Migraine treatment

Treating an attack

Take treatment as early as possible in an attack.

• Painkillers: ibuprofen, aspirin or paracetamol. Soluble versions may work faster.
• Triptans: such as sumatriptan or zolmitriptan. They work on the brain chemicals involved in migraine. Some are available from pharmacies. NICE suggests trying a triptan together with a painkiller.
• Anti-sickness medicine: can help with nausea and help other medicines work.
• Newer medicines: if triptans do not work or are not suitable, you may be offered a medicine called a gepant, such as rimegepant.

Many people find it helps to lie down in a dark, quiet room.

Preventing attacks

If you have frequent or severe attacks, you may be offered a preventive medicine, taken every day even when you feel well. Options include:

• propranolol, a beta blocker
• amitriptyline, a low-dose antidepressant
• topiramate. This must not be taken in pregnancy, and anyone who could get pregnant must follow a pregnancy prevention programme
• candesartan, a blood pressure medicine

It can take a few months to know if a preventive medicine is working.

Specialist treatments

If several preventive medicines have not worked, a specialist may offer:

• CGRP medicines, given as monthly or three-monthly injections, or as tablets such as atogepant, which block a chemical involved in migraine
• Botox injections for chronic migraine

Other options

• Acupuncture: NICE says a course may be considered if some preventive medicines are not suitable.
• Riboflavin (vitamin B2) may help some people. Ask your GP or pharmacist first.
• Menstrual migraine: if attacks are linked to your periods, there are specific treatments. Ask your GP.

Migraine and contraception

If you have migraine with aura, you should not usually take the combined contraceptive pill or other combined hormonal contraception, because it raises the risk of stroke. Talk to your GP or a sexual health clinic about other options.

Next, read about living well with migraine.