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 (LINKIN 15). 

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 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 managementIdentificationManagement when possibleTry an App like Curelator for a detailed trigger analysisAvoid obsession and anxiety
DietAvoid demonstrated food triggers Drink 2-3 liters of water dailyAvoid skipping mealsAvoid high sugar loads Eat more proteinSee a nutritionist to try more restrictive diets like ketogenic, elimination, FODMAP etc 
SleepSleep hygiene and routineAvoid sleep medications, or use sparinglyCognitive Behavioral TherapySleep ClinicDetect and treat sleep apnea 
PacingSetup reasonable expectationsTime management and planning Learn to saying no, and or delegateOccupational therapyPsychotherapyProfessional coaching
Relaxation techniquesBreathing exercisesProgressive Muscle RelaxationYin Yoga Mindfulness programBiofeedback with a therapistPsychotherapy
ExerciseRegular gentle exercise: walk, stationary bike, stretching, Adapt to capacity Kinesiology and physiotherapy to find adapted exercises or increase performance
PostureDesktop adaptation PillowsSupported bed positionOccupational therapyPhysiotherapy 
Use medications optimallyBasic use of acute and preventive medicationsUse of injections at homeSpecial combinations for severe attacksCombination of multiple preventives

Acute treatments: treat the attack

Anti-inflammatoriesAspirin DiclofenacIbuprofenKetorolacMefenamic acidNabumetoneNaproxenAspirinCambia, VoltarenAdvil, MotrinToradolPonstanNo brand anymoreAleve, Anaprox
Ergot derivativesDihydroergotamineErgotamineDHE, MigranalCafergot (rare)
Anti-emeticsDimenhydrinateChlorpromazineProchlorperazineMetoclopramideOdansetronGravolLargactilStémétilMaxeran, MetoniaZofran
OthersEssential oils Mint gels and rollers
Combined analgesics*** DANGER of chronificationAcetaminophen or aspirin combined with caffeine, barbiturates or codeine and oxycodone
FiorinalTylenol 1,2,3,4AnacinOxycocetPercocetTramacet
OpioidsShort actingLong acting*** DANGER of chronification and side effectsBuprenorphineCodeineFentanylHydromorphoneMorphineTramadolOxycodoneButransEmtecDilaudidStatexZytramSupeudol
GepantsRimegepantUbrogepantNOT AVAILABLE YET IN CANADA

Preventive treatments, medications

Anti-hypertensiveAmlodipineCandesartanNadololPropranololVerapamil NorvascAtacandCorgardInderalIsoptin
Anti-seizureGabapentinTopiramatePregabalinValproic acidNeurontinTopamaxLyricaEpival 
Botox** Chronic migraine onlyBotulinum toxinBotox
CGRP antibodiesErenumabFremanezumabGalcanezumabAimovigAjovy (NOT AVAILABLE YET)Emgality
SupplementsCoenzyme Q10MagnesiumVitamin 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)AcetazolamideFlunarizineLamotrigineMemantinePizotifenTizanidineDiamoxSibeliumLamictalNamendaSandomigranZanaflex
Cannabinoids(NOT supported by research yet)SyntheticFrom the plant:Inhaled, edibles, oils, tincturesCesametMany

Procedures, devices and injections

Target for procedureComments
Nerve blocksAuriculotemporalGreater occipitalLesser occipitalSupra-orbitalSupra trochlearCan be done in the clinic by a trained physician
Needling techniquesAcupunctureDry needlingTrigger point injectionsCan be done by physiotherapists, acupuncture specialists, physicians
Facet blocksCervicalLumbar Done with X-ray supervision by specialists
Sphenopalatine Ganglion blocks
Usually done by ENT doctorsSome devices used by other physicians
Median branch blockC2-C3 and other levels in the neckDone with X-ray supervision by specialists
GlassesFL41 tintTheraspecsAxon Optics
Cold / heat applicationDifferent ways to apply cold and hotMigraine Hat
NeuromodulationTranscutaneousTranscranial magneticVagus nervePeripheral stimCefalyeNEURA (NOT YET)Gamma Core
Daith Piercing*** NO evidence

Dealing with others and life situations

People interactingWhat can be done
At workEmployerCo-workersInsurance companyHealth ProgramReasonable adaptationsAllied health consultationPlan for missed daysLearn about disability rules
Personal lifePartnerKidsFriendsOpen communicationFlexibility in planningDelegating tasks Plan for bad days 
At schoolTeachersSchool staffAllied health at schoolSchool nurseAttack plan for schoolAdaptations (exam, homework)Information for teachers
TravelTravel staffCompanions during travelTouristic staffMedical staff abroadPlan and manage triggersMedications when travellingBring medical info summary
Emergency Room ED doctors and nurses Treating physicianFamily and close onesWorkplaceMake a written plan Learn what the ED can and cannot doLearn 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. 


MAIN: use the Migraine Tree image? 


Print This Post Print This Post