Often the only way to get rid of a migraine is to take painkillers and sleep it off.
Sufferers normally rest up in a dark room until it has passed – which can be up to 72 hours.
There are many options for migraine that can be tried – some help at the point of migraine and others are preventative.
And there are new treatments coming onto the market that are not just repurposed drugs for other conditions.
Triptans
Triptans reduce the pain and sickness of a migraine attack at the time they are taken.
Naratriptan and frovatriptan usually take longer to reach their maximum effect but their effect lasts longer.
But if a patient’s attacks peak quite quickly, a triptan such as sumatriptan, zolmitriptan, eletriptan or rizatriptan may be more appropriate.
Two doses of any triptan are allowed in 24 hours and they should not be used more than 10 days in a month.
Analgesics
This is medication that treats the pain of a migraine attack at the time they are taken and includes paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.
Prophylactics
Prophylactics are preventative medicines for migraines taken every day.
Most preventive medications currently available are repurposed from other conditions.
They include:
- Angiotensin II blockers (for hypertension)
- Anti-convulsants (for epilepsy)
- Anti-serotonergic drugs (for depression)
- Beta-blockers (for hypertension)
- Calcium channel blockers
- Tricyclic antidepressants
- CGRP monoclonal antibodies (described below)
Botox injections
Botox (botulinum toxin type A) is a type of nerve toxin that paralyses muscles. It was discovered that those who had the cosmetic injections had fewer headaches.
Botox is approved for use on the NHS for the treatment of chronic migraine – at least 15 headache days a month – in adults who have tried other treatments.
Doctors think it works by blocking chemicals called neurotransmitters that carry pain signals from within your brain.
CGRP monoclonal antibodies
Calcitonin gene-related peptide antibodies (CGRP) monoclonal antibodies (mAbs) are a new type of treatment for migraine.
CGRP mAbs are the first preventive medicines specifically developed for the treatment of migraine.
Several are now available on the NHS. This includes erenumab (brand name Aimovig), fremanezumab (Ajovy), galcanezumab (Emgality) and eptinezumab (Vyepti).
The drugs target CGRP, released by the nerves and blood vessels during a migraine attack. It is thought to cause pain.
The new drugs target CGRP to prevent migraine developing.
All of the medicines are taken by injection, either monthly or every few months.
Gepants
Gepants are like the tablet form of the injectable CGRPs antibodies described above.
There are currently three gepants – ubrogepant (not yet on the NHS), atogepant and rimegepant – and others in development. They are CGRP receptor antagonists.
Gepants bind to the CGRP receptors on nerves and block its effects. Gepants (unlike triptans) do not constrict or tighten the blood vessel. They prevent them from dilating.
This makes them safer for people with heart issues and they can be used in people with cardiovascular disease.
Early indications suggests that gepants may be the first acute treatment not associated with medication overuse headache. Due to this, they may also be used as a preventive treatment.
Greater Occipital Nerve (GON) block
There are injections which contain small doses of local anaesthetic and/or steroid which is injected around the greater occipital nerve – which travels up each side of the back of the head.
Evidence suggests a GON block can provide short-term benefit to some people with migraine, reducing how often migraines occur and their severity.
Around one in three people do not see any benefit from a GON block.
Lifestyle measures
If none of these treatments help a patient’s symptoms, or they’re getting worse, a referral to a specialist may be made.
A GP may also recommend making changes to lifestyle to help manage migraines, such as eating at regular times and drinking less caffeine.
These include:
- Eat meals at regular times
- Exercise
- Get plenty of sleep
- Manage stress
- Drink plenty of water and less alcohol and caffeine
- Limit trigger foods, such as spicy food
Sources: NHS and The Migraine Trust