Migraine: the ultimate treatment list
According to the Golden Rule of the Migraine World, there are no one-size-fits-all treatments. Therefore, how can you find the treatments and approaches that will help YOU? There are so many, it can be bewildering. How can you find your way among the quick fixes, the cure promises and the well-meaning people who are telling you what to do?
The table below is an overview of your options
Options are in the table whether or not they are based on research. Some may not be indicated medically but are used in «the real world». We did not include all the health care professionals that can be consulted for migraine, that is in another document (See this post).
Look for pages on desired topics in the Migraine Tree and be aware that more options will be added as research expands. Always discuss with your health care provider to see if an option is appropriate for you. Remember that different physicians may have different ways to practice and preferred treatments.
Lifestyle adaptations and behavioral approaches
| Basic situation | Advanced situation | |
| Information | Learn about migraine. The more you know, the better you can self-manage. Knowledge is power. | Some situations are complex and information found online may not answer all your questions. |
| Headache diary | Different paper and app versionsUse and bring to appointments | Diaries can be very detailed but more details can make the analysis difficult |
| Trigger management | Identification Management when possible | Try an App like Curelator for a detailed trigger analysis Avoid obsession and anxiety |
| Diet | Avoid demonstrated food triggers Drink 2-3 liters of water daily Avoid skipping meals Avoid high sugar loads Eat more protein | See a nutritionist to try more restrictive diets like ketogenic, elimination, FODMAP etc |
| Sleep | Sleep hygiene and routine Avoid sleep medications, or use sparingly | Cognitive Behavioral Therapy Sleep Clinic Detect and treat sleep apnea |
| Pacing | Setup reasonable expectations Time management and planning Learn to saying no, and or delegate | Occupational therapy Psychotherapy Professional coaching |
| Relaxation techniques | Breathing exercises Progressive Muscle Relaxation Yin Yoga | Mindfulness program Biofeedback with a therapist Psychotherapy |
| Exercise | Regular gentle exercise: walk, stationary bike, stretching, Adapt to capacity | Kinesiology and physiotherapy to find adapted exercises or increase performance |
| Posture | Desktop adaptation Pillows Supported bed position | Occupational therapy Physiotherapy |
| Use medications optimally | Basic use of acute and preventive medications | Use of injections at home Special combinations for severe attacks Combination of multiple preventives |
Acute treatments: treat the attack
| Generic | Brand | |
| Analgesics | Acetaminophen | Tylenol |
| Anti-inflammatories | Aspirin Diclofenac Ibuprofen Ketorolac Mefenamic acid Nabumetone Naproxen | Aspirin Cambia, Voltaren Advil, Motrin Toradol Ponstan No brand anymore Aleve, Anaprox |
| Triptans | Almotriptan Eletriptan Frovatriptan Naratriptan Rizatriptan Sumatriptan Zolmitriptan | Axert Relpax Frova Amerge Maxalt Imitrex Zomig |
| Ergot derivatives | Dihydroergotamine Ergotamine | DHE, Migranal Cafergot (rare) |
| Anti-emetics | Dimenhydrinate Chlorpromazine Prochlorperazine Metoclopramide Odansetron | Gravol Largactil Stémétil Maxeran, Metonia Zofran |
| Others | Essential oils Mint gels and rollers | |
| Combined analgesics *** DANGER of chronification | Acetaminophen or aspirin combined with caffeine, barbiturates or codeine and oxycodone | Fiorinal Tylenol 1,2,3,4 Anacin Oxycocet Percocet Tramacet |
| Opioids Short acting Long acting *** DANGER of chronification and side effects | Buprenorphine Codeine Fentanyl Hydromorphone Morphine Tramadol Oxycodone | Butrans Emtec Dilaudid Statex Zytram Supeudol |
| Ditans | Lasmiditan | NOT AVAILABLE YET IN CANADA |
| Gepants | Rimegepant Ubrogepant | NOT AVAILABLE YET IN CANADA |
| Others |
Preventive treatments, medications
| Generic | Brand | |
| Anti-hypertensive | Amlodipine Candesartan Nadolol Propranolol Verapamil | Norvasc Atacand Corgard Inderal Isoptin |
| Anti-seizure | Gabapentin Topiramate Pregabalin Valproic acid | Neurontin Topamax Lyrica Epival |
| Anti-depressants | Amitriptyline Nortriptyline Venlafaxine | Elavil Aventyl Effexor |
| Botox ** Chronic migraine only | Botulinum toxin | Botox |
| CGRP antibodies | Erenumab Fremanezumab Galcanezumab Eptinezumab | Aimovig Ajovy Emgality Vyepti |
| Supplements | Coenzyme Q10 Magnesium Vitamin B2 (Butterbur or Petadolex at risk for liver toxicity) | Different brands and combinations |
| Others (NOT first line therapy but can be used in selected patients) | Acetazolamide Flunarizine Lamotrigine Memantine Pizotifen Tizanidine | Diamox Sibelium Lamictal Namenda Sandomigran Zanaflex |
| Cannabinoids (NOT supported by research yet) | Synthetic From the plant:Inhaled, edibles, oils, tinctures | Cesamet Many |
Procedures, devices and injections
| Target for procedure | Comments | |
| Nerve blocks | Auriculotemporal Greater occipital Lesser occipital Supra-orbital Supra trochlear | Can be done in the clinic by a trained physician |
| Needling techniques | Acupuncture Dry needling Trigger point injections | Can be done by physiotherapists, acupuncture specialists, physicians |
| Facet blocks | Cervical Lumbar | Done with X-ray supervision by specialists |
| Sphenopalatine Ganglion blocks | Usually done by ENT doctors Some devices used by other physicians | |
| Median branch block | C2-C3 and other levels in the neck | Done with X-ray supervision by specialists |
| Glasses | FL41 tint | Theraspecs Axon Optics |
| Cold / heat application | Different ways to apply cold and hot | Migraine Hat |
| Neuromodulation | Transcutaneous Transcranial magnetic Vagus nerve Peripheral stim | Cefaly eNEURA (NOT YET) Gamma Core |
| Daith Piercing *** NO evidence |
Dealing with others and life situations
| People interacting | What can be done | |
| At work | Employer Co-workers Insurance company Health Program | Reasonable adaptations Allied health consultation Plan for missed days Learn about disability rules |
| Personal life | Partner Kids Friends | Open communication Flexibility in planning Delegating tasks Plan for bad days |
| At school | Teachers School staff Allied health at school School nurse | Attack plan for school Adaptations (exam, homework) Information for teachers |
| Travel | Travel staff Companions during travel Touristic staff Medical staff abroad | Plan and manage triggers Medications when travelling Bring medical info summary |
| Emergency Room | ED doctors and nurses Treating physician Family and close ones Workplace | Make a written plan Learn what the ED can and cannot do Learn about alarm signals |
This is probably not the end, more options may become available. But it should give you an idea of what can be done to improve migraine.
Post#14
