood symptoms are also present. Venlafaxine may also be considered in selected cases.

Anticonvulsants — Topiramate and valproate are used for migraine prevention. Their suitability depends on the individual because they can cause side effects and have important precautions. Valproate requires particular caution in people who are pregnant or could become pregnant.

Calcium channel blockers — Flunarizine is used in some regions as a preventive option, particularly when other treatments are not suitable or well tolerated.

CGRP-Targeted Preventive Therapies

Calcitonin gene-related peptide (CGRP) plays an important role in migraine biology. Treatments that target CGRP or its receptor have become an important option for migraine prevention.

CGRP monoclonal antibodies (mAbs) include:

• Erenumab
• Fremanezumab
• Galcanezumab
• Eptinezumab

Depending on the medicine, these treatments may be administered monthly, quarterly, or intravenously. Response varies from person to person, and a healthcare professional can determine whether a CGRP-targeted treatment is appropriate.

Rimegepant — This gepant may also be used as a preventive treatment under an appropriate prescribing schedule.

Non-Oral Preventive Options

• Botulinum toxin (Botox) — OnabotulinumtoxinA is used for chronic migraine and is administered through a series of injections around the head and neck at regular intervals.
• Neuromodulation devices — Non-invasive devices such as transcranial magnetic stimulation (TMS), external trigeminal nerve stimulation (eTNS), and non-invasive vagus nerve stimulation (nVNS) may be used for acute or preventive treatment in selected patients and regions.

Non-Pharmacological Treatments for Migraine

Non-drug approaches are an important complement to medication-based migraine treatments. Mool Health recommends integrating lifestyle strategies alongside medical treatment for the best outcomes.

Lifestyle-Based Treatments for Migraine

• Consistent sleep schedule — Irregular sleep is a commonly reported migraine trigger. Maintaining similar sleep and wake times throughout the week may help reduce attacks.
• Regular meals and hydration — Skipping meals and dehydration can trigger migraine in susceptible people. Regular meals and adequate fluids may help maintain a more stable migraine threshold.
• Regular moderate exercise — Aerobic exercise may help reduce migraine frequency in some individuals. Exercise should be increased gradually because intense exertion itself can be a trigger for some people.
• Stress management — Cognitive behavioural therapy (CBT), mindfulness, relaxation techniques, and progressive muscle relaxation may help reduce stress-related migraine burden.
• Trigger identification and management — Keeping a migraine diary can help identify patterns involving sleep, meals, stress, hormonal changes, weather, caffeine, alcohol, or other potential triggers.

Complementary and Supportive Treatments

Some people also use complementary treatments alongside standard migraine care. These approaches should generally be viewed as supportive rather than as replacements for prescribed treatment.

• Acupuncture — Some evidence supports acupuncture as a preventive option for migraine in selected individuals.
• Biofeedback — Biofeedback teaches awareness and control of physiological responses such as muscle tension and may help some people manage migraine.
• Magnesium — Magnesium supplementation is sometimes used as an adjunct preventive strategy, particularly in certain migraine patterns.
• Riboflavin (vitamin B2) — Riboflavin is another supplement that has been studied for migraine prevention.
• Coenzyme Q10 (CoQ10) — CoQ10 may provide modest preventive benefit for some people.

Supplement doses and suitability can vary, particularly during pregnancy, with kidney disease, or when other medicines are being taken. Discuss regular high-dose supplementation with a healthcare professional.

Treatments for Specific Migraine Types

Different migraine subtypes may require tailored treatment approaches.

Menstrual Migraine Treatments

Menstrual migraines — those occurring around the beginning of menstruation — can be particularly difficult to treat. Depending on the individual, treatment options may include:

• Short-term preventive treatment around the expected menstrual period
• Longer-acting triptans such as frovatriptan or naratriptan in selected patients
• Magnesium supplementation in some treatment plans
• Hormonal strategies when appropriate and prescribed by a healthcare professional

Hormonal treatment is not suitable for everyone, so contraceptive or hormone-related decisions should be discussed with a clinician who knows the individual's migraine type and medical history.

Chronic Migraine Treatments

Chronic migraine is generally defined as headache occurring on 15 or more days per month for more than 3 months, with migraine features on at least 8 of those days.

Treatments may include:

• Botulinum toxin injections
• CGRP-targeted preventive treatments
• Topiramate or other appropriate preventive medicines
• Management of medication overuse if acute medicines are being taken too frequently
• Lifestyle and trigger-management strategies

Migraine with Aura: Special Considerations

Migraine with aura requires some additional treatment considerations. For example, combined oestrogen-containing contraceptives may not be appropriate for some people with migraine with aura because of cardiovascular and stroke-related considerations.

People with migraine with aura should discuss contraception, smoking status, cardiovascular risk factors, and migraine treatment with an appropriate healthcare professional.

How to Get Started with Migraine Treatment

1. Track your migraines — Record attack dates, duration, severity, associated symptoms, suspected triggers, and medicines taken.
2. Consult a healthcare provider — A GP, neurologist, or headache specialist can confirm whether the headaches fit a migraine pattern and assess whether further evaluation is needed.
3. Establish an acute treatment plan — Identify what to take and when to take it when an attack begins.
4. Assess the need for preventive treatment — Frequent or disabling attacks may justify preventive therapy.
5. Implement lifestyle adjustments alongside medication — Regular sleep, meals, hydration, physical activity, and stress management are important components of migraine care.
6. Allow adequate time for preventive treatment — Many preventive medicines require several weeks before their effect can be evaluated properly.
7. Review and adjust — Follow up with your healthcare provider and use your migraine diary to assess whether attack frequency or severity is improving.

Common Mistakes to Avoid in Migraine Treatment

• Taking acute medication too frequently — Frequent use of certain pain medicines or migraine medicines can contribute to medication overuse headache
• Stopping preventive treatment too early — Preventive therapies often need time before their benefit can be properly assessed
• Ignoring lifestyle factors — Sleep, hydration, meals, exercise, and stress can all influence migraine patterns
• Assuming every headache is migraine — A new or substantially changed headache pattern should be professionally assessed
• Changing prescription treatment without medical advice — Preventive and acute medicines can have contraindications and interactions

When to Seek Urgent Medical Attention

Certain headache features require immediate medical assessment because they may indicate a condition other than migraine.

• A sudden, extremely severe headache that reaches maximum intensity rapidly
• Headache with fever, stiff neck, confusion, rash, or seizures
• Headache following significant head injury
• A new headache that progressively worsens over days or weeks
• New weakness, paralysis, persistent vision loss, severe speech difficulty, or loss of consciousness
• A substantially different neurological symptom pattern from previous migraine attacks

Migraine Treatments vs. Doing Nothing: Expected Outcomes

Approach	Expected Outcome
No treatment	Attacks may last 4–72 hours and can significantly affect normal activity
OTC analgesia used appropriately	May provide adequate relief for some mild to moderate attacks
Triptans	Can provide significant relief for many moderate to severe migraine attacks
Preventive medication	Aims to reduce monthly migraine frequency, severity, or disability
CGRP-targeted treatments	Can substantially reduce migraine days in some patients who respond to treatment
Botulinum toxin for chronic migraine	Can reduce headache days in appropriately selected people with chronic migraine
Lifestyle plus medical treatment	Provides a combined approach targeting both attacks and modifiable migraine triggers

Mool Health's Perspective on Migraine Treatment

Migraine treatment works best when it is personalised. Two people with the same number of migraine days may need very different treatment plans depending on whether they experience aura, nausea, menstrual migraine, cardiovascular risk factors, sleep problems, medication overuse, or other health conditions.

Acute treatment focuses on reducing the impact of individual attacks, while preventive treatment aims to reduce how often those attacks happen. Lifestyle measures such as regular sleep, hydration, meals, exercise, stress management, and trigger awareness can support both approaches.

The goal of migraine care is not simply to tolerate fewer headaches. Effective treatment should also reduce disability, improve daily functioning, decrease reliance on rescue medication, and make migraine more predictable and manageable.

If your current treatment is not working, migraines are becoming more frequent, or you are using acute medication repeatedly throughout the month, a healthcare professional can reassess your treatment plan and determine whether preventive therapy or a different acute treatment may be appropriate.