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Migraine: the ultimate treatment list

According to the Golden Rule of the Migraine [1] 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 [2]). 

[3]

Look for pages on desired topics in the Migraine Tree [3] 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 situationAdvanced situation
InformationLearn 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 diaryDifferent paper and app versionsUse and bring to appointmentsDiaries can be very detailed but more details can make the analysis difficult
Trigger managementIdentification
Management when possible
Try an App like Curelator for a detailed trigger analysis
Avoid obsession and anxiety
DietAvoid 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 
SleepSleep hygiene and routine
Avoid sleep medications, or use sparingly
Cognitive Behavioral Therapy
Sleep Clinic
Detect and treat sleep apnea [4] 
PacingSetup reasonable expectations
Time management and planning 
Learn to saying no, and or delegate
Occupational therapy
Psychotherapy [5]
Professional coaching
Relaxation techniquesBreathing exercises
Progressive Muscle Relaxation
Yin Yoga [6] 
Mindfulness program
Biofeedback with a therapist
Psychotherapy
ExerciseRegular gentle exercise: walk, stationary bike, stretching, 
Adapt to capacity 
Kinesiology and physiotherapy [7] to find adapted exercises or increase performance
PostureDesktop adaptation 
Pillows
Supported bed position
Occupational therapy
Physiotherapy 
Use medications optimallyBasic use of acute and preventive medicationsUse of injections at home
Special combinations for severe attacks
Combination of multiple preventives

Acute treatments: treat the attack


GenericBrand
AnalgesicsAcetaminophenTylenol
Anti-inflammatoriesAspirin 
Diclofenac
Ibuprofen
Ketorolac
Mefenamic acid
Nabumetone
Naproxen
Aspirin
Cambia, Voltaren
Advil, Motrin
Toradol
Ponstan
No brand anymore
Aleve, Anaprox
Triptans [8]Almotriptan
Eletriptan
Frovatriptan
Naratriptan
Rizatriptan
Sumatriptan [9]
Zolmitriptan
Axert
Relpax
Frova
Amerge
Maxalt
Imitrex
Zomig
Ergot derivativesDihydroergotamine
Ergotamine
DHE, Migranal
Cafergot (rare)
Anti-emeticsDimenhydrinate
Chlorpromazine
Prochlorperazine
Metoclopramide
Odansetron
Gravol
Largactil
Stémétil
Maxeran, Metonia
Zofran
OthersEssential oils 
Mint gels and rollers

Combined analgesics
*** DANGER of chronification
Acetaminophen or aspirin combined with caffeine [10], 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

DitansLasmiditanNOT AVAILABLE YET IN CANADA
GepantsRimegepant
Ubrogepant
NOT AVAILABLE YET IN CANADA
Others

Preventive treatments, medications


GenericBrand
Anti-hypertensiveAmlodipine
Candesartan
Nadolol
Propranolol
Verapamil 
Norvasc
Atacand
Corgard
Inderal
Isoptin
Anti-seizureGabapentin
Topiramate [11]
Pregabalin
Valproic acid
Neurontin
Topamax
Lyrica
Epival 
Anti-depressantsAmitriptyline [12]
Nortriptyline
Venlafaxine
Elavil
Aventyl
Effexor
Botox
** Chronic migraine [13] only
Botulinum toxinBotox
CGRP antibodiesErenumab
Fremanezumab
Galcanezumab
Aimovig
Ajovy (NOT AVAILABLE YET)
Emgality
SupplementsCoenzyme Q10
Magnesium [14]
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, tincturesCesamet
Many

Procedures, devices and injections


Target for procedureComments
Nerve blocksAuriculotemporal
Greater occipital
Lesser occipital
Supra-orbital
Supra trochlear
Can be done in the clinic by a trained physician
Needling techniquesAcupuncture [15]
Dry needling
Trigger point injections
Can be done by physiotherapists, acupuncture specialists [16], physicians
Facet blocksCervical
Lumbar 
Done with X-ray supervision by specialists
Sphenopalatine Ganglion blocks
Usually done by ENT doctors
Some devices used by other physicians
Median branch blockC2-C3 and other levels in the neckDone with X-ray supervision by specialists
GlassesFL41 tintTheraspecs
Axon Optics
Cold / heat applicationDifferent ways to apply cold and hotMigraine Hat
NeuromodulationTranscutaneous
Transcranial magnetic
Vagus nerve
Peripheral stim
Cefaly [17]
eNEURA (NOT YET)
Gamma Core

Daith Piercing
*** NO evidence


Dealing with others and life situations


People interactingWhat can be done
At workEmployer
Co-workers
Insurance company
Health Program
Reasonable adaptations
Allied health consultation
Plan for missed days
Learn about disability rules
Personal lifePartner
Kids
Friends
Open communication
Flexibility in planning
Delegating tasks 
Plan for bad days 
At schoolTeachers
School staff
Allied health at school
School nurse
Attack plan for school
Adaptations (exam, homework)
Information for teachers

TravelTravel 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