What are acute treatments for migraine?

Acute treatments are medications to help you to break a migraine attack, not to prevent one. These medications are taken as needed when a migraine starts. They are different from preventive treatments, taken  regularly to decrease the frequency of migraines (See this post). 

What is the goal of an acute treatment?

The goal is to return to your usual activities as soon as possible. Usually, this means within 1 to 2 hours. The medication should be effective, reliable, and have no significant side effects. If you have severe attacks, the goal may be to decrease symptoms (pain, nausea, sensory sensitivity, others) even if a return to function is not possible.

How can I tell the difference between migraine attacks and tension headaches? 

Pay attention to your symptoms of migraine. Are you sensitive to light? Irritable? Nauseous? Do you get throbbing pain? These are symptoms of migraine. When you become familiar with the warning signs of your attacks, you can treat them earlier and increase your success. Many migraine attacks start at a mild degree but then deteriorate.

How will I find the right, acute treatments for me?

Every patient is different. To find the proper treatment, you may need to try several medications and combinations to find what works best for you. It is rare for a treatment to be effective in 100% of attacks, so we suggest that you try each new medication for a few separate migraine attacks. Track results on a headache diary (See this post). Evaluate benefits and side effects to decide if a medication is right for you. Discuss with your healthcare provider. 

When should I treat the migraine attack? Sometimes I try to wait to see if it will pass…

Treating the attack early increases your chances of success and return to function. For some people their migraine attacks are always the same, but others have different types, some rising quickly, others slowly. Some start during sleep. The sequence of symptoms may vary, but once an attack is full blown, it becomes more difficult to stop it (See this post The Treating Early principle). In the case of gepants, studies have shown that treating during your prodrome (if you have a recognizable and reliable one) can be beneficial.

My migraine attacks come on quickly, or I wake up with them. What should I do?

Consider asking your doctor for a medication that does not need to be absorbed by the stomach, such as a nasal spray, suppository, or injection (See this post). Such options may be effective.

Can I combine several acute treatments? 

The different categories of acute medications may be taken together to treat different parts of the attack. For example, you may need something for pain and nausea. Different migraine medications act through various mechanisms, and combining them may increase your chances of success. Different attacks may require different combinations. (See this post) 

What about a rebound headache? How many days per month can I safely treat?

If you have more than two days a week with headaches, be very careful! The risk of drug-induced (rebound or medication overuse) headaches starts at ten days per month, and gets higher with higher frequency. (See this post). If you have headaches more often than this, you may need a preventive medication to help reduce the frequency of your migraine attacks. As a note, gepants taken acutely do not induce rebound, they could even add a preventive effect

Can I use opioid (narcotic) medications for migraine?

Opioids or narcotics are usually avoided for migraine treatment because they are more likely to result in a temporary response where the migraine attack returns in a few hours or the next day. The brain becomes more sensitized to pain after using opioids, and there is a greater risk for rebound headaches. The pattern of migraine often becomes more frequent and more severe in people who use opioids (See this post). 

There are many options for you! Learn more about the Treat Early concept and the Combination Principle and find the best ways to gain back your life. 

Migraine Talks Podcasts: Episode 1 Treating a migraine attack, Episode 2 Severe Attacks

PDF How To Use Acute Medications – Make the attack stop

REFERENCES

Worthington I, Pringsheim T, Gawel MJ, Gladstone J, Cooper P, Dilli E, et al. Canadian Headache Society Guideline: acute drug therapy for migraine headache. Can J Neurol Sci. 2013;40(5 Suppl 3):S1-s80.

Gilmore B, Michael M. Treatment of acute migraine headache. Am Fam Physician. 2011;83(3):271-80.

Mayans L, Walling A. Acute Migraine Headache: Treatment Strategies. Am Fam Physician. 2018;97(4):243-51.

Rapoport AM. Acute treatment of migraine: established and emerging therapies. Headache. 2012;52 Suppl 2:60-4.

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