Quarterly Research Reports

Introduction

Welcome to the first issue of the Migraine World Summit (MWS) Quarterly Research Report. The Quarterly Research Report highlights recent research publications related to migraine and headache.

We hope you find the MWS Quarterly Research Report a helpful way to discover some of the latest findings related to migraine and headache from published research papers.

Each individual report is intentionally brief in order to provide a quick overview. The goal is to give you an idea of current research and to share some insights that may improve your understanding of migraine.

Consult your headache specialist or primary care physician to discuss how any of the research findings might apply to you.

Some medical publications don’t provide free online access. In some cases, your health care professional may be able to print a copy for you.

Please note that our volunteer support team members are patients themselves and are not able to reply to questions about the research or comment on these medical studies.

Authors highlighted in bold are those who have spoken at the Migraine World Summit.

Quotes are taken directly from the research paper.

Feedback

We welcome your feedback on this new report. Please share via email to [email protected].

Disclaimer

The views reflected in this research report do not represent the views of the Migraine World Summit. This report is not designed to replace a consultation with your doctor. Seek medical advice before making any changes to your treatment plan.

Report Downloads

Quarter 1, 2022 Quarterly Research Report Download >>

New Treatments List

New Treatments List

The chart below summarizes significant medical treatments newly available in various regions (the United States, as well as Australia, Canada, England, and Ireland) since 2017. These include preventive and acute therapies in the form of drugs, devices, or procedures approved by a regulatory authority for treatment of migraine or certain types of headaches.

Please consult the complete Migraine World Summit Treatment Directory, updated annually, for additional information.

Generic NameBrand NameAcute/Preventive/BothClassAvailability by Region (AUS, CAN, ENG, IRE) Acute/Preventive/Both
Anti-CGRPsUSAAUSCANENGIRE
erenumabAimovigPreventiveCGRP monoclonal antibodyPreventivePreventivePreventivePreventive
fremanezumabAjovyPreventiveCGRP monoclonal antibodyPreventivePreventivePreventivePreventive
galcanezumabEmgalityPreventiveCGRP monoclonal antibodyPreventivePreventivePreventivePreventive
eptinezumabVyeptiPreventiveCGRP monoclonal antibodyPreventivePreventiveN/AN/A
Gepants
atogepantQuliptaPreventiveSmall molecule CGRP receptor antagonistN/AN/AN/AN/A
rimegepantNurtec ODTBothSmall molecule CGRP receptor antagonistN/AN/AN/AN/A
ubrogepantUbrelvyAcuteSmall molecule CGRP receptor antagonistN/AN/AN/AN/A
Ditans
lasmiditanReyvowAcute5-HT1F receptor agonistN/AN/AN/AN/A
Ergot alkaloid-derivatives
dihydroergotamine mesylate (DHE)TrudhesaAcuteErgot alkaloid-derivativeN/AN/AN/AN/A
NSAIDs
celecoxib liquidElyxybAcuteNonsteroidal anti-inflammatory drugN/AN/AN/AN/A
Other
Remote wearable neuromodulation (REN) deviceNerivioAcuteNeuromodulation deviceN/AN/AN/AN/A
Supraorbital TNS unit or external trigeminal nerve stimulation (eTNS) deviceCefalyBothNeuromodulation deviceBothBothBothBoth
Vagus nerve stimulation (VNS) devicegammaCoreBothNeuromodulation deviceBothBothBoth (cluster headache)Both (cluster headache)
Transcranial magnetic stimulation (TMS) devicesTMS MiniBothNeuromodulation deviceN/AN/SBothN/A
Non-invasive combined occipital and trigeminal nerve stimulation deviceRelivion MGAcuteNeuromodulation deviceN/AN/AN/AN/A
Green light lampAllay LampAcuteTherapeutic light deviceN/AN/AN/AN/A

Treatment Directory – Nonmedical

Non-Medical Migraine Treatments

We recommend you read the Quick Start guide before using this directory.

This section includes a wide variety of alternative, complementary, natural, and holistic treatments. They are categorized as Therapy, Behavioral Therapy, Physical Therapy, Product/Device, Procedure, Lifestyle and Vitamin/Supplement.

Although these are nondrug related treatments and generally nonprescription, they should be discussed with your doctor as part of your total treatment plan.

How to use this reference:

  • Nonmedical Treatment: The therapy/vitamin/lifestyle practice/device/procedure being used i.e. Acupuncture.
  • Treatment Type: Acute treatments are taken at the onset of a migraine attack to help treat the symptoms of pain, nausea or other migraine- related disability. Preventive treatments help reduce or stop migraine attacks from occurring in the first place. Preventive treatments are often taken regularly (i.e. daily, weekly, monthly) whether or not you have a migraine attack.
  • Cost: Is the treatment free to perform or does it involve a paid cost? Acupuncture involves a cost to see an acupuncturist.
  • Format: The category of the treatment, i.e. acupuncture is listed as a “Therapy”
  • Description: A short summary about the treatment benefits, risks, and administration.

Treatments are listed in alphabetical order.

Search on any term by using the search field.  Sort on any column. Show more rows by increasing the display number.

Treatment TypeCostNonmedical TreatmentFormatDescription
PreventivePaid5-HTP (5 Hydroxytryptophan)Vitamin/Supplement5-HTP is a nonessential amino acid that contributes to increased production of serotonin, melatonin, dopamine, norepinephrine, and beta-endorphins, which all play a role in sleep, mood and pain regulation. People with migraine may have low serotonin levels. 5-HTP is directly converted to serotonin in nerve cells and the liver before it can reach the brain. Several publications have raised concern of a significant risk of heart valve disease from high levels of serotonin in the blood because of its direct effect on the heart. The supplement 5-HTP is made from a natural plant source (Griffonia simplicifolia).
PreventivePaidAcceptance and Commitment Therapy (ACT)Behavioral therapyAcceptance and Commitment Therapy (ACT) is a form of mindfulness-based therapy theorizing that greater well-being can be attained by accepting the difficulties that come with life, and by overcoming negative thoughts and feelings.
Acute & PreventivePaidAcupressurePhysical therapyAcupressure has been practiced in Asia for thousands of years. By learning how to stimulate pressure points, you may be able to relieve minor or moderate symptoms of migraine head pain and gastrointestinal distress. Acupressure can be self-administered to specific pressure points using a deep, probing pressure with fingertip, knuckle or soft, pointed object, such as a pencil eraser. If you have not found relief after the first point, try the same points on the opposite side of the body.
Acute & PreventivePaidAcupressure braceletsProduct/DeviceBands that apply pressure on the meridian point on the inside of the wrist that is said to be associated with nausea and motion sickness. Some studies suggest there is a therapeutic benefit to magnets in alleviating pain or other health concerns. Common types include magnetic bands and Sea-Bands.
PreventivePaidAcupunctureProcedureA Traditional Chinese Medicine technique that involves the insertion of very fine, solid needles into certain points of the body. According to Traditional Chinese Medicine, acupuncture helps headaches by encouraging the production of the body’s natural painkillers called endorphins.
PreventiveFreeAdvocacyLifestyleAdvocacy is the public support of a particular cause. An example of advocacy would be supporting greater funding of migraine research, which would benefit the migraine community as a whole.
PreventivePaidAlexander TechniqueTherapyThe Alexander Technique is a system designed to retrain poor posture to ensure minimum effort and strain on the body. This can help prevent headaches that result from poor posture.
PreventiveFreeAltruismLifestyleAltruism, or the principle and practice of concerning oneself with the well-being of others, activates the reward center in the brain. Volunteering, donating to charity, or even reaching out to help a friend in need can have the added benefit of boosting your own health, happiness, and sense of purpose.
PreventivePaidApplied Kinesiology (AK)Physical therapyKinesiology is the study of body movement. Applied Kinesiology (AK) is a system using basic muscle testing to evaluate areas of dysfunction within the body. AK methodology is primarily concerned with neuromuscular function and how it relates to the regulation of structural, chemical and mental physiology. It uses the principle that the body is a self-maintaining, self-correcting mechanism.
Acute & PreventivePaidAromatherapyProduct/DeviceAromatherapy uses plant materials and aromatic plant oils to help alter one’s mood, cognitive, psychological or physical well-being. Blends of plant oils, essential oils and other aromatic compounds are often utilized through topical application, massage inhalation, or water immersion to stimulate a desired response. Aromatherapy oils often for migraine include lavendar oil, peppermint oil, and Damascus rose oil.
PreventivePaidAshwaghandhaVitamin/supplementAshwagandha, also known as Indian ginseng or withania somnifera, is an herb used in traditional Indian medicine (i.e., Ayurveda). It is most often used to relieve stress and anxiety but may be used to treat other conditions or symptoms, such as migraine, epilepsy, joint pain, and diabetes. Ashwagandha comes in various forms, including pills, liquids, and powders.
Acute & PreventiveFreeAvoid bright screensLifestyleBright screens such as TVs, computer screens, phones, and other LED screens emit a particular spectrum of light that people with migraine may be sensitive to. Avoiding bright screens can be a way to reduce this visual trigger for those who are sensitive to bright lights. Wearing special blue-light blocking glasses can help reduce digital eye strain and fatigue when staring at computer and TV screens for prolonged periods of time.
Acute & PreventiveFreeAvoid fluorescent lightingLifestyleFluorescent lights emit a particular spectrum of light. People with migraine may be sensitive to the spectrum of light emitted by fluorescent lights.
Acute & PreventiveFreeAvoid loud, sustained noiseLifestyleLoud noise, constant noise, piercing, or ringing sounds are migraine triggers for some, and may worsen a person’s migraine condition for those who are vulnerable.
Acute & PreventiveFreeAvoid odors/smokeLifestyleStrong odors, incense, perfume, deodorants, chemical smells, cleaning products, cigarette smoke, air pollution, vehicle exhaust, and other pungent or unnatural scents are known to be migraine triggers for some. Exposure may trigger an attack or worsen an attack in progress.
PreventiveFreeAvoid processed foodsLifestyleProcessed foods often contain artificial ingredients and preservatives that can contribute to migraine. These include MSG, soy, sulfates/sulfites, nitrates, nitrites, and gluten among others. See Dietary Changes for more trigger ingredients and foods.
Acute & PreventiveFreeAyurvedaLifestyleAyurveda is an ancient Indian practice that involves a variety of treatments including yoga, massage, acupuncture, diet, and herbal medicine to encourage health and well-being. Ayurveda names three elemental substances, the doshas (called Vata, Pitta, and Kapha), and states that a balance of the doshas results in health, while imbalance results in disease. 
PreventivePaidBarometerProduct/DeviceBarometric pressure changes might affect the pressure in the brain or the way the brain blocks pain, though it’s not well understood at this stage. However, a barometer can help people with migraine who are sensitive to pressure changes to better anticipate this trigger and avoid other controllable triggers (e.g. food, stress) during risky weather.
Acute & PreventivePaidBehavioral therapy apps & online toolsProduct/DeviceThere are an increasing number of online therapy and self-care apps available to help with a variety of issues, including mental health and pain. Examples of therapy based options include Betterhelp, Talkspace and Online-Therapy.com. Mental-health and Mindfulness focused ones include Calm, Headspace, Insight Timer, Curable, iCBT, Sanvello, and MindShift.
Acute & PreventivePaidBio-behavioral therapyBehavioral therapyBio-behavioral therapy is a pain management therapy that teaches skills for controlling physical reactions to stress and pain through relaxation and stress reduction. The idea is that stress is perhaps one of the most common behavioral factors that interacts with physical factors in the perpetuation of pain.
Acute & PreventiveFree & PaidBiofeedbackBehavioral therapyBiofeedback is a technique that teaches people how to control certain body functions such as blood pressure, heart rate, and spasms in the arteries supplying the brain with the help of a sensory device. Once skills are learned, they can be practiced anywhere.
PreventivePaidBlack cohoshVitamin/SupplementBlack cohosh (Actaea racemosa) is an herb sometimes used to treat perimenopause and menopause symptoms. It is native to North America, and its roots and rhizomes are made up of glycosides (sugar compounds), isoferulic acids (anti-inflammatory substances), and phytoestrogens (plant-based estrogens). Warning: the wrong variety can lead to liver toxicity symptoms.
PreventivePaidBlood test - Food sensitivities/nutritionOtherA food-allergy blood test may offer clues to which foods the body is reacting to, as these foods may be affecting an individual’s health and migraine. A food-allergy blood test can also determine if supplementation is necessary, by seeing if magnesium or vitamin D are deficient, for example.
PreventivePaidBlood test – Genetic dysfunctionOtherTesting for genetic dysfunctions can help uncover potential causes that may be provoking migraine attacks. For example an MTHFR and homocysteine blood test can indicate a deficiency in the processing of folate and require a specific treatment that may lead to reduced migraine.
AcutePaidBlue menthol gelProduct/DeviceThere are several forms of blue menthol gel on the market. It is a topical cooling gel used for pain relief, inflammation, joint swelling, etc. Blue gel can cause skin irritation.
PreventivePaidBoswellia / Indian frankincenseVitamin/SupplementBoswellia is an herbal extract from the Boswellia serrata tree. It is available as a resin, pill, or cream. Boswellia has been shown to reduce inflammation in the body by preventing the formation of leukotrienes. A 2012 study indicated boswellia extract can reduce the intensity and frequency of cluster headaches.
PreventivePaidBowen therapyPhysical therapyBowen therapy is a holistic remedial body technique that works on the soft connective tissue of the body. It is used to treat musculoskeletal or related neurological issues, including acute sports injuries and chronic or organic conditions. Practitioners claim it is a gentle, relaxing method that does not use forceful manipulation.
Acute & PreventiveFreeBreathing relaxation techniquesBehavioral therapyDeep breathing is a simple way to relax and reduce stress. For example, taking 3 or 10 deep, slow breaths can help reduce anxiety and control stress. Also, alternate-nostril breathing, called nadi shodhana pranayama in yoga, can help control anxiety.
PreventivePaidButterburVitamin/SupplementButterbur is an herbal supplement that has been reported to be effective in reducing the frequency and severity of migraine attacks in some people with migraine. Caution should be exercised with butterbur as it contains components called pyrrolizidine alkaloids (PAs) that are toxic to the liver and may cause cancer. The concentrations of this toxin vary depending on which part of the plant is harvested and where the plant is grown. Getting butterbur from a reputable source is important. The brand name Petadolex is regarded as one of the most pure and PA-free. The long-term health effects of butterbur have not been studied.
Acute & PreventivePaidCaffeineLifestyleCaffeine is a stimulant that increases alertness, decreases fatigue, and improves muscle coordination. It is often found in coffee, tea, chocolate, and soft drinks. Caffeine is addictive. It is quickly absorbed by the body and moves rapidly to the brain. If used in excess, caffeine can be overstimulating and cause anxiety and sleep problems. Caffeine can help the body absorb some medications faster. Some sources suggest it can assist pain relievers by up to 40 percent. Caffeine is a double-edged sword for people with migraine. Any change in caffeine levels can contribute to an attack in some people. Consuming too much, too little, or skipping a day may also be a migraine trigger for some.
PreventivePaidCalciumVitamin/SupplementCalcium is essential for building and maintaining bone, and is required for the healthy functioning of the heart, muscles, blood and nerves.
AcutePaidCapsaicinVitamin/SupplementHot peppers (chilis) contain a substance known as capsaicin, a natural ingredient found in many topical pain-relief creams and ointments. Capsaicin has the ability to draw something called substance-P out of your nerves. Substance-P is a chemical messenger that carries a signal to the brain that is translated as pain. When you effectively block the messenger, you block the pain, too. Use caution, as contact with skin or eyes can be dangerous.
PreventivePaidCervical tractionProduct/DeviceAlso known as Neck Traction. This is a method to relieve neck pain by providing an opportunity for your neck muscles and pinched nerves to be released. Tension is placed on the head to pull it up and away from the neck, stretching muscles and ligaments around the vertebrae of the spine and expanding the space between the vertebrae. Also see Occipital Lift Technique.
PreventivePaidChinese herbal medicineVitamin/SupplementChinese herbal medicine is part of the ancient Chinese practice of Traditional Chinese Medicine. Chinese herbal medicine takes a holistic approach to understanding the body’s normal function and disease processes, and focuses on prevention. Herbs are prescribed to restore balance to the opposing forces of energy, Yin and Yang. A Chinese herbal practitioner prescribes a specific Chinese herbal formula designed to match and treat your health problems.
PreventivePaidChiropractorPhysical therapyChiropractors seek to relieve headache disorders based on the diagnosis and manipulative treatment of misalignments of the joints, particularly those of the spinal column. Manual techniques such as realignment may benefit corresponding nerves, muscles, or organs. Some medical doctors warn against allowing manipulation of the neck, which can result in a stroke.
PreventivePaidCoenzyme Q10 (CoQ10)/ UbiquinolVitamin/SupplementCoQ10 is a chemical naturally produced by the body and is essential for the proper functioning of cells. CoQ10 can help minimize damage to cells caused by the environment and other factors. There haven’t been many high quality trials but preliminary findings support the use of added CoQ10 for migraine treatment. A more concentrated form is known as ubiquinol. Sources of CoQ10 can be found as a supplement and naturally in most foods, with highest concentrations in the organs of animals (livers, hearts, and brains), soybeans, broccoli, dairy, avocados, the germ in grains, and most oils nuts and seeds.
PreventivePaidCognitive Behavior Therapy (trauma focused)Behavioral TherapyTrauma-focused cognitive behavioral therapy is a short-term intervention therapy for children, adolescents, adult survivors and families trying to overcome the destructive effects of early trauma such as abuse, violence, or grief.
Acute & PreventiveFree & PaidCognitive behavioral therapy (CBT)Behavioral therapyCognitive behavioral therapy (CBT) is a type of psychotherapy that helps people to change unhelpful or unhealthy thinking habits, feelings, and behaviors. CBT may be used to treat problems including anxiety, depression, low self-esteem, uncontrollable anger, substance abuse, eating disorders, and other problems. There is scientific evidence that supports the use of CBT for migraine.
PreventivePaidCognitive behavioral therapy for insomnia (CBT-I)Behavioral therapyCognitive behavioral therapy for insomnia (CBT-I) is a structured program that helps people identify and replace thoughts and behaviors that cause or worsen sleep problems with habits that promote sound sleep. Treatment takes approximately 6-8 sessions and can be done with a therapist or via an app.
AcutePaidCooling gel sheetProduct/DeviceApplying cold items or ice packs to the head helps promote circulation and reduces the inflammation in the head caused by migraine.
PreventiveFreeCreative therapyBehavioral therapyCreative therapy includes a variety of hands-on artistic activities that slow down your mind, increase your concentration, and help you feel more present. This art-induced meditative state comes with many proven health benefits for pain relief, and less anxiety and depression. Forms include music therapy, dance/movement therapy, visual art therapy and expressive writing.
PreventivePaidDaith piercingProcedureThe daith piercing punctures the upper lobe of the ear with an earring, and is said to correspond to an acupressure point within the ear that lines up with the digestive system. It is typically performed at a tattoo parlor. The procedure takes a long time to heal and runs the risk of infection. Experts believe it offers a temporary placebo effect for migraine relief and no lasting therapeutic value. There is currently no evidence supporting its use.
AcuteFreeDark, quiet roomLifestyleWhen a migraine attack occurs, it’s been described as a malfunction where normal sensory inputs such as light, sound, or smell can cause pain. Removing yourself from these irritants can expedite your recovery, and many people find moderate to major relief in a dark, quiet room.
PreventiveFree & PaidDetoxification (Detox)LifestyleA detox is a diet plan that requires you to follow a particular diet over a certain period of time in order to cleanse the body. It may also include (paid) herbal supplements or other methods, such as colonic irrigation, all of which aim to remove environmental and dietary toxins from the body. There is no evidence supporting its benefits or its use for migraine prevention.
PreventiveFreeDiet - 5:2 dietLifestyleThe 5:2 diet is an intermittent fasting diet that has become popular after Dr Michael Mosley’s documentary on the benefits of intermittent fasting. This diet involves eating normally for five days out of a seven-day period and greatly restricting the amount of food eaten on the other two days. Preliminary studies have shown that intermittent fasting can fend off illnesses including cancer, diabetes, heart disease, and neurodegenerative disorders. It is not highly recommended for people with migraine, however, who typically respond better to a diet regime that promotes regular meals.
PreventiveFreeDiet - Anti-inflammatory dietLifestyleAn anti-inflammatory diet is a style of eating that centers on foods that lower inflammation in the body. Mainstays of an anti-inflammatory diet include fruits and vegetables, whole grains, beans and nuts, fish, and fresh herbs and spices. The diet is high in omega-3 fatty acids and omits foods that are processed, greasy, or sugary. Widely regarded as a healthy lifestyle choice, an anti-inflammatory diet may help in the reduction of chronic pain.
PreventiveFreeDiet - Elimination dietLifestyleAn elimination diet is often conducted under the guidance of a doctor or nutritionist to establish which foods are triggering migraine attacks. An elimination diet requires an individual to strip back to a few safe foods for several weeks to establish a baseline before gradually reintroducing foods one at a time, often several days apart. If a migraine attack occurs while a new food is being introduced, then it may be attributed to that food and consequently the food is removed from the diet.
PreventiveFreeDiet – Gluten-free dietLifestyleGoing gluten-free has been reported to help some people with migraine. Celiac disease occurs when the small intestine is hypersensitive to gluten, leading to difficulty in digesting food. Although people with migraine do not necessarily have celiac disease, some patients may be gluten sensitive. These patients’ test results often are negative for traditional reactions to gluten, but instead show signs of a different immune reaction. If you experience gastrointestinal symptoms such as bloating, diarrhea, and constipation, as well as fatigue and mental “fog,” it may be worth trying a gluten-free diet. There is, however, no strong evidence linking this diet to migraine.
PreventiveFreeDiet - High in omega-3/low in omega-6LifestyleEating a diet high in omega-3 fatty acids can decrease the frequency of headaches in persons with migraine. Eating a diet high in omega-3 fatty acids and low in omega-6 fatty acids can further decrease headache frequency in persons with migraine. Foods that are high in omega-3 fatty acids include deep cold-water fishes (e.g., mackerel, salmon, sardines), krill, and flax seeds. Intake of omega-6 fatty acids can be reduced by avoiding processed foods and adding in more fruits and vegetables.
PreventiveFreeDiet - Ketogenic dietLifestyleThis is a high-fat, adequate-protein, low-carbohydrate, low-sugar diet that in medicine is used primarily to treat difficult-to-control epilepsy in children. In small case studies, migraine has been shown to improve while on a ketogenic diet. Further study is needed. 
PreventiveFreeDiet - Mediterranean dietLifestyleThe Mediterranean diet is modeled after the traditional diets of Mediterranean countries like Italy and Greece. The diet is considered anti-inflammatory and is often recommended as a means of preventing disease and promoting longevity. Main components include a high intake of vegetables, fruits, whole grains, and healthy fats (such as olive oil); frequent consumption of fish, poultry, nuts, and eggs; and limited consumption of dairy and red meat.
PreventiveFreeDiet - Paleo dietLifestyleThe Paleo diet, also known as the Caveman or Stone Age diet, mimics the hunter-gatherer diet of our Paleolithic ancestors. It promotes consumption habits that avoids grains, legumes, and some dairy products in favor of the foods available to our ancestors during this period. Caution should be taken, as any diet that excludes entire food groups may be detrimental. Published studies for the diet are small, with too few participants to claim reputable scientific evidence.
PreventiveFreeDiet - Vegan dietLifestyleVegans, in addition to being vegetarian, do not use other animal products and by-products such as eggs, dairy products, honey, leather, fur, silk, wool, cosmetics, and soaps derived from animal products. There is no evidence linked to migraine improvement.
PreventiveFreeDiet - Vegetarian dietLifestyleVegetarians do not eat meat, fish, or poultry. There is no evidence linked to migraine improvement.
PreventiveFreeDietary changesLifestyleWhat you eat can play a significant role in your migraine. There are a number of foods that are problematic for a large number of migraine sufferers. Understanding which foods, if any, trigger your migraine attacks can be essential to successful migraine management. Common food triggers to be aware of are food additives such as nitrites and MSG (monosodium glutamate), food coloring, chocolate, aged cheese, red wine, beer, caffeine, citrus fruits, cured meats, aspartame and ice cream. If you are unsure, it may be worthwhile speaking with your doctor or seeing a dietitian or nutritionist to manage your diet. They can also help determine if you have any food allergies that may be contributing to your migraine attacks.
PreventivePaidD-Ribose (Beta-D-ribofuranose)Vitamin/SupplementD-Ribose is a type of sugar that is produced by the body which can be used as a supplement. It’s often used to improve athletic performance and the ability to exercise by boosting muscle energy. It has also been used to help prevent cramping, pain, and stiffness after exercise in those with genetic disorders.
Acute & PreventivePaidDry needlingPhysical therapyDry needling is a treatment performed by trained physiotherapists (or physical therapists) that involves inserting thin, filament needles into trigger points — knotted parts of the muscle that affect function and motion and can cause pain. Dry needling can help alleviate tension and allow muscles to return to a relaxed state. In a person with migraine, dry needling could especially help improve pain in the muscles of the temples, jaw, neck, shoulders, and back of the head. For those for whom muscle tightness is a trigger, dry needling could serve as a preventive treatment for migraine.
PreventiveFreeEliminate cigarette smokingLifestyleQuitting smoking is a smart choice for your health. Cigarette smoke contains over 4,000 chemicals including 43 known cancer-causing (carcinogenic) compounds and 400 other toxins. Apart from the obvious health benefits, cigarette smoke is a trigger for some people with migraine, and the chemical damage to an individual’s health that results from smoking is likely to make existing health conditions worse.
PreventiveFreeEliminating alcoholLifestyleAlcohol causes headaches even for people who don’t experience migraine. If you are susceptible to migraine and you drink alcohol, it is almost always a contributing factor. It is one of the least disputed food triggers for migraine because it is so common. About a third of migraine sufferers list alcohol as a trigger.
PreventiveFreeEliminating caffeineLifestyleWhile caffeine has its advantages (see Caffeine for detail), for many people with migraine, the disadvantages outweigh the benefits. Consequently, a person with migraine may gradually wean down and eventually eliminate their caffeine consumption over time.
PreventiveFreeEliminating chocolateLifestyleSome people with migraine list chocolate as a trigger food. Some neurologists say it is a migraine trigger because it contains the amino acid tyramine. The connection could also be that some people tend to crave chocolate during stress and hormonal changes, both of which may also trigger headaches.
PreventiveFreeEliminating dairyLifestyleDairy can be a migraine trigger for some. Much of the world's population is lactose intolerant and can't consume large amounts of dairy foods.
PreventiveFreeEliminating glutenLifestyleSee ‘Diet – Gluten-Free’
PreventiveFreeEliminating MSGLifestyleMSG, or monosodium glutamate, is an amino acid used as a food preservative and flavor enhancer. It has been named as a common migraine trigger. It is not limited to Chinese food and has many aliases, making it difficult to detect on packaged foods ingredient listings.
PreventiveFreeEliminating nitrates/nitritesLifestyleNitrates are converted into nitrites once they are digested. Foods high in artificially added nitrates have been linked to migraine as well as a potentially higher risk of cancer. Processed meats such as bacon, hot dogs, sausages, cured ham, cold cuts, and related products commonly have artificially added nitrates as a preservative.
PreventiveFreeEliminating soyLifestyleSoy has been linked to migraine in some people. In addition to soy beans, soy products are often included in breads, crackers, cakes, rolls, processed cereals, canned soups, ice cream, frozen desserts, margarines, butters, salad dressings, sauces, breakfast bars, and other products, as well as soy sauce, soy lattes, tofu, and miso.
PreventiveFreeEliminating sulfates/sulfitesLifestyleSulfates are found commonly in wine as a preservative, though some preservative-free wines are now available. Sulfates are thought to be a reason why wine is a significant migraine trigger. Sulfate is also used as a preservative in dried fruit and many dried-fruit products.
PreventiveFreeEliminating tyramineLifestyleTyramine has been recognized as a common migraine trigger, though experts are still trying to understand why. One explanation might be that tyramine can cause nerve cells in the brain to release a chemical called norepinephrine, and the norepinephrine may cause changes in the brain that lead to migraine. Tyramine is found in red or balsamic vinegar, aged cheeses, chocolate, smoked fish, bacon, sausages, hot dogs, avocado, red plums, bananas, citrus fruits, olives, processed meats, and some types of alcohol.
AcuteFreeEmotional freedom technique (EFT)Behavioral therapyEmotional freedom technique (EFT), also referred to as "tapping", is an alternative treatment for physical pain and emotional distress. EFT involves fingertap tapping on the meridian points (like the ones used in acupuncture) to restore the body's energy, which can lead to relieving symptoms of a negative experience or emotion.
Acute & PreventivePaidEpsom salt bathsProduct/DeviceMagnesium sulfate is the scientific name for Epsom salt. The magnesium and sulfates in Epsom salt are apparently absorbed through the skin and may increase the magnesium levels in your body. Epsom salt baths are popular for softening and exfoliating skin, relaxation, drawing impurities out of skin and relieving migraine and cold or flu symptoms. Consult with your physician before taking Epsom salt baths if you are pregnant or have a medical condition.
PreventivePaidEssential oilsProduct/deviceSee Aromatherapy.
AcutePaidEvening primrose oilVitamin/SupplementEvening primrose oil contains “fatty acids” which are thought to help decrease inflammation related to conditions like arthritis or migraine. Evening primrose oil has been used for a range of disorders, including skin complaints such as eczema, psoriasis, and acne. It is also used for other conditions including rheumatoid arthritis, multiple sclerosis, high cholesterol, and heart disease.
PreventiveFreeExerciseLifestyleExercise helps with rest and relaxation and it also helps release stress, a common trigger for migraine. Most experts recommend at least 30 minutes of moderate exercise daily to get the best results for stress reduction. If you can find things you enjoy doing, you’re more likely to be consistent. Anything is better than nothing. If exercise triggers migraine, however, start small. If you’re outside, wear polarized sunglasses. Ensure that you’ve eaten enough and stay hydrated. Starting small and building upwards is a much more successful approach than trying to jump in without preparation. Many people with migraine find yoga, Pilates, or t’ai chi to be great low-impact options.
PreventivePaidFeverfewVitamin/SupplementFeverfew is an herb with leaves containing natural anti-inflammatory qualities. It may prevent the release of blood-vessel dilating substances in the brain and may reduce inflammatory substances from developing, both of which can increase pain levels. It does provide relief for some sufferers and, given its low side effects, it is a relatively low-risk option.
PreventivePaidFolateVitamin/SupplementFolate is also known as folic acid or vitamin B9. This vitamin is important for cell growth and metabolism. Folate is the natural version found in foods, and folic acid is the man-made version found in supplements and added to foods. See Folic Acid for more details.
PreventivePaidFolic acid / Vitamin B9Vitamin/SupplementFolic acid is a type of B vitamin that is normally found in foods such as dried beans, peas, lentils, oranges, whole-wheat products, liver, asparagus, beets, broccoli, Brussels sprouts, and spinach. Folic acid helps your body produce and maintain new cells, and also helps prevent changes to DNA that may lead to cancer. As a medication, folic acid is used to treat folic acid deficiency and certain types of anemia (lack of red blood cells) caused by folic acid deficiency.
PreventiveFreeForest bathingLifestyleForest bathing is a Japanese technique that involves sitting in the forest and being surrounded by greenery. In Traditional Chinese Medicine this is one of the treatments for issues relating to the Wood element, which includes migraine.
Acute & PreventivePaidGingerVitamin/SupplementGinger is an herb known for its antinausea, antidiarrhea, and digestion-aiding properties. It can be consumed in many forms including raw, as powders, in supplements and in ginger ale. Ginger is used in migraine to alleviate the symptoms of nausea and vomiting. Ginger root can also be used in the treatment of migraine. Ginger contains more than 200 substances in its oils that help facilitate its many roles. For migraine, it is thought that ginger may block prostaglandins, which stimulate muscle contractions and control inflammation and some hormones.
PreventivePaidGlucosamineVitamin/SupplementGlucosamine is a natural chemical compound found in the body. As a supplement, glucosamine is most often used to try to ease the joint pain caused by arthritis.
AcutePaidGreen-Light Lamp, The Allay Lamp Product/DeviceTherapeutic light device designed to reduce anxiety and migraine intensity during an attack. It is based on scientific evidence from seven years of research at Harvard Medical School. The studies show that light made up of all the colors of light (red, blue, yellow, etc.) generates large electrical signals in the eye and brain, which tend to hurt people with light sensitivity. A very specific narrow band - which is the only light emitted by the Allay Lamp - generates smaller electrical signals in the eye and brain.
AcuteFreeHeat therapyLifestyleHeat therapy can increase blood flow to muscles and help relax them. Heat therapy can also stimulate nerve endings, which may block pain signals from the affected area to the brain. Examples of heat therapy include heating pads, heat lamps, hot packs, and hot water bottles. If the temperature of the heat therapy becomes too high, discomfort or even burns may occur.
Acute & PreventivePaidHerbal teasVitamin/SupplementHerbal teas contain vitamins and nutrients. Drinking hot herbal tea can also be a calming and relaxing activity that helps with hydration. Commonly used teas to help with migraine related symptoms include Dandelion, Chamomile, Ginger, and Mint.
PreventivePaidHomeopathyTherapyHomeopathy is a form of alternative medicine that claims to stimulate the body’s own healing response to disease using highly diluted preparations (potentizing). There are no effective homeopathic vaccines, and homeopathic treatments should not be used to replace conventional medical treatment of serious diseases or infections. The effectiveness of homeopathy has not been proven by medical science.
Acute & PreventiveFreeHydrationLifestyleDehydration is a common migraine trigger. Keeping water on hand throughout the day helps ensure you get the recommended eight glasses per day.
Acute & PreventiveFreeHydrotherapyLifestyleHydrotherapy involves the use of water for pain relief and treatment. Using ice packs on the head or splashing the face with cold water can help provide relief. Having hot and cold showers dilates then constricts blood vessels, which stimulates circulation. Exercise in water, such as water aerobics, is another form of hydrotherapy.
PreventivePaidHyperbaric oxygen therapyTherapyHyperbaric oxygen therapy (HBOT) is an immersive, enclosed chamber where 100 percent oxygen flows with no mask or cannulae. It does not require a prescription. Hyperbaric oxygen therapy hasn’t been shown to be as effective for migraine as it is for cluster headache. See Oxygen in Medical Treatments.
PreventivePaidHypnotherapy/ HypnosisTherapyHypnosis is the induction of a state of consciousness in which a person apparently is highly responsive to suggestion or direction. Its use in therapy to recover suppressed memories or to allow modification of behavior is controversial.
AcuteFreeIce/cold therapyProduct/DeviceCold slows down blood flow to an injury, thereby reducing pain and swelling. Cold therapy slows circulation, reduces inflammation, muscle spasms, and pain. It is often found to be helpful for people wanting to "take the edge off” a migraine attack by applying ice or cooling gel sheets to painful areas on the head. Wearable ice packs permit sleeping and movement while worn.
PreventiveFreeImproving postureLifestylePoor posture can result in tightening muscles in the neck or scalp, which may lead to headache and migraine. Extended reading looking down at a mobile phone or hunching over a computer, laptop, or gaming console can lead to neck and back pain and can trigger an attack. Modern laptops encourage poor posture. Correcting postural issues may help relieve migraine and reduce the frequency of attacks.
PreventivePaidIron supplementsVitamin/SupplementIron is a mineral found naturally in foods as well as a vitamin supplement. Iron is required for growth, development, normal cellular functioning, and synthesis of some hormones and connective tissue.
PreventivePaidIsoflavonesVitamin/SupplementIsoflavones (e.g. Promensil) are polyphenolic compounds that are capable of exerting estrogen-like effects. For this reason, they are classified as phytoestrogens – plant-derived compounds with estrogenic activity. Legumes, particularly soybeans, are the richest sources of isoflavones in the human diet.
PreventivePaidKrill oilVitamin/SupplementKrill oil capsules are a more highly concentrated form of omega-3 fats than fish oil capsules, with similar benefits. The omega-3 fats EPA and DHA play an important role in emotional health, and deficiencies have been linked to mood disorders. Krill oil helps reduce inflammation, which causes pain. (See Omega-3).
Acute & PreventivePaidLavender oilVitamin/SupplementLavender oil may help reduce nervous tension and pain, and enhance blood circulation. Its calming scent makes it a popular choice for anxiety issues. It is also used as a natural alternative to help with insomnia.
PreventivePaidL-carnitineVitamin/SupplementL-carnitine is an amino acid naturally produced by the body. It can be used as a supplement when natural levels are low or for those on a vegetarian diet. Not FDA approved for migraine.
PreventivePaidL-methylfolate / Levomefolic acidVitamin/SupplementL-methylfolate is a particular type of folic acid supplement that provides the body with folate. It can assist in the management of low plasma or low red blood cell folate in patients.
PreventivePaidMagnesium (including variants i.e., citrate, glycinate, threonate oxide)Vitamin/SupplementDuring a migraine attack, low levels of magnesium have been shown in the brain. It’s thought that magnesium deficiency and migraine may be related since magnesium is required for proper nerve function. Magnesium as a preventive may be especially helpful for those with hormonal migraine. Sources of magnesium include legumes, nuts, whole grains, seeds, leafy green vegetables, soy products, bananas, dried apricots, avocados, and supplements. Dr. Mark Hyman recommends a high dose of magnesium citrate or glycinate at 300-600 mg twice per day to help prevent migraine attacks. Magnesium threonate may be used to improve sleep if one has trouble falling asleep.
PreventivePaidMagnotherapyTherapyAlso known as magnet therapy or magnetic therapy. It is an alternative practice involving the use of static magnetic fields. Practitioners of magnotherapy claim that subjecting certain parts of the body to magnetostatic fields produced by permanent magnets has beneficial health effects. These physical and biological claims are unproven and no effects on health or healing have been established.
PreventiveFreeManage stressLifestyleStress in its many forms is one of the most significant factors for people with migraine. Stress can come from strong emotions, both negative and positive. But it can also descend into anxiety, panic attacks, and depression. Stress can easily creep up on you. You get used to it. It can feel familiar or even normal without any realization of the heavy toll it takes. Stress can be beneficial at a mild level, but beyond a certain point it starts causing major damage to your health, particularly in relation to migraine conditions.
Acute & PreventiveFreeMeditationBehavioral therapyRecent research has shown very promising results for meditation, with all participants reporting less severe migraines as well as other benefits including reduced stress, less anxiety, better sleep, better general health, concentration, self awareness, and self control.
PreventivePaidMelatoninVitamin/SupplementMelatonin acts on the receptors for many pain-relieving molecules in the brain (e.g. opioid receptors), leading to a decrease in pain sensations when melatonin levels are high. Melatonin supplements have been shown to lower pain intensity, and a clinical trial found that 3 mg of melatonin 30 minutes before bedtime helped to reduce the overall frequency, intensity, and duration of migraine headaches for the subjects in the study.
AcutePaidMenthol/Mint, CamphorVitamin/SupplementPeppermint and menthol are numbing and calming, making them useful to soothe the overactive nervous system during a migraine attack. It can be inhaled, applied topically, or ingested. There’s growing evidence that menthol for migraine is just as effective as over-the-counter medications to treat an attack in the early stages. Camphor is a waxy terpene commonly used in creams ointments, and lotions. It has a wide variety of topical uses, including as an anti-inflammatory. Can be used to treat mild to moderate pain.
PreventiveFree & PaidMigraine BuddyProduct/DeviceUsing a migraine app means being able to go to your doctor with proper documentation to answer questions such as, "How many migraine days do you have? How many types of treatments are you taking?" It also assists with identifying potential triggers, showing how migraine evolved with the treatment provided and the level of relief with those treatments.
PreventivePaidMigraine Support FormulaVitamin/SupplementThis is a multivitamin product designed specifically for people with migraine, which combines several well-known vitamins and supplements to help relieve migraine into one pill. Vitamins included are riboflavin, niacin, vitamin B6, magnesium, ginger, CoQ10, white willow, feverfew, butterbur & black pepper.
Acute & PreventiveFree & PaidMindfulnessLifestyleA form of meditation based on a moment-by-moment awareness of thoughts, feelings, bodily sensations, and surrounding environment. It means tuning in to the present moment, paying attention to thoughts and feelings without judgment. Though it has its roots in Buddhist meditation, mindfulness has entered the mainstream in part through the work of Jon Kabat-Zinn and his Mindfulness Based Stress Reduction (MBSR) program. Thousands of studies have documented the mental and physical benefits of MBSR, often used in pain reduction.
PreventivePaidMyofascial releasePhysical therapyMyofascial release (MFR) is a soft-tissue therapy for the treatment of skeletal muscle immobility and pain. This alternative medicine therapy aims to relax contracted muscles, improve blood and lymphatic circulation, and stimulate the stretch reflex in muscles.
PreventivePaidN1-Headache appProduct/DeviceN1-Headache is a smartphone app that allows users to track migraine symptoms, triggers, and medications for 90 days and then produces an individualized report. N1 can identify triggers and protectors and is able to eliminate nonrelevant factors. This approach can help untangle the interactions between triggers and protectors that govern attacks.
PreventivePaidNaturopathyTherapyNaturopathy is a holistic approach to wellness based on the principle that the body has the inherent ability to heal itself. Using gentle therapeutic techniques, the body, mind, and emotions are supported during the healing process. Naturopathic medicine has been criticized for its lack of scientific evidence and conflicts with evidence-based medicine. For example, many naturopaths oppose vaccination.
Acute & PreventivePaidNeck/Scalp massagePhysical therapyMassage involves working and acting on the body with pressure that is either manual or with mechanical aid. Peer-reviewed medical research has shown that massage can help with pain relief, anxiety, and depression, as well as temporarily reduce blood pressure and heart rate.
PreventivePaidNiacin / Vitamin B3Vitamin/SupplementVitamin B3 helps release energy from carbohydrates, fats, and cholesterol while regulating blood sugar levels. Supplemental vitamin B3 causes the face and skin to flush, which is thought to help release the pressure of a migraine headache.
PreventivePaidNight or Mouth guardProduct/DeviceA dental guard (occlusal splint, mouth guard, night guard, or bite plate) is a custom-fitted dental device meant to prevent teeth grinding and jaw clenching, either while awake or asleep. Mouth guards not only protect the teeth but can also alleviate jaw and head pain that occurs from bruxism, or clenching and grinding of the teeth.
Acute & PreventivePaidNoise-cancelling headphonesProduct/DeviceNoise-canceling headphones block out ambient sound and background noise. Reduction in noise can be helpful for those with sound sensitivity during a migraine attack and in preventing migraine if noise is a trigger. Noise-canceling headphones are widely available by most major brands including Bose, Sony, Apple, Beats, Bang & Olufsen, and JBL, etc.
PreventivePaidNutraceuticalsVitamin/supplementNutraceuticals are products derived from food sources that provide nutrition and medicinal benefits. Examples of nutraceuticals include dietary supplements, diets, herbal products, and vitamins.
Acute & PreventivePaidOccipital lift techniquePhysical therapyTypically performed by a manual therapist, for example a physiotherapist or chiropractor, the occipital lift technique is where the therapist gently lifts the head away from the neck to allow for a release in tension and muscle relaxation. Practitioners believe that this practice may facilitate an increase in venous and lymphatic drainage from the skull, improve circulation, promote relaxation, and reduce blood pressure, all of which can relieve headaches.
PreventivePaidOmega-3Vitamin/SupplementOmega-3 fatty acids are found mostly in fish and fish oils but also in nuts, seeds, and vegetable oils. According to the American Heart Association, the omega-3 in fish oil may reduce inflammation, aid in preventing blood clotting, improve blood pressure, and steady the heart rhythm. This may be useful in the reduction of migraine as it may reduce inflammation in the head. Sources of fish oil can be obtained from taking supplements or by eating fish including mackerel, tuna and salmon, among others.
PreventivePaidOsteopathyPhysical therapyOsteopathy is a type of alternative medicine physical therapy that emphasizes physical manipulation of the body's muscle tissue and bone. It can be used to correct misalignments that may trigger migraine attacks in some people.
AcuteFreePassage of timeLifestyleWhile not technically considered a treatment, the passage of time is one of the most common tactics people with migraine employ to get over the worst part of their attacks. Resorting to “waiting it out” may be due to a lack of effective acute treatment, lack of knowledge about available treatments, or a lack of willingness to try new options with the help of a doctor.
Acute & PreventivePaidPedialyteVitamin/SupplementPedialyte is designed to promote rehydration and electrolyte replacement in ill children. Compared to Gatorade, Pedialyte contains more sodium and potassium, and does not contain sucrose, but may contain synthetic sweeteners.
PreventivePaidPeppermint oilVitamin/SupplementPeppermint oil is used for a variety of health conditions and can be taken orally in dietary supplements or topically as a skin cream or ointment. Some evidence suggests that peppermint oil may help relieve symptoms of irritable bowel syndrome and indigestion. Despite promising findings, there is no clear-cut evidence to support its use for other health conditions. Its use is not advisable for pregnant women.
PreventiveFreePERMA™ Theory of Well-BeingBehavioral therapyPERMA™ Theory of Well-Being focuses on five building blocks that enable an individual's flourishing: Positive Emotion, Engagement, Relationship, Meaning, and Accomplishment. There are techniques to increase each building block and the process will vary from person to person. Having a greater sense of well-being can help with having fewer sleep problems, lower levels of burnout, and better self-control and coping abilities.
PreventivePaidPetadolex (butterbur extract)Vitamin/SupplementButterbur is an herbal supplement that has been reported to be effective in reducing the frequency and severity of migraine in some people with migraine. However, caution should be exercised with butterbur, as it contains components called pyrrolizidine alkaloids (PAs), which are toxic to the liver and may cause cancer. The concentrations of this toxin vary depending on which part of the plant is harvested and where the plant is grown. Petadolex is a brand name of the vitamin producer whose makers claim that it doesn’t contain the harmful chemicals (PAs) within butterbur.
PreventivePaidPhysiotherapy / Physical TherapyPhysical therapyPhysical therapy or physiotherapy has the potential to release pressure, tension, strain, or injury that may lead to headaches. It is also a medically respected approach to treat physical ailments. People with migraine are known to have a number of trigger points in the shoulders, back, and neck. Releasing these areas may be particularly useful to help desensitize nerves, which may be leading to migraine, particularly if you feel your migraine attacks are caused by neck issues.
PreventiveFree & PaidPilatesLifestylePilates is a system of exercise with or without special apparatus, designed to improve physical strength, flexibility, and posture, and enhance mental awareness. The two primary types are Mat Pilates, which can be done for free or in a paid class; and Reformer Pilates, which requires the use of a specially designed table and is usually done with a paid instructor at a studio or physical therapy office.
Acute & PreventivePaidPillow (Shaped or Cooling)LifestyleA pillow that supports the natural curve of the neck can help to reduce neck pain and improve sleep quality. A pillow with a cooling segment can be comforting during a migraine attack.
Acute & PreventivePaidPlacebo response-Occurs when a person perceives an improvement (a nocebo response is a negative response or worsening) in symptoms or overall health after receiving a treatment or medication. This is from the psychological effect of receiving this treatment/medication, rather than the treatment/medication itself. Sometimes a sugar pill is enough to improve a person’s condition because of this effect. This is a powerful effect and could be even more so if harnessed into a treatment.
Acute & PreventiveFreePrayerLifestylePrayer can provide comfort, strength, and reassurance for those who practice it as part of their faith. It offers hope for those who are dealing with chronic pain and health issues.
PreventivePaidProbioticsVitamin/SupplementProbiotics are live bacteria and yeasts that are good for your health, especially your digestive system. Increasing evidence considers the gut to be the “second brain,” and the gut-brain connection to be a significant factor in our well-being. They can be consumed through supplments or naturally in many fermented foods including certain yogurts, pickles, sauerkraut, miso, tempeh, kombucha, sourdough bread, and some cheeses.
Acute & PreventiveFree & PaidProgressive muscle relaxation therapyBehavioral therapyProgressive muscle relaxation, also known as Jacobson's relaxation technique, involves tensing a group of muscles while breathing in, then relaxing them while breathing out. Muscle groups are tensed and relaxed in sequence until the entire body is relaxed. This strategy is helpful for migraine, anxiety, and general stress management.
AcutePaidPsilocybinVitamin/SupplementPsilocybin is a naturally occurring psychedelic prodrug compound produced by various species of mushrooms. The prodrug is converted by the body to psilocin, which has mind-altering effects similar to LSD and mescaline. Psilocybin has been reported to abort cluster headache attacks.
PreventivePaidPsychotherapyBehavioral therapyPsychotherapy is a general term for treating mental health problems or emotional difficulties by talking with a psychiatrist, psychologist, or other mental health provider. Psychotherapy can help a person to take control of their life and respond to challenging situations with healthy coping skills. For persons with chronic conditions, psychotherapy can help with accepting the diagnosis and condition, making adjustments to everyday life, and managing related emotions and stresses.
Acute & PreventiveFree & PaidQigongLifestyleQigong practice involves posture or movements, breathing techniques, and mental focus, which aim to integrate and cleanse the body and mind. Qigong is a type of mind-body training; regular practice helps physical relaxation and mental calm.
PreventiveFree & PaidReflexologyPhysical therapyReflexology is an alternative medicine involving the application of pressure to the feet and hands with specific thumb, finger, and hand techniques without the use of oil or lotion. It is based on a system of zones and reflex areas that purportedly reflect an image of the body on the feet and hands, with the premise that such work affects a physical change to the body.
PreventivePaidReikiPhysical therapyReiki is a technique commonly called palm healing or hands-on healing. Through the use of this technique, practitioners believe that they are transferring "universal energy" through the palms of the practitioner, which they believe encourages healing. It is based on “qi,” which practitioners say is a universal life force, although there is no empirical evidence that this life force exists. Global cancer societies state that Reiki should not be a replacement for conventional treatment of diseases such as cancer, but that it may be used a supplement to standard medical treatment.
Acute & PreventiveFree & PaidRelaxation techniquesBehavioral therapyRelaxation techniques help control stress. They can also help you fall asleep faster. Common relaxation techniques include meditation, t’ai chi, massage, and deep breathing.
PreventivePaidRemedial massagePhysical therapyRemedial massage, also known as medical masssage or sports massage, is a type of massage that focuses on relieving muscle tension and treating chronic pain. It can can reduce headaches by relieving muscle tension throughout the body.
PreventiveFreeResilienceLifestyleResilience is the process of adapting well (or "bouncing back") in the face of adversity, trauma, tragedy, threats, or significant sources of stress. Resilience helps people get through difficult circumstances and also empowers them to grow and improve their life along the way.
AcuteFreeRub/pressure templesLifestyleRubbing or placing pressure on the temples can be a self-massage technique that is sometimes known as "the temple rub.” It’s simple to apply. Take deep breaths and rub your temples in gentle circles. Rubbing your temples in forward circles toward your ears and nose is generally the direction suggested. Do so for at least 10 circles and 10 deep breaths. It is claimed to help relieve headache and neck aches.
PreventivePaidSaffronVitamin/SupplementSaffron contains several plant-derived chemical compounds that are known to be antioxidant, disease preventing, and health promoting. It is also an excellent source of vitamins and minerals including vitamin A, folic acid, riboflavin, niacin, vitamin C, copper, potassium, calcium, manganese, iron, selenium, zinc, and magnesium.
AcutePaidSalt Crystals/Salt lampsVitamin/SupplementNatural salts such as Himalayan salt contain numerous minerals and electrolytes. Taking 2 teaspoons mixed with lemon juice in a cup of water may help a migraine attack. Salt lamps — which are thought to help purify the air by attracting moisture, humidity, and other airborne water molecules — may also be used.
PreventiveFreeSEEDSLifestyleSEEDS is an acronym for a lifestyle management technique. It stands for regular Sleep, regular Eating, regular Exercise, Drinking water (staying well-hydrated and avoiding caffeine and alcohol), and Stress reduction.
Acute & PreventiveFreeSelf-acupressurePhysical therapyAcupressure is an ancient practice of using the fingers to gradually press key healing points, which stimulate the body's natural self-curative abilities. Self-acupressure is the practice of pressing on these certain points yourself, rather than by an acupressure practitioner. There are many different points, but the Hoku Point (LI4), just behind the webbing between your thumb and index finger, is considered helpful in relieving headaches.
PreventivePaidShiatsuPhysical therapyShiatsu is a Japanese form of massage therapy that involves targeted hand pressure to certain body points to help restore the “energy balance” and promote relaxation.
Acute & PreventiveFreeSleepLifestyleSleep is a restorative brain function that affects many other aspects of bodily function. It is a vital and often neglected area for people with migraine. Sleep helps the body to heal itself. It powers down areas of the body so that recovery and repair can be performed. As a preventive measure, good sleep hygiene is a practice that ensures at least 7-8 hours per night on a consistent sleep/wake cycle. As an acute treatment, many people list sleep as one of the most effective acute treatments for migraine.
Acute & PreventivePaidSleeping maskProduct/DeviceA sleeping mask is a simple tool used to cover the eyes to facilitate sleep in an area with distracting lights. If you are woken by light early in the morning, wearing a sleeping mask may facilitate more sleep after the sun has risen.
Acute & PreventivePaidSmartphone and computer-screen filtersProduct/DeviceSmartphone filters, such as Apple's Dark Mode, in which users can choose a dark palette for all screens, views, menus and controls. Contrast and transparency can be adjusted for comfort and legibility. For computer screens, f.lux is a free software that changes a user's computer dispay to adapt to the time of day: warm at night, and like sunlight during the day. Such filters are said to promote better sleep.
PreventiveFreeSmell retraining therapyPhysicalSmell retraining therapy is typically used as a treatment for loss of smell. It helps to rebuild the connection between the nose and the brain to recover the sense of smell. It involves sniffing several potent scents for 10-15 seconds each time, 2-4 times/day, for 10-16 weeks. The most recommended scents are rose, lemon, cloves, and eucalyptus.
PreventiveFreeSocial connectionLifestyleSocial connection is the feeling of belonging to a group and feeling close to other people. The support one receives from their social connections can add to the feelings of meaning and purpose in life, which then contributes to resilience.
Acute & PreventiveFreeSocial supportLifestyleSocial support can be broken down into four forms. Emotional: people who offer the proverbial shoulder to cry on. Informational: people you can go to for advice and information. Belonging: people who give you the sense that you're not alone, you're part of a family or a community. Esteem: people who make you feel like you have value and worth.
AcutePaidSports DrinksProduct/DeviceSport drinks like Gatorade and Powerade that aid in rehydration contain a mixture of helpful electrolytes including sodium and potassium, as well as sugar and water. Electrolytes are required for hydration and proper nerve and muscle function.
PreventivePaidSt. John’s WortVitamin/SupplementSt. John’s Wort is most used for depression and conditions that sometimes go along with depression, such as anxiety, tiredness, loss of appetite, and trouble sleeping. There is scientific evidence supporting its effectiveness for mild to moderate depression. The evidence for migraine is inconclusive. Consult your Doctor before taking it as many contraindications exist for St. John's Wort.
PreventiveFreeStretchingLifestyleStretching can be beneficial in relieving muscle tension that can lead to stiffness and pain. Neck exercises and shoulder shrugs can be helpful in keeping the area around the neck and head limber. It also helps settle trigger points. Next time you feel an oncoming attack, try a few gentle stretches and see if it helps alleviate the attack.
PreventiveFree & PaidT’ai ChiLifestyleT’ai chi is a form of traditional Chinese exercise that purports to improve health by changes in mental focus, breathing, coordination, and relaxation. The goal of t’ai chi is to “rebalance” the body's own healing capacity. It has been practiced in China for hundreds of years. A 15-week intervention of t’ai chi practice was effective in reducing headache impact and also effective in improving perceptions of some aspects of physical and mental health.
Acute & PreventivePaidTHCVitamin/supplementTHC is a psychoactive compound of marijuana used by some for preventive or acute migraine treatment. THC and marijuana are controlled substances in the U.S., prohibited by federal law.
PreventivePaidTinted migraine glasses and contactsProduct/DeviceMigraine glasses or contacts fitted with an FL-41 tint, offered in indoor and outdoor tints, reduce glare and blue light from digital screens. People with photophobia and light sensitivity as a trigger may find benefit with these products. Yellow-tinted and amber-tinted lenses are popular choices for managing light sensitivity.
Acute & PreventivePaidTrigger point injectionsPhysical therapyTrigger points are knotted or tightly banded areas of a muscle; when pressed, it can produce pain within the muscle and even pain in other areas (called "referred pain"). Trigger points within the muscles of the head, neck, and shoulders can cause migraine attacks by themselves — or they can be a result of migraine attacks. Trigger point injections involve the inserting of numbing medication into the trigger point to relieve pain in the affected areas. They are typically performed by doctors in an outpatient setting.
PreventivePaidTriphalaVitamin/SupplementTriphala means “three fruits.” Triphala is a traditional Ayurvedic herbal formulation consisting of Amalaki (Emblica officinalis), Bibhitaki (Terminalia belerica), and Haritaki (Terminalia chebula). Triphala is most commonly known for its use as a gentle bowel tonic, being helpful in digestion, and assisting natural internal cleansing.
PreventivePaidTurmericVitamin/SupplementTurmeric is an herb that contains curcumin, a substance with powerful anti-inflammatory and antioxidant properties.
PreventivePaidValerianVitamin/SupplementValerian is an herb. The roots are used as a muscle relaxer. Outside of migraine treatment, valerian is most commonly used as a sleep aid. It can also be helpful for stress and anxiety. You can find valerian as a supplement as it is not easily found in food.
Acute & PreventivePaidVapor inhaler stickProduct/DeviceOften using menthol as the active ingredient, inhaler sticks may be used to treat nasal congestion and help clear the sinuses, which may be adding pressure or contributing to a migraine attack.
PreventivePaidVestibular rehabilitationPhysical therapyFor people who experience severe dizziness or vertigo with migraine, vestibular rehabilitation offers an exercise-based program to help restore vestibular function and balance. Depending on the problems identified, three principal methods of exercise can be prescribed: 1) Habituation, 2) Gaze Stabilization, and/or 3) Balance Training.
PreventivePaidVisceral manipulationPhysical therapyVisceral manipulation is a gentle manual technique involving specific placement of soft manual forces to encourage the normal mobility, tone, and motion of the viscera (internal organs) and the connective tissue and ligaments that support each organ onto our skeleton. Specific techniques are used to evaluate how abnormal forces might be affecting your normal body functions or affecting your skeleton, soft tissues, and organs. Techniques are then used to gently assist releasing the tension lines and improve visceral mobility. These manipulations are believed to improve the functioning of individual organs, the systems the organs function within, and the structural integrity of the entire body. There is not conclusive evidence to support visceral manipulation.
PreventivePaidVision Therapy / Eye ExercisesPhysical therapyEye exercises are thought to help improve vision and strengthen the muscles surrounding the eye that assist with normal function. Scientific evidence for eye exercise regimes are controversial with little evidence to support some of the claims made by practitioners. It is thought that with better vision comes less visual strain, which may contribute to migraine attacks.
PreventivePaidVitamin B complexVitamin/SupplementThis is a multivitamin that includes a range of B vitamins. Some of the benefits from a B-complex multivitamin may include energy production, a healthy function of the nervous system and assisting in the conversion of food to energy.
PreventivePaidVitamin B12/CobalaminVitamin/SupplementThe key role of vitamin B12 is the normal functioning of the brain, the nervous system, and the formation of blood. It is involved in the metabolism of every cell of the human body. Vitamin B12 is found in most animal-derived foods including fish, shellfish, meat (especially liver), poultry, eggs and milk.
PreventivePaidVitamin B2/RiboflavinVitamin/SupplementRiboflavin/vitamin B2 has been reported as useful in migraine treatment due to its role in helping heal and strengthen brain cells. This can be taken as a supplement or by consuming foods high in vitamin B such as milk, cheese, leafy vegetables, liver, kidneys, legumes, yeast, mushrooms, almonds, soybeans, wheat bran, salmon, and sun-dried tomatoes.
PreventivePaidVitamin B6/PyridoxineVitamin/SupplementVitamin B6 is involved in the process of making serotonin and norepinephrine, which are chemicals that send signals to the brain. Vitamin B6 is also involved in the formation of a protein layer around the nerve cells called myelin. Deficiencies in this vitamin may cause health issues affecting the nerves, skin, and circulatory system. Mild deficiency of vitamin B6 is common. Sources of B6 include cereal, grains, legumes, vegetables (carrots, spinach, peas, potatoes), milk, cheese, eggs, fish, liver, meat, and flour.
PreventivePaidVitamin D3 / CholecalciferolVitamin/SupplementA significant correlation exists between low levels of blood serum cholecalciferol and higher rates of various cancers, multiple sclerosis, tuberculosis, heart disease, and diabetes. Supplementation may serve a preventive role for migraine.
PreventivePaidVitex agnus-castus Vitamin/SupplementVitex agnus-castus, also called vitex, chaste tree, or chasteberry, is a shrub. It's fruit and seed are used as a herbal supplement, often to balance hormones, among other uses. Research on its benefits are limited.
PreventiveFreeWalking in natureLifestyleA recent Stanford study has demonstrated 30 minutes of walking in nature to be as effective as an SSRI antidepressant for mild or moderate depression. As it combines exercise and stress relief, it is certainly worth trying as part of a migraine prevention strategy.
Acute & PreventiveFreeWearing sunglassesProduct/DeviceGlare from the sun may contribute to migraine. Ensuring you have sunglasses with sufficient UV protection and polarization to reduce glare may provide significant relief. Wear polarized sunglasses even when there is the smallest amount of sunshine if you are sensitive to sunlight.
PreventiveFreeWeight lossLifestyleObesity is associated with an increased risk of progression from episodic to chronic migraine. For overweight individuals, weight loss may contribute to a reduction in the frequency, severity, and duration of their migraine attacks.
PreventivePaidWhite willowVitamin/SupplementWhite willow bark is an anti-inflammatory supplement that is thought to restrict prostaglandins and reduce pain.
PreventiveFree & PaidYogaLifestyleA form of exercise that involves stretching, maintaining poses, and breathing control to strengthen muscles and increase blood flow. It can promote calmness and is often used in combination with meditation and breathing exercises. Yoga can be done independently or in a class under the direction of an instructor with minimal equipment aside from a mat. There are various forms of yoga including restorative, Hatha, Vinyasa, Yin, and Iyengar, among others.
PreventivePaidZincVitamin/SupplementZinc is needed for the proper growth and maintenance of the human body. It is found in several systems and biological reactions and it is needed for immune function, wound healing, blood clotting, thyroid function, and much more. Meat, seafood, dairy products, nuts, legumes, and whole grains offer relatively high levels of zinc. Low zinc levels have been associated with depression and diabetes among other conditions.

Treatment Directory – Medical

Medical Treatments

We recommend you read the Quick Start guide before using this directory.

Treatments are listed in rows with a short description. This section includes Drugs, Devices, and Procedures.

How to use this reference:

  • Generic name: The active ingredient in the medication e.g. ibuprofen is the active ingredient in Advil.
  • Brand Name: The branded product that contains the active ingredient e.g. Advil is a branded product, the active ingredient of which is ibuprofen.
  • Drug Class: The classification of the active ingredient e.g. ibuprofen’s drug class is NSAID (nonsteroidal anti-inflammatory).
  • Prescription (RX) Required: If a prescription is required it will be shown with an ‘X’. If no prescription is required, it will be blank.
  • Format: This refers to the different formats available for a treatment e.g. tablets, capsules, injection, intranasal, topical, etc.
  • Treatment Type: Acute medications are taken at the onset of a migraine attack to help treat the symptoms of pain, nausea, or other migraine- related disability. Preventive treatments help reduce or stop migraine attacks from occurring in the first place. Preventive treatments are often taken regularly (e.g. daily, weekly, monthly), whether or not you have a migraine attack.
  • Description: A short summary about what the treatment does.

Search on any term by using the search field.  Sort on any column. Show more rows by increasing the display number.

Generic Name (Active Ingredient List)Brand NamesDrug ClassRXFormatTreatment TypeDescription
Acetaminophen & CodeineTylenol 3 or 4, PanadeineCombination - OpioidXPill, LiquidAcuteAcetaminophen/paracetamol with codeine is an opioid and analgesic/antipyretic combination. It works in the brain and nervous system to decrease mild to moderately severe pain.
Acetaminophen (Paracetamol)Little Fevers, Panadol, Tylenol & othersAnalgesic (painkiller)Liquid, Pill, SuppositoryAcuteAcetaminophen is also known as paracetamol depending on where you live. A pain reliever and fever reducer, the exact mechanism of action of acetaminophen is unclear. Many common pain conditions including headache, muscle aches, arthritis, backache, toothaches, colds, and fevers are treated with acetaminophen. It relieves pain in mild arthritis but does not affect the underlying inflammation and swelling of the joint.
Acetaminophen, Butalbital & CaffeineAnolor 300, Dolgic LQ, Esgic, Fioricet, Margesic, Orbivan, Repan, Zebutal & othersCombination - BarbiturateXPillAcuteAcetaminophen is a pain reliever and fever reducer. Butalbital is a barbiturate, known to relax muscle contractions involved in a tension headache. Caffeine is a stimulant that can relax muscle contractions in blood vessels to improve blood flow. The combination is used to treat tension headaches caused by muscle contractions. Butalbital has a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment. Butalbital is not available in some countries and restricted in others due to its dangerous side effects.
Acetaminophen, Dichloralphenazone & IsomethepteneDuradrin, MidrinAnalgesic (painkiller)XPillAcuteAcetaminophen, dichloralphenazone, and isometheptene is a combination analgesic, sedative, and sympathomimetic. It works by decreasing pain, providing sedation, and narrowing the blood vessels in the head and brain. It is used to treat migraine, certain other types of headaches (tension, neurovascular), among other conditions.
AcetazolamideDiamox, Diamox SequelsDiureticXPillAcute & PreventiveAcetazolamide medications are used to treat glaucoma, epilepsy, altitude sickness, periodic paralysis, idiopathic intracranial hypertension, and heart failure. It is sometimes used to treat high-pressure headaches by lowering the production of spinal fluid. Acetazolamide is not well-studied as a preventive treatment for migraine in general, and there is no solid evidence for its effectiveness outside the context of familial hemiplegic migraine.
Acetylsalicylic acid (ASA)Aspirin, Baby aspirinNonsteroidal anti-inflammatory drugs (NSAIDs)Orally-dissolving tablet, PillAcute & PreventiveRegular low-dose aspirin or "baby" aspirin may be one of the most effective ways to help prevent migraine with aura. When tested against topiramate, a common migraine preventive, Italian researchers found that low doses of aspirin daily may be up to six times more effective than topiramate. Up to 1,000 mg of aspirin may also be used in the acute treatment of migraine.
Acetylsalicylic acid (ASA) or Aspirin & CombinationsAsproClear, Bayer Aspirin, Bufferin, Easprin, Ecotrin, Ecpirin, Excedrin, Fasprin & othersCombination – NSAIDPill, Powder, and othersAcuteAspirin/ASA is an NSAID that works by reducing substances in the body that cause pain, fever, and inflammation. It is used to treat pain and reduce fever or inflammation. Sometimes aspirin is used to treat or prevent heart attacks, strokes, and chest pain (angina) but it should be used for cardiovascular conditions only under the supervision of a doctor. Some aspirin combination drugs, like Excedrin, also contain acetaminophen and caffeine. Check the label to be sure. Overuse of combination treatments containing caffeine may lead to medication overuse headache.
AcyclovirZoviraxAntiviralXPill, Topical ointmentPreventiveAcyclovir is an antiviral drug that is used to treat infections caused by certain types of viruses. It treats shingles caused by herpes zoster and outbreaks of herpes simplex. In people with frequent outbreaks of genital herpes, acyclovir is used to help reduce the number of future episodes. Acyclovir can also be useful in the treatment of fibromyalgia and allodynia, often in conjunction with other medications.
AgomelatineValdoxanAntidepressantXPillPreventiveAgomelatine is primarily used to treat depression. It acts on brain receptors for melatonin, a hormone that is important for regulating sleep, as well as serotonin receptors. It is the only antidepressant that acts on melatonin receptors.
Air pressure modulation deviceNociraNeuromodulationXDeviceAcuteNocira is an investigational new migraine treatment device intended to deliver a comfortable and non-invasive treatment experience. The device delivers a modulated pattern of gentle puffs of air into the ear, which stimulates pressure-activated sensory neurons to reset the brain's pain response. The pilot study saw 67% of its participants pain-free after 20 minutes of treatment with Nocira. The device operates by way of earpieces controlled through a mobile phone app. Additional clinical trials are planned. Not yet FDA approved as of March 2021.
AlmotriptanAxert, AlmogranSerotonin 5-HT1 agonists or TriptansXPillAcuteAlmotriptan is a second-generation serotonin 5-HT1 receptor agonist, also known as a triptan. An agonist mimics the effects of the neurotransmitter found naturally in the brain. It works by narrowing the blood vessels around the brain, blocking pain signals and the release of substances that cause other migraine symptoms. A person with migraine is thought to be hypersensitive to widened blood vessels exerting pressure on the brain.
AlprazolamNiravam, XanaxBenzodiazepinesXPillPreventiveAlprazolam belongs to a group of drugs called benzodiazepines. It works by slowing down the movement of chemicals in the brain that may become unbalanced. This results in a reduction in nervous tension or anxiety. Alprazolam is used to treat anxiety disorders, panic disorders, and anxiety caused by depression.
AmitriptylineElavil, EndepAntidepressantXPillPreventiveAmitriptyline is a tricyclic antidepressant. It affects brain chemicals that may become unbalanced. Amitriptyline is used to treat symptoms of depression.
AmphetamineAdzenys XR-ODT, Dyanavel XR, EvekeoStimulantXPillPreventiveAmphetamine is a stimulant used to treat attention-deficit hyperactivity disorder (ADHD), narcolepsy, and obesity. Stimulants increase the level of dopamine, a neurotransmitter associated with pleasure, movement, and attention. Use of this medication should be closely monitored, as it carries a high risk for addiction. In the context of migraine, amphetamine can contribute to medication overuse headache (MOH).
Angiotensin-converting enzyme (ACE) inhibitorsPrinivil, Qbrelis, Zestril, Epanded, Vasotec, AltaceHypertensionxPillPreventiveAngiotensin-converting enzyme (ACE) inhibitors are commonly prescribed to treat high blood pressure, heart problems, and other conditions by helping to relax veins and arteries. A 2019 study concluded that ACE inhibitors could be used as a preventive treatment for migraine in persons with high blood pressure or high risk of side effects, but the evidence did not support use of it as a preventive otherwise.
AprepitantEmendNeurokinin-1 receptor antagonist (antiemetic)XPillAcuteUsed to prevent chemotherapy-induced or postoperative nausea and vomiting, and for CVS (Cyclic Vomiting Syndrome, a migraine variant). Also used to control nausea and vomiting related to intravenous DHE (dihydroergotamine).
AsenapineSaphrisOther - schizophrenic & bipolarXPillPreventiveAsenapine treats schizophrenia. It is used alone or along with lithium or valproate to treat acute manic or mixed episodes associated with bipolar disorder or manic-depression. Asenapine is an atypical antipsychotic. Exactly how it works is not known. It may work by blocking certain substances in the brain.
Aspirin & CodeineAspalgin, Disprin ForteAnalgesic (painkiller)XPillAcuteAspirin with codeine is an analgesic combination. It works to relieve pain by dulling pain perception in the brain and blocking certain chemicals in the body that cause pain, swelling, and inflammation. It helps relieve mild to severe pain. Codeine is an opioid and opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment.
Aspirin, Butalbital & CaffeineFiorinal, Fortabs, Farbital, Fiormor, Fiortal, Idenal, Isollyl, Lanorinal & othersCombination - BarbiturateXPillAcuteAspirin is a pain reliever, anti-inflammatory, and fever reducer. Butalbital is part of a group of drugs called barbiturates, which have high risk for addiction and medication overuse headache (MOH). They are known to relax muscle contractions involved in tension headache. Caffeine is a stimulant that can relax muscle contractions in blood vessels to improve blood flow. The combination of aspirin, butalbital, and caffeine is used to treat tension headaches caused by muscle contractions.
Aspirin, Caffeine & Orphenadrine NorgesicCombination - NSAIDXPillAcuteOrphenadrine, aspirin, and caffeine is a muscle relaxant and stimulant combination. It works by decreasing pain and inflammation, which helps muscles to relax. This combination relieves mild to moderate pain from certain muscle problems.
AtenololTenorminBeta blockerXPillPreventiveAtenolol is part of a group of drugs called beta blockers. Beta blockers affect the heart and the circulation of blood flow through arteries and veins. Atenolol is used to treat angina (chest pain) and hypertension. It may also be used to treat or prevent heart attack.
AtogepantQuliptaSmall molecule CGRP receptor antagonist (Gepant)XPillPreventiveAtogepant is an oral CGRP receptor antagonist used for the preventive treatment of episodic migraine. Atogepant is chemically distinct from ubrogepant, an orally-administered CGRP receptor antagonist for the acute treatment of migraine. Atogepant has a longer half-life, making it suitable for preventive treatment. It was approved by the FDA in September 2021.
BaclofenLioresal, GablofenMuscle RelaxantXPillAcuteBaclofen is a muscle relaxer and an antispastic agent. Baclofen is used to treat muscle symptoms caused by multiple sclerosis including spasm, pain, and stiffness.
Barbital/BarbitoneMedinal, VeronalBarbiturateXCachets, PillPreventiveAs barbital is a controlled substance, other substances have largely replaced barbital-based medications. When barbitone was first introduced, it was considered a great improvement over the existing hypnotics. It was used as a sleeping aid (hypnotic) from 1903 until the mid-1950s. Barbiturates have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment.
Bariatric surgery--XProcedurePreventiveBariatic surgery, including gastric bypass, is a weight-loss surgical procedure. Weight reduction, by means of bariatric surgery, for obese individuals may contribute to a reduction in the frequency, severity, and duration of migraine attacks. The beneficial impact of weight loss on migraine has been noted to a comparable degree for both bariatric surgery and weight lost through lifestyle modification. Obesity is associated with an increased risk of progression from episodic to chronic migraine.
BudesonideEntocort, Pulmicort, Rhinocort AquaSteroidXNasal Spray, PillPreventiveBudesonide is a steroid that reduces inflammation in the body. Budesonide is primarily used to treat mild to moderate Crohn's disease.
BuprenorphineBuprenex, TemgesicOpioidXInjection, PillAcuteBuprenorphine is an opioid analgesic. It works on the brain and nervous system to decrease pain. It can help relieve moderate to severe pain. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment.
Butalbital-BarbiturateX-AcuteButalbital has been discontinued as a single agent and is not recommended as a single agent or in combination drugs, due to high risk for addiction and medication overuse headache (MOH). It is known to relax muscle contractions involved in a tension headache. Butalbital is often combined with other medications, such as acetaminophen, aspirin, and codeine for the treatment of headache.
CandesartanBlopress, Atacand, Amias, RatacandHypertensionXPillPreventiveCandesartan is an angiotensin II receptor blocker (ARB). It works by relaxing blood vessels. This helps to lower blood pressure. Candesartan is used to treat high blood pressure alone or with other medicines. It is used in certain patients to treat heart failure. It may also be used for other conditions as determined by your doctor.
Cannabidiol oil (CBD)Hundreds of OTC brandsPhytocannabidiolTopicals, Edibles, Oils, Sublingual, & VaporsAcute & PreventiveCBD is the nonpsychoactive part of the cannabis, or marijuana, plant. CBD oil is made by extracting CBD from the cannabis plant then diluting it with a carrier oil. It has quickly become popular in the health and wellness community, with several research-backed studies suggesting it may be helpful in alleviating such conditions as anxiety, depression, and chronic pain, including migraine. It comes in many formats including edibles such as gummies and baked goods, topical creams and gels, among others. Epidiolex is the first FDA-approved prescription for highly purified CBD oil which is used in some forms of epilespy.
CarbamazepineCarbatrol, Epitol, Equetro, TEGretol, TEGretol XRAnticonvulsantXPillPreventiveCarbamazepine is an anticonvulsant. It works by decreasing nerve impulses that cause seizures and pain. Carbamazepine is used to treat seizures and nerve pain such as trigeminal neuralgia and diabetic neuropathy. It is also used to treat bipolar disorder.
CarvedilolCoregBeta blockerXPillPreventiveCarvedilol is a beta blocker. Beta blockers affect the heart and blood circulation. Carvedilol is used to treat heart failure and hypertension. It is also used after a heart attack that has compromised your heart’s ability to function effectively.
CelecoxibBextra, Celebrex, Elyxyb, VioxxNonsteroidal anti-inflammatory drugs (NSAIDs)XLiquid, PillAcute & PreventiveCelecoxib is an NSAID. It works by reducing hormones that cause inflammation and pain in the body. Celecoxib is used to treat pain or inflammation caused by many conditions such as arthritis, ankylosing spondylitis, and menstrual pain. Celecoxib is also used in the treatment of hereditary polyps in the colon. Vioxx and Bextra are no longer available due to increased risk of heart attack and stroke. It is sometimes recommended before exercise to prevent a migraine attack. Celebrex is the only brand available in the U.S. Vioxx and Bextra are no longer available due to increased risk of heart attack and stroke. Elyxcyb is an oral liquid format.
CelecoxibCelebrex, Vioxx, BextraCOX inhibitorXPillAcute & PreventiveA subclass of NSAIDs that work by reducing the production of prostaglandins, the chemicals that promote inflammation, pain, and fever. The enzymes that produce prostaglandins are called cyclooxygenase (COX). There are two types: COX-1 and COX-2. Unlike older NSAIDs that block both inhibitors, the newer COX-2 inhibitors only block the COX-2 enzyme. Sometimes recommended before exercise to prevent a migraine attack. Celebrex is the only brand available in the U.S. Vioxx and Bextra are no longer available due to increased risk of heart attack and stroke.
CetirizineZyrtecAntihistaminePillAcuteCetirizine is an antihistamine that reduces the natural chemical histamine in the body. Histamine can produce symptoms of sneezing, itching, watery eyes, and runny nose. Cetirizine is used to treat cold or allergy symptoms such as sneezing, itching, watery eyes, or runny nose. It is also used to treat itching and swelling caused by hives.
ChlorpromazineLargactil, ThorazineOther - schizophrenic & bipolarXInjection, Pill, SuppositoryPreventiveChlorpromazine is a phenothiazine. The exact way chlorpromazine works is not known. It is used to treat certain mental or mood disorders (e.g. schizophrenia), the manic phase of manic-depressive disorder, anxiety and restlessness before surgery, the blood disease porphyria, severe behavioral and conduct disorders in children, nausea and vomiting, and severe hiccups. It is also used with other medicines to treat symptoms associated with tetanus.
CitalopramCipramil, CelexaAntidepressantXPillPreventiveCitalopram is a selective serotonin reuptake inhibitor (SSRI). This medication works by helping to restore the balance of serotonin in the brain. Citalopram is used to treat depression. It may improve your energy level and feelings of well-being. Leading neurologist Dr. Andrew Charles has flagged SSRI medications as having the potential to make migraine worse. If you take an SSRI and have migraine, consider discussing with your doctor whether an alternative medication might be right for you.
ClonazepamKlonopinBenzodiazepinesXPills TabletsAcuteClonazepam belongs to a group of drugs called benzodiazepines and is known as an anticonvulsant drug. It is used as a treatment to prevent and control seizures and also for panic attacks, insomnia, and anxiety disorders. Clonazepam works by calming down the brain and nerves.
ClonidineCatapres, Dixarit, KapvayHypertensionXPillPreventiveClonidine lowers blood pressure by decreasing the levels of certain chemicals in your blood. This allows your blood vessels to relax and your heart to beat more slowly and easily. Clonidine is used to treat hypertension. The Kapvay brand of clonidine is used to treat attention deficit hyperactivity disorder (ADHD).
CodeineMigraleveOpioidXPill, SuppositoryAcuteCodeine is used to treat mild to moderately severe pain. Codeine or 3-methylmorphine (a naturally occurring methylated morphine) is an opiate used for its analgesic, antitussive, antidiarrheal, antihypertensive, anxiolytic, antidepressant, sedative, and hypnotic properties. It is also used to suppress premature labor contractions, myocardial infarction, and for many other uses. It is often sold as a salt in the form of either codeine sulfate or codeine phosphate in the United States and Australia. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment.
Combination therapy--XVariousPreventiveCombination therapy uses more than one method of treatment for a condition. An example of combination therapy for migraine prevention is using both Botox and a CGRP monoclonal antibody. An example of combination therapy for a migraine attack is using both a neuromodulation device and a triptan.
CPAP machineRESmart, ResMed, Philips, Fisher & PaykelVentilatorXDevicePreventiveContinuous Positive Airway Pressure (CPAP) therapy is a common treatment for obstructive sleep apnea. It includes a small machine that supplies a constant and steady air pressure, a hose, and a mask or nose cannula.
CyclobenzaprineAmrix, Fexmid, FlexerilMuscle relaxantXPillAcuteCyclobenzaprine is a muscle relaxant. It works by blocking nerve impulses or pain sensations that are sent to your brain. It is used together with rest and physical therapy to treat skeletal muscle conditions such as pain or injury.
CyproheptadinePeriactinAntihistamineXPillPreventiveCyproheptadine is an antihistamine. It works by blocking the action of histamine to reduce allergy symptoms. Cyproheptadine is used to treat symptoms of allergic reactions caused by seasonal allergies, food, blood, or plasma. It is also used to treat mild, uncomplicated hives.
DesvenlafaxineKhedezla, PristiqAntidepressantXPillPreventiveDesvenlafaxine is in the class of antidepressant drugs called selective serotonin and norepinephrine reuptake inhibitors (SNRI). SNRIs block or delay the reuptake of the neurotransmitters, serotonin and norepinephrine by the presynaptic nerves. This increases the levels of these two neurotransmitters in the synapse and tends to elevate mood. Serotonin-norepinephrine reuptake inhibitors (SNRIs) are used to treat depression, anxiety disorder, panic disorder and other mood disorders.
DiazepamValiumOther - psychoactive benzodiazepineXInjection, Pill, SuppositoryAcuteDiazepam is a benzodiazepine. It affects chemicals in the brain that may become unbalanced and cause anxiety. Diazepam is used to treat anxiety disorders, alcohol withdrawal symptoms, or muscle spasms. Diazepam is sometimes used with other medications to treat seizures.
DiclofenacCambia, Cataflam, Voltaren-XR, Zipsor, Zorvolex, VoltarenNonsteroidal anti-inflammatory drugs (NSAIDs)Injection, Gel, Pill SuppositoryAcuteDiclofenac is an NSAID. It is used to treat mild to moderate pain, or signs and symptoms of osteoarthritis or rheumatoid arthritis. The Cataflam brand of this medicine is also used to treat menstrual cramps. Diclofenac oral powder (Cambia) is used to treat migraine attacks acutely.
Dihydroergotamine mesylate (DHE)Dihydergot, DHE 45, Migranal, TrudhesaErgot alkaloid - derivativeXInjection, Nasal sprayAcuteDihydroergotamine (DHE) is used to treat acute migraine with or without aura, and cluster headaches. DHE is an ergot derivative. It works by constricting blood vessels in the brain, which can help to relieve migraine. Trudhesa, a DHE nasal spray targeting the upper nasal space, was approved by the FDA in September 2021; it is thought that the nasal spray allows the medication to work faster and more effectively.
DiltiazemCardizem, Cartia XT, Dilacor XR, Dilt-CD, Diltzac, Flunarizine, Matzim LA, Tiazac & othersCalcium channel blockersXPillPreventiveDiltiazem is part of a group of drugs called calcium channel blockers. These work by relaxing the muscles of your heart and blood vessels. Diltiazem is used to treat hypertension, angina (chest pain), and certain heart rhythm disorders.
DimenhydrinateGravol, Dramamine & othersAntihistamine, antiemeticInjection, Liquid, Pill, SuppositoryAcuteUsed to prevent and treat nausea, vomiting, and dizziness due to motion sickness. Gravol is used to control vomiting associated with migraine but it has largely been replaced by Zofran (ondansetron).
DiphenhydramineBenadryl, Nytol, Simply Sleep & othersAntihistaminePillAcuteUsed to control high levels of histamine. May speed relief of migraine when taken with migraine medications.
Divalproex sodiumDepakote, Depakote ER, Depakote SprinklesAnticonvulsantXPillPreventiveDivalproex sodium affects chemicals in the body that may be involved in causing seizures. It is used to treat various types of seizure disorders. It is sometimes used together with other seizure medications. Divalproex sodium is also used to treat manic episodes related to bipolar disorder and to prevent migraine headaches.
DomperidoneMolax, Motilium, Motinorm Costi, Nomit AntiemeticXInjection, Pill, SuppositoryAcuteAntiemetics help relieve the nausea associated with migraine attacks. Domperidone helps increase the transit of food through the stomach which helps facilitate its antinausea properties.
Dosulepin/DothiepinProthiaden, Dothep, Thaden, DopressAntidepressantXPillPreventiveDosulepin is a tricyclic antidepressant. This class of antidepressants is named after its chemical structure, which contains three rings of atoms. Today they have largely been replaced in clinical use by newer classes of antidepressants.
DoxylamineRestavit, DozileAntihistaminePillAcuteDoxylamine is an antihistamine. It works by depressing the central nervous system to produce drowsiness. Doxylamine is used to treat occasional sleeplessness and reduce difficulty falling asleep.
Doxylamine, Paracetamol & CodeineMersyndolAntihistaminePillAcuteMersyndol is an analgesic intended for short-term use to relieve moderate pain and fever. Paracetamol and codeine are both active ingredients designed to help reduce pain. See Codeine & Paracetamol. Doxylamine is a type of antihistamine that can cause drowisness and/or have a calming effect.
DuloxetineCymbaltaAntidepressantXPillPreventiveDuloxetine is a selective serotonin and norepinephrine reuptake inhibitor (SNRI). SNRIs block or delay the reuptake of the neurotransmitters, serotonin and norepinephrine, by the presynaptic nerves. This increases the levels of these two neurotransmitters in the synapse and tends to elevate mood. SNRIs are used to treat depression, anxiety disorder, panic disorder, and other mood disorders. Duloxetine can also be useful in the treatment of fibromyalgia and allodynia.
Ear insufflation therapy-NeuromodulationXProcedureAcuteEar insufflation therapy is the administration of small bursts of air or ozone gas to the ear drum via a tool called a pneumatic otoscope. Researchers believe these controlled puffs of air stimulate pressure-activated nerve receptors found in the ears, resetting the pain centers in the brain. This in-office procedure is not currently FDA approved but rather a new and developing concept being investigated.
EletriptanRelpaxSerotonin 5-HT1 agonists or TriptansXPillAcuteEletriptan is a second-generation triptan drug intended for the treatment of migraine. It is used as an abortive treatment to help block a migraine attack that is already in progress.
EptinezumabVyeptiCGRP monoclonal antibodyXIV InfusionPreventiveEptinezumab is a preventive CGRP monoclonal antibody approved by the FDA in February 2020. CGRP monoclonal antibodies attach to the calcitonin gene-related peptide (CGRP) and inactivate it. Eptinezumab is given as an IV infusion four times a year.
ErenumabAimovigCGRP monoclonal antibodyXInjectionPreventiveErenumab is a preventive CGRP monoclonal antibody approved by the FDA in May 2018. This CGRP monoclonal antibody attaches to CGRP receptors to inhibit its function. Erenumab is self administered monthly. An FDA warning was added for erenumab about high blood pressure after the first dose. If you are on erenumab or start it, you should monitor your blood pressure.
Ergotamine tartrateCafergot, Ergomar, MigrilErgot alkaloid - derivativeXPill, SuppositoryAcuteErgotamine is an ergot derivative. It works by narrowing blood vessels in the brain, which can help to relieve migraine. Some brands, like Cafergot, also contain caffeine.
EscitalopramLexaproAntidepressantXPillPreventiveEscitalopram is a selective serotonin reuptake inhibitor (SSRI). It works by restoring the balance of serotonin which helps to improve certain mood problems. It is used to treat depression or generalized anxiety disorder. Leading neurologist Dr. Andrew Charles has flagged SSRI medications as having the potential to make migraine worse. If you take an SSRI and have migraine, consider discussing with your Doctor whether an alternative medication might be right for you.
Estrogen patchAlora, Estraderm, EstroGel, Vivelle & othersEstradiol hormoneXTransdermal patchPreventiveAn estrogen patch used for 7 to 10 days during the tail end of the menstrual cycle before a menstrual period may blunt the cyclic fall in estrogen and prevent a menstrual migraine.
EszopicloneLunestaHypnoticXPills TabletsAcuteEszopiclone is a sedative, also called a hynoptic. It affects chemicals in one's brain that may be unbalanced in people with insomnia. Eszopiclone causes relaxation to help one fall asleep and stay asleep.
Eye Drops – Dry EyesArtificial Tears, Cyclosporine, RestasisImmunosuppressantXEye dropsPreventiveBecause dry-eye symptoms are prevalent in people with migraine, doctors may prescribe artificial tears. Nonprescription eye drops contain preservatives, while prescription formulas like Cyclosporine or Restasis do not. Both decrease inflammation that can cause dry eyes and discomfort for people with migraine.
Eye drops – GlaucomaLevobunolol, TimololBeta blockerXEye dropsAcute & PreventiveBeta blocker eye drops, used to treat glaucoma, have been shown in a series of patients to provide almost complete pain relief from acute migraine over years of use. The mechanism of action of the drops is believed to be the passage of the beta blockers into the nasal cavity, which is then rapidly absorbed into the blood vessels.
FamciclovirFamvirAntiviralXPillPreventiveFamciclovir is an antiviral drug that is used to treat infections caused by certain types of viruses. It treats shingles caused by herpes zoster and outbreaks of herpes simplex. In people with frequent outbreaks of genital herpes, famciclovir is used to help reduce the number of future episodes. It can also be useful in the treatment of fibromyalgia and allodynia, often in conjunction with other medications.
FludrocortisoneFlorinef AcetateSteroidXPillPreventiveFludrocortisone is a corticosteroid. It works by causing the kidneys to retain sodium and acting as a replacement for cortisone when the body does not produce enough. It is used to treat adrenocortical insufficiency in Addison’s disease and for treating salt-losing adrenogenital syndrome.
FlunarizineSibeliumCalcium channel blockersXPillPreventiveFlunarizine is part of a group of drugs called calcium channel blockers. These work by relaxing the muscles of your heart and blood vessels. Flunarizine reduces calcium entry into neurons making them less “excitable.”
FluoxetineLovan, Prozac, SarafemAntidepressantXPillPreventiveFluoxetine is a selective serotonin reuptake inhibitor (SSRI) antidepressant used to treat major depressive disorder, bulimia nervosa, obsessive-compulsive disorder, panic disorder, and premenstrual dysphoric disorder (PMDD). Leading neurologist Dr. Andrew Charles has flagged SSRI medications as having the potential to make migraine worse. If you take an SSRI and have migraine, consider discussing with your Doctor whether an alternative medication might be right for you.
FluvoxamineLuvoxAntidepressantXPillPreventiveFluvoxamine is a selective serotonin reuptake inhibitor (SSRI). It works by restoring the balance of serotonin, a natural substance in the brain, which helps to decrease obsessive or compulsive behavior. It is used to treat obsessive-compulsive disorder (OCD) and other conditions. Leading neurologist Dr. Andrew Charles has flagged SSRI medications as having the potential to make migraine worse. If you take an SSRI and have migraine, consider discussing with your doctor whether an alternative medication might be right for you.
FosaprepitantEmend for InjectionNeurokinin 1 receptor antagonist (antiemetic)XInjectionAcuteUsed to prevent chemotherapy-induced or postoperative nausea and vomiting and for CVS (Cyclic Vomiting Syndrome, a migraine variant). Also used to control nausea and vomiting related to intravenous DHE (dihydroergotamine).
FremanezumabAjovyCGRP monoclonal antibodyXInjectionPreventiveFremanezumab is a preventive monoclonal antibody approved by the FDA in September 2018 for the prevention of migraine. This CGRP monoclonal antibody attaches to CGRP and inactivates it. Ajovy is self administered monthly or quarterly, as your physician advises.
FrovatriptanFrova, MigardSerotonin 5-HT1 agonists or TriptansXPillAcuteFrovatriptan is a triptan. It works by narrowing the blood vessels in the brain, which helps to relieve migraine. It is used to treat acute migraine with or without aura in adults. It should not be used as a migraine preventive.
GabapentinGralise, Horizant, Neurontin, GabaroneAnticonvulsantXPillPreventiveGabapentin is an anticonvulsant medication. It affects chemicals and nerves in the body that are involved in the cause of seizures and some types of pain. Gabapentin is used in adults to treat nerve pain caused by herpes virus or shingles. The Horizant brand is also used to treat restless legs syndrome (RLS). The Neurontin brand is also used to treat seizures in adults and children who are at least 3 years old.
GalcanezumabEmgalityCGRP monoclonal antibodyXInjectionPreventiveGalcanezumab is a CGRP monoclonal antibody approved by the FDA in September 2018 for prevention of migraine, and for treatment of episodic cluster headache in June 2019. This CGRP monoclonal antibody attaches to CGRP and inactivates it. Emgality is self administered monthly for migraine. For cluster, it is self administered initially at a loading dose at the start of a cluster period and then monthly until the end of the cluster period.
Greater occipital nerve (GON) blockDecadron, Dexamethasone Intensol, Dexasone, Solurex, Baycadron / Xylocaine, XTLido & othersOther - steroid & anestheticXInjectionPreventiveThis treatment injects a steroid and lidocaine into the greater occipital nerve (GON) to block pain messages to the brain from the GON. The occipital nerves are two pairs of nerves originating in the upper cervical vertebrae. The GON is located beneath the scalp in the back of the head. This region of the brain deals with vision including color recognition, spatial awareness, and word recognition. Most people who have migraine and headache also have tenderness in the suboccipital region of the skull. In cases where migraine is resistant to medication, or treatment is hindered by adverse effects, a GON block may be explored.
Hormone Therapy-Other - hormonesXPillPreventiveHormone replacement therapy (HRT) refers to any form of hormone therapy where the patient receives hormones, either to supplement a lack of naturally occurring hormones, or to substitute other hormones for naturally occurring hormones. HRT is typically prescribed for those experiencing either natural or surgically induced menopause. The main types of hormones involved are estrogens, progesterone or progestins, and sometimes testosterone. For pre-menopausal use, contraceptive pills containing hormones may be used to skip periods (and can avert menstrual migraine).
HydrocodoneHysingla ER, Zohydro EROpioidXNasal Spray, Pill, SuppositoryAcuteHydrocodone is an opioid pain medication. Zohydro ER and Hysingla ER are extended-release forms of hydrocodone that are used for around-the-clock treatment of severe pain. Extended-release hydrocodone is not for use on an as-needed basis for pain. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment.
HydromorphoneDilaudid-HP, JurnistaOpioidXPillAcuteHydromorphone is an opioid analgesic. It works in the brain and nervous system to reduce pain. It is used to treat moderate to severe pain in opioid-tolerant patients who require larger than usual doses to provide adequate pain relief. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment.
HydroxyzineAtarax, Alamon, Equipose, Vistaril IM, Hyzine, Rezine, Vistaril IM, Vistazine & othersAntihistamineXInjection, PillAcuteHydroxyzine reduces activity in the central nervous system. It also acts as an antihistamine that reduces natural chemical histamine in the body. Histamine can produce symptoms of sneezing and runny nose, or hives on the skin. Hydroxyzine is used as a sedative to treat anxiety and tension. It is also used with other medications for anesthesia. Hydroxyzine may also be used to control nausea and vomiting, and to treat allergic skin reactions such as hives or contact dermatitis.
IbuprofenAdvil, Genpril, IBU, Midol, Motrin, Nuprin, Nurofen & othersNonsteroidal anti-inflammatory drugs (NSAIDs)Injection, Pill, Suppository, TopicalAcuteIbuprofen is an NSAID that works by reducing hormones that cause inflammation and pain in the body. Ibuprofen is used to reduce fever and treat pain or inflammation caused by many conditions such as headache, toothache, back pain, arthritis, menstrual cramps, or minor injury.
Ibuprofen & CodeineProVen Plus, Rafen Plus, Panafen Plus, Nurofen PlusNonsteroidal anti-inflammatory drugs (NSAIDs)PillAcuteIbuprofen, an NSAID, combined with codeine, an opioid, is used to reduce pain and inflammation. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment. See ibuprofen and codeine for their separate descriptions.
IndomethacinIndocin, IndocidNonsteroidal anti-inflammatory drugs (NSAIDs)XInjection, Pill, Suppository, TopicalAcuteIndomethacin is used to treat patent ductus arteriosus (PDA) in certain premature infants. It is thought to work by blocking the action of a certain chemical in the body called prostaglandin.
Intrauterine Device (IUD)Kyleena, Liletta, Mirena, ParaGard, SkylaOther - hormonesXDevicePreventiveAn IUD is a T-shaped device that is inserted into the uterus as a birth control method. There are five types, four of which are hormonal (Liletta, Kyleena, Mirena, and Skyla) and one that is made of copper and is hormone free (ParaGard). For some women with menstrual migraine, continuous hormone treatment may be helpful in preventing attacks linked to falling estrogen levels.
IrbesartanAbisart, AvaproHypertensionXPillPreventiveIrbesartan is an angiotensin II receptor blocker (ARB), which relaxes blood vessels. This helps to lower blood pressure. It is also used in certain patients to treat kidney problems caused by diabetes.
Isometheptene mucateDuradrin, MidrinOtherPillAcuteIsometheptene works by causing the blood vessels in the brain to narrow. By decreasing the width of blood vessels, isometheptene helps relieve the pain from migraine attacks. It is often used in combination with other active ingredients. The British National Formulary states that, as more effective preparations are now available, this is no longer widely used.
KetamineKetalarAnestheticXInjection, IVAcuteKetamine is an anesthetic. It works in the brain to inhibit painful sensations. Because it has powerful psychogenic side effects and can produce adverse reactions in some patients, it is frequently administered under careful supervision by an anesthesiologist.
KetoprofenActron, Orudis, OruvailNonsteroidal anti-inflammatory drugs (NSAIDs)XInjection, Pill, TopicalAcuteKetoprofen is an NSAID. Exactly how it works is not known. It may block certain substances in the body that are linked to inflammation. NSAIDs treat the symptoms of pain and inflammation. They do not treat the disease that causes those symptoms. Ketoprofen is used to treat rheumatoid arthritis or osteoarthritis, menstrual cramps and pain, and other conditions as determined by your doctor.
KetorolacToradolNonsteroidal anti-inflammatory drugs (NSAIDs)XInjection, IV, PillAcuteKetorolac is an NSAID indicated for short-term management of moderate to severe pain. Concerns about the high incidence of side effects has led to restriction in its dosage and maximum duration of use. In the U.K., treatment should be initiated only in a hospital. Maximum duration of treatment should not exceed five days for tablets, or two days for continuous daily dosing with intravenous or intramuscular formulations. May be used intravenously in hospital or emergency settings. Ketorolac is used in the short-term treatment of moderately severe pain (usually after surgery), alone or in combination with other medicines.
LasmiditanReyvow5-HT1F receptor agonist (Ditan)XPillAcuteLike triptans, ditans work on serotonin receptors, but they work on the receptors that are not found on the blood vessels. Ditans are a potential acute therapy option for people with migraine who have heart conditions, as they avoid the blood vessels while working on similar mechanisms as triptans. Lasmiditan has been shown to work when migraine pain has progressed to moderate or severe.
LevetiracetamKeppraAnticonvulsantXPillPreventiveLevetiracetam is an anticonvulsant. Exactly how it works is not known, but it may work by slowing abnormal nerve impulses in the brain. Levetiracetam is used to treat partial-onset, myoclonic, or other types of seizures in patients with epilepsy. It may be used in combination with other medicines.
LidocaineBurn-O-Jel, LMX4, LMX5Analgesic (painkiller)xTopicalAcuteLidocaine is commonly used for numbing an area of the body to reduce pain or discomfort. Some topical lidocaine prescriptions can also be used to relieve nerve pain — these come in forms of gel or skin patches that can be worn on the neck, shoulders and forehead for migraine. Over-the-counter creams are also available to help relieve joint and muscle pain.
LithiumEskalith, LithobidAntimanic agentXPill, SolutionPreventiveLithium can be used to prevent hypnic headache, a type of headache that occurs exclusively during sleep and awakens the patient. Taken at bedtime, lithium has been shown to be effective in preventing a hypnic headache attack from occurring. Lithium is also indicated for use as a mood stabilizer to treat manic episodes associated with bipolar disorder. Lithium should be used with caution in cases of kidney or thyroid disease, dehydration, or in conjunction with diuretics.
LoratadineAlavert, Alavert Allergy, Claritin, lear-Atadine, Clear-Atadine Children's, Dimetapp ND,Tavist ND, Wal-itin & othersAntihistaminePillAcuteLoratadine is an antihistamine that reduces the effects of natural chemical histamine in the body. Histamine can produce symptoms of sneezing, itching, watery eyes, and runny nose. Loratadine is used to treat the symptoms of allergies, such as sneezing, watery eyes, and runny nose. It is also used to treat skin hives and itching in people with chronic skin reactions.
LorazepamAtivanBenzodiazepinesXPills, Tablets, injectionAcuteLorazepam belongs to a group of drugs called benzodiazepines and is used to treat the symptoms of anxiety disorders. It is thought lorazepam works by enhancing the activity of certain neurotransmitters in the brain.
Marijuana/Medical cannabis--XEdibles, Pill+E236, Tea, OilsAcuteThe use of medical marijuana for the management of chemotherapy-induced nausea, glaucoma, spasticity in multiple sclerosis, and neuropathic pain has been clinically demonstrated to some extent. The likelihood of undesirable adverse reactions limits its applications, and therapeutic use may be limited to either concomitant therapy or when conventional therapy has failed.
MeclizineAntivert, Bonine, Dramamine Less DrowsyAntiemeticsPillsAcute & PreventiveMeclizine is an antiemetic with less associated drowsiness than some other antiemetics. It is used to help prevent motion sickness and treat dizziness (vertigo), both of which can be symptoms of migraine.
Mefenamic acidPonstan, PonstelNonsteroidal anti-inflammatory drugs (NSAIDs)PillAcuteMefenamic acid is an NSAID. Exactly how it works is not known. It may block certain substances in the body that are linked to inflammation. NSAIDs treat the symptoms of pain and inflammation. Mefenamic acid is used for menstrual pain. It may be used for short term (no more than 7 days) treatment of mild to moderate pain.
MeloxicamMobic, MovalisNonsteroidal anti-inflammatory drugs (NSAIDs)XPillAcuteMeloxicam is an NSAID that works by reducing hormones that cause inflammation and pain in the body. Meloxicam is used to treat pain or inflammation caused by osteoarthritis or rheumatoid arthritis in adults and children who are at least 2 years old.
MemantineAbixa, Akatinol, Axura, Ebixa, Memox, NamendaOther - central nervous system agentXPillPreventiveMemantine is an N-methyl-D-aspartate (NMDA) receptor antagonist. It works by blocking excess activity of a substance in the brain called glutamate, which may reduce the symptoms associated with Alzheimer disease. Memantine is not a cure for Alzheimer disease. It is used to help treat moderate to severe Alzheimer-type dementia.
MeperidineDemerolOpioidXInjection, PillAcuteMeperidine is an opioid analgesic. It works in the brain and nervous system to decrease pain. Meperidine is used in the short-term treatment of moderate to severe pain. It may also be used before or during surgery (e.g. to support anesthesia), for pain relief during labor and delivery, or for other conditions as determined by your doctor. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment.
Metaxalone SkelaxinMuscle relaxantXPillAcuteMetaxalone is a muscle relaxant used to relax muscles and relieve pain caused by strains, sprains, and other musculoskeletal conditions. Its exact mechanism of action is not known, but it may be due to general central nervous system depression.
MethazolamideGlaucTabs, NeptazaneDiureticXPillAcute & PreventiveThese medications are used to treat glaucoma, epilepsy, altitude sickness, periodic paralysis, idiopathic intracranial hypertension, and heart failure. Sometimes used to treat high-pressure headaches by lowering the production of spinal fluid.
Methocarbamol & AcetaminophenRobaxin, RobaxacetMuscle relaxantInjection, PillAcuteMethocarbamol is a central muscle relaxant used to treat skeletal muscle spasms. It is used in conjunction with acetaminophen. See acetaminophen for a separate description of this medication.
Methyl salicylateMenthoderm, Thera-Gesic Plus, Salonpas Pain PatchOther - topical rubefacientTopicalAcuteMethyl salicylate, or menthol cream, is a topical analgesic. It works by temporarily relieving minor pain. Topical rubefacients cause irritation and reddening of the skin, due to increased blood flow. They are used in the treatment of pain in various musculoskeletal conditions and in the temporary relief of minor aches and pains caused by arthritis, simple backache, strains, sprains, and bruises.
MethysergideDeseril, SansertAnti-serotonergic (Anti 5-HT)XPillPreventiveThe exact way that methysergide works is unknown. It is believed to be involved in narrowing the veins and arteries that supply blood to your head. Serotonin 5-HT is a chemical occurring in the body, and is thought to play a key role in migraine. These drugs block 5-HT2 receptors to stop the effects of 5-HT. Methysergide is a semi-synthetic ergot alkaloid. It should only be administered under hospital supervision because of potential side effects including retroperitoneal fibrosis and fibrosis of heart values and pleura.
MetoclopramideMaxolon, Metozolv ODT, Pramin, ReglanAntiemeticXInjection, PillAcuteMetoclopramide increases muscle contractions in the upper digestive tract which speeds up the rate at which the stomach empties into the intestines. It is used short term to treat heartburn caused by gastroesophageal reflux when other medications have not relieved symptoms. Metoclopramide is also used to treat slow gastric emptying in people with diabetes (also called diabetic gastroparesis) which can cause nausea, vomiting, heartburn, loss of appetite, and a feeling of fullness after meals.
Metoclopramide & ParacetamolAnagrain, Metomax, ParamaxCombination - Analgesic & antiemeticPillAcuteThe combination of metoclopramide and paracetamol is used to treat the symptoms of migraine, both to relieve headache (the paracetamol) and to treat associated nausea and vomiting (the antiemetic). In addition to its direct antiemetic effect, metoclopramide also stimulates gastric emptying (prokinetic), which is often delayed during migraine attacks, and accelerates the absorption of paracetamol.
MetoprololDutoprol, Betaloc, LopressorBeta blockerXPillPreventiveMetoprolol is a beta blocker that affects the heart and circulation. Metoprolol is used to treat angina (chest pain) and hypertension. It is also used to treat or prevent heart attack.
Mini-prevention--XVariousPreventive & AcuteMini-prevention involves keeping a diary or journal to track days of migraine attacks to identify the days at risk in advance and then treat in anticipation of those days. Treating in anticipation of risk involves starting treatment a day before the attack onset (or the morning of) and then continuing treatment twice daily for five to seven days. A person would continue this regimen regardless of whether an attack is occurring because the likelihood of an attack in that time period is high. Mini-prevention is especially helpful for the treatment of menstrually related migraine.
MirtazapineRemeronAntidepressantXPillPreventiveMirtazapine is an antidepressant. It affects chemicals in the brain that may become unbalanced and cause depression. Mirtazapine is used to treat major depressive disorder.
MometasoneElocon, NasonexSteroidNasal Spray, TopicalAcuteMometasone is a corticosteroid that works by reducing inflammatory reactions and modifying immune reactions in the body. The topical format is used for treating and preventing allergic nasal symptoms including congestion, sneezing, itching, and runny nose. It is also used for treatment of growths in the nose (nasal polyps). As a spray, it reduces inflammatory reactions in the nasal airway in response to allergens and irritants in the air. It is used to treat itching, redness, and swelling in many skin conditions.
MorphineAVINza, Kadian, MS ContinOpioidXInhalation, Injection, Pill, SuppositoryAcuteMorphine is an opioid pain medication. Morphine is used to treat moderate to severe pain. Short-acting formulations are taken as needed for pain. The extended-release form of this medicine is for around-the-clock treatment of pain and is not for use on an as-needed basis for pain. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment.
MoxonidinePhysiotensHypertensionXPillPreventiveMoxonidine is a blood pressure treatment that works by relaxing the muscles in the walls of your blood vessels. This means that your blood vessels widen, which reduces your blood pressure and allows blood and oxygen to circulate more freely around your body.
NadololCorgardBeta blockerXPillPreventiveNadolol is a beta blocker. It works by slowing down the heart and decreasing the amount of blood it pumps out. This helps to decrease blood pressure, helps the heart pump more efficiently, and reduces the workload on the heart. Nadolol is used in the long-term management of angina (chest pain). It is also used alone or with other medicines to treat high blood pressure.
NaproxenAleve, Anaprox, Midol Extended Relief, Naprelan 375, Naprosyn, Synflex & othersNonsteroidal anti-inflammatory drugs (NSAIDs)PillAcuteNaproxen is an NSAID that works by reducing hormones that cause inflammation and pain in the body. Naproxen is used to treat pain or inflammation caused by conditions such as arthritis, ankylosing spondylitis, tendinitis, bursitis, gout, or menstrual cramps. Naproxen is the preferred NSAID for long-term use in people with a high risk of cardiovascular complications, due to its relatively low risk of causing such complications.
NaratriptanAmerge, NaramigSerotonin 5-HT1 agonists or TriptansXPillAcuteNaratriptan is a serotonin 5-HT1 receptor agonist. It works by narrowing blood vessels in the brain. It is used to relieve certain types of migraine.
NimodipineNimotopCalcium channel blockersXInjection, PillPreventiveNimodipine is a calcium channel-blocking agent. Exactly how nimodipine works is unknown. It is used to help reduce problems from a lack of oxygen caused by bleeding from a blood vessel in the brain.
NitrazepamAlodorm, Insoma, Mogadon, Nitrosun, Ormodon, Paxadorm, Somnite & othersHypnoticXPillAcuteNitrazepam is a hypnotic drug of the benzodiazepine class, indicated for the short-term relief of severe, disabling anxiety and insomnia. It also has sedative and motor-impairing properties, as well as amnestic, anticonvulsant, and skeletal muscle relaxant effects.
Nonsteroidal anti-inflammatory drugs (NSAIDs)Advil, Bayer Aspirin, Aleve, Celebrex, Miniprin, Motrin, Ponstel, Voltaren & others Nonsteroidal anti-inflammatory drugs (NSAIDs)PillAcute & PreventiveNonsteroidal anti-inflammatory drugs (NSAIDs) are a group of medicines that reduce inflammation and relieve pain and fever. There are many different kinds of NSAIDs which can be grouped according to their preference for COX-1 and COX-2 enxymes. NSAIDs are used to treat mild-to-moderate pain from a wide range of conditions including headaches, migraine attacks, arthritis, toothache and fevers.
NortriptylineAllegron, PamelorAntidepressantXPillPreventiveNortriptyline belongs to a group of medicines called tricyclic antidepressants (TCAs). It is used to treat depression and some other conditions. It affects chemicals in the brain that may become unbalanced.
Omega Procedure (see also Reed Procedure®)-NeuromodulationXSurgically implanted neuromodulationPreventiveThe Omega Procedure is a trademarked surgical procedure for patients diagnosed with chronic migraine that involves implanting an occipital-nerve stimulator beneath the skin while the patient is under general anesthesia. It requires an initial minor surgery for a trial period, and a second surgery for permanent implantation as well as a battery-pack change every 10 years. Removal or repair requires surgery. The Omega Procedure and the Reed Procedure® are the same surgical procedure; the difference is solely in their registered names. From a practical standpoint, the difference comes in the relative experience of the physicians involved. Not FDA approved.
OnabotulinumtoxinABotoxMuscle relaxantXInjectionPreventiveOnabotulinumtoxinA (Botox), also called botulinum toxin type A, is made from the bacteria that causes botulism. Botulinum toxin blocks nerve activity in the muscles, causing a temporary reduction in muscle activity. Botox can be used to prevent chronic migraine in adults but should not be used to treat tension headache. It is an in-office procedure where multiple injections are inserted into the muscles of the forehead, head and neck. Treatment is repeated every 12 weeks if successful; however, there are maximum dose limits to be aware of. Botox is also used for other conditions and for cosmetic purposes.
OndansetronZofran, Zofran ODT, ZuplenzAntiemeticXInjection, PillAcuteOndansetron blocks the actions of chemicals in the body that can trigger nausea and vomiting. It is used to prevent nausea and vomiting that may be caused by surgery or by medicine to treat cancer (chemotherapy or radiation).
Other neuromodulation devicesRelivion MGNeuromodulationXDeviceAcuteRelivion is a smartphone-controlled, cloud-connected, multichannel neuromodulation device. It offers precise, personalized care by delivering stimulation to six branches of the occipital and trigeminal nerves via three adaptive output channels. This creates a cumulative effect by releasing neurotransmitters in the brain stem and modulating brain networks associated with control of pain and mood. Approved as an OTC in Europe in July 2019. Cleared by FDA in March 2021 and is available with a prescription in the United States.
OxycodoneEndone, Oxecta, OxyContin, Oxyfast, RoxicodoneOpioidXInjection, Pill, SuppositoryAcuteOxycodone is an opioid pain medication used to treat moderate to severe pain. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment.
Oxygen-Inhalant/DeviceXCannula/MaskAcute & PreventiveIt has been shown that oxygen causes a marked decrease in cerebral blood flow concurrent with a reduced degree of pain in cluster headache. There are two high-flow oxygen delivery methods for migraines: normobaric and hyperbaric, with normobaric more effective for migraine.
Oxymetazoline nasalAllerest, Afrin, Mucinex, Nostrilla, SinexDecongestantNasal SprayAcuteOxymetazoline solution is a decongestant. It works by shrinking swollen and congested nasal tissues (mucous membranes) by constricting blood vessels. This results in relief of congestion, improved drainage of mucus, and improved breathing through the nose. Local application using nose drops or sprays causes more intense and rapid vasoconstriction than oral medicines such as tablets or syrups.
PantoprazoleProtonix, Protonix IV, SomacProton-pump inhibitorsXInjection, PillAcutePantoprazole is a proton-pump inhibitor that decreases the amount of acid produced in the stomach. It is used to treat erosive esophagitis and other conditions involving excess stomach acid, such as Zollinger-Ellison syndrome. Pantoprazole is not for immediate relief of heartburn symptoms. Leading neurologist Dr. Andrew Charles has flagged proton-pump inhibitors as having the potential to make migraine worse. If you use one and have migraine, consider discussing with your doctor whether an alternative medication might be right for you.
Paracetamol & CodeineParacodolOpioidXPillAcuteParacetamol combined with codeine phosphate is used for the relief of moderate to severe pain when milder painkillers are not effective. Paracetamol is an analgesic and also an antipyretic, which helps reduce your body temperature if you have a fever. Codeine phosphate is also an analgesic and acts by blocking pain and emotional response to pain. See codeine for more detail. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment.
Paracetamol & IbuprofenMaxigesicCombination - Analgesic & NSAIDPillAcuteFor the temporary relief of mild to moderate pain associated with migraine, headache, backache, menstrual pain, dental pain, rheumatic and muscular pain, pain of non-serious arthritis, cold and flu symptoms, sore throat and fever. This combination is especially suitable for pain which requires stronger analgesia than ibuprofen or paracetamol alone.
Paracetamol (Acetaminophen)Little Fevers, Panadol, Tylenol & othersAnalgesic (painkiller)Liquid, Pill, SuppositoryAcuteParacetamol is also known as Acetaminophen depending on where you live. A pain reliever and fever reducer, the exact mechanism of action of paracetamol is unclear. Many common pain conditions including headache, muscle aches, arthritis, backache, toothaches, colds, and fevers are treated with paracetamol. It relieves pain in mild arthritis but does not affect the underlying inflammation and swelling of the joint.
PFO valve closure--XProcedurePreventiveMultiple studies suggest that migraine with aura is more prevalent in subjects with patent foramen ovale (PFO), an open passage between the chambers of the heart. Several studies suggest that PFO closure, a surgical procedure, may be an effective treatment for migraine. However, the grade of evidence from these studies is low.
Phenylephrine Hydrochloride & IbuprofenSudafed PECombination - Decongestant & NSAIDPillAcuteContains ibuprofen and phenylephrine hydrochloride, which are effective in relieving the symptoms of influenza and cold, including fever, headache, painful sinuses, sore throat, and muscle and joint pain. Moreover, it helps relieve a runny or stuffy nose and nasal sinuses.
Phenylephrine Hydrochloride & ParacetamolDimetapp PE Sinus Pain, Lemsip Cold & Flu, Panadol Cold & Flu, SudafedCombination - Decongestant & AnalgesicPillAcuteThis combination medication contains a decongestant & analgesic (paracetamol) and can help ease symptoms such as blocked or runny nose, sore throat, and body aches and headaches.
PizotifenSandomigranAnti-serotonergic (Anti 5-HT)XPillPreventivePizotifen acts on serotonin 5-HT, a chemical that is thought to play a key role in migraine. It is part of a class of drugs that block 5-HT2 receptors to inhibit the effects of 5-HT. Pizotifen also has antihistamine properties and is related to the tricyclic group of antidepressants.
PotassiumVariousVitamin/SupplementXIV Infusiton, Pill, LiquidAcute & PreventiveA mineral and electrolyte that assists in several body functions, including blood pressure, water balance, muscle contractions, digestion, heart rhythm and pH balance. It is sometimes taken in supplement form to balance electrolytes which are often low due to migraine and nausea.
PrednisoneRayos, SterapredSteroidXInjection, Nasal Spray, Pill, Suppository, AcutePrednisone is a corticosteroid that prevents the release of substances in the body that cause inflammation. It is used as an anti-inflammatory or an immunosuppressant medication. Prednisone treats many different conditions such as allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, and breathing disorders.
PregabalinLyricaAnticonvulsantXPillPreventivePregabalin is an anticonvulsant and neuropathic pain agent. Exactly how pregabalin works is not known. It is thought to bind to certain areas in the brain that help reduce seizures, nerve pain, and anxiety. Pregabalin is used to treat fibromyalgia or nerve pain caused by certain conditions (e.g., shingles, diabetic nerve problems, spinal cord injury). It is also used in combination with other medicines to treat certain types of seizures. Pregabalin can also be useful in the treatment of allodynia.
ProchlorperazineCompazine, Stemzine, Buccastem, Stemetil, PhenotilAntiemetic & AntipsychoticXInjection, Pill, SuppositoryAcuteProchlorperazine is a phenothiazine. It is not known exactly how it works. It is a highly potent typical antipsychotic, 10–20× more potent than chlorpromazine. It is used to help control severe nausea and vomiting, and to treat schizophrenia. It is also used to treat migraine. Intravenous administration can be used to treat status migrainosus.
PromethazinePhernergan, Phenadoz, PrometheganAntihistamine & antiemeticXInjection, Pill, SuppositoryAcutePromethazine works by changing the actions of chemicals in your brain. Promethazine also acts as an antihistamine. It blocks the effects of the naturally occurring chemical histamine in your body. Promethazine is used to treat allergy symptoms such as itching, runny nose, sneezing, itchy or watery eyes, hives, and itchy skin rashes. It also prevents motion sickness, and treats nausea and vomiting or pain after surgery. It is also used as a sedative or sleep aid.
PropranololHemangeol, Inderal LA, Inderal XL, InnoPran XL, InderalBeta blockerXInjection, Pill, SuppositoryPreventivePropranolol is a beta blocker. Beta blockers affect the heart and blood circulation. Propranolol is used to treat tremors, angina (chest pain), hypertension, heart rhythm disorders, and other heart or circulatory conditions. It is also used to treat or prevent heart attack and to reduce the severity and frequency of migraine.
PseudoephedrineContac Cold, Elixsure Decongestant, Entex, Genaphed, Sudafed, Suphedrin, Unifed & othersDecongestantPillAcutePseudoephedrine is a decongestant that shrinks blood vessels in the nasal passages. Dilated blood vessels can cause nasal congestion or stuffy nose. Pseudoephedrine is used to treat nasal and sinus congestion, or congestion of the tubes that drain fluid from your inner ears, called the Eustachian tubes.
QuetiapineSeroquelAnti-psychoticXPillPreventiveQuetiapine is an atypical antipsychotic. Exactly how it works is not known. It is thought to affect certain substances in the brain. It is used to treat schizophrenia or bipolar disorder.
Radiofrequency ablation--XProcedurePreventiveRadiofrequency ablation or neurotomy is an in-office procedure that uses heat generated by radio waves to target specific nerves and temporarily turn off their ability to send pain signals. Due to the proximity to other nerves in the face, a high degree of technical precision is necessary to perform the procedure. Radiofrequency ablation is generally considered for the treatment of chronic headaches that have failed to respond to other treatments or procedures.
Reed Procedure® (see also Omega Procedure)-NeuromodulationXSurgically implanted neuromodulationPreventiveThe Reed Procedure® is a surgical procedure for patients diagnosed with chronic migraine that involves implanting an occipital nerve stimulator beneath the skin while the patient is under general anesthesia. It requires an initial minor surgery for a trial period and a second surgery for permanent implantation as well as a battery pack change every 10 years. Removal or repair requires surgery. The Omega Procedure and the Reed Procedure® are the same surgical procedure; the difference is solely in their registered names. From a practical standpoint, the difference comes in the relative experience of the physicians involved. Not FDA approved.
Remote wearable neuromodulation (REN) deviceNerivioNeuromodulationXDeviceAcuteNerivio is a wireless non-invasive remote electrical stimulation wearable device applied to the upper arm at the onset of migraine headache or aura. Nerivio induces an inherent pain inhibition brain mechanism, resulting in clinically significant pain relief. Nerivio is controlled by a smartphone app, which includes a treatment diary. It was FDA cleared for use in adults in October 2020 and for adolescents in January 2021.
RimegepantNurtec ODTSmall molecule CGRP receptor antagonist (Gepant)XOrally-dissolving tabletAcute & PreventiveRimegepant is a gepant that treats acute migraine with or without aura by blocking CGRP receptors. CGRP is a brain chemical that causes vasodilation, inflammation, and pain at sites along the trigeminovascular pathway. Early studies show promise in the lack of association of gepants with medication overuse headache. It was FDA approved for acute treatment in February 2020 and for the preventive treatment of episodic migraine in June 2021.
RizatriptanMaxaltSerotonin 5-HT1 agonists or TriptansXPill, SublingualAcuteRizatriptan is a triptan that works by narrowing dilated blood vessels in the brain, relieving migraine. It is used to treat migraine with or without aura. It should not be used to prevent migraine or to treat cluster headache.
SertralineZoloftAntidepressantXPillPreventiveSertraline is an selective serotonin reuptake inhibitors (SSRIs) antidepressant. It is used to treat depression, obsessive-compulsive disorder, panic disorder, anxiety disorders, post-traumatic stress disorder (PTSD), and premenstrual dysphoric disorder (PMDD). Leading neurologist Dr. Andrew Charles has flagged SSRI medications as having the potential to make migraine worse. If you take an SSRI and have migraine, consider discussing with your medical practitioner whether an alternative medication might work for you.
Sodium valproateEpilimAnticonvulsantXInjection, PillPreventiveValproate is an anticonvulsant that works by increasing a certain chemical in the brain. The injectable form of sodium valproate is used to control epileptic seizures in patients who are unable to take the oral form. It is also used for the treatment of migraine and bipolar disorder.
Sphenopalatine ganglion (SPG) deviceSphenocath, Allevio, & Tx360 NeuromodulationXDevicePreventiveThe Sphenopalatine Ganglion (SPG) is a group of nerve cells that is linked to the trigeminal nerve, the main nerve involved in headache. Application of local anesthetics (or numbing medications) to block or partially block the SPG, can be helpful in reducing head and facial pain. Three devices have been approved for performing SPG blocks. A doctor inserts a very thin plastic tube into the nose to insert numbing medication in and around the SPG.
SumatriptanImigran, Imitrex, Treximet, Zembrace Symtouch, Onzetra XSail, Sumavel DoseProSerotonin 5-HT1 agonists or TriptansX Needle-less injection, Nasal Spray, PillAcuteSumatriptan is a triptan that works by narrowing blood vessels in the brain, which helps to relieve migraine and cluster headache. Sumatriptan is used to treat migraine with or without aura. It is one of the most common treatments with numerous high quality studies demonstrating its efficacy for the treatment of acute migraine. It is also used to treat cluster headache. The Treximet brand is a combination of sumatriptan and naproxen sodium, both of which are available as generics.
Supraorbital TNS unit or External Trigeminal Nerve Stimulation (eTNS)CefalyNeuromodulationXDeviceAcute & PreventiveA battery-powered electrical stimulator that's applied to the forehead. The device activates a low-level electrical current intended to stimulate the upper branches of the trigeminal nerve, which transmits some of the pain associated with migraine. The Cefaly I is a headband; Cefaly II is a smaller rechargeable unit with adjustable intensity.
Telcagepant-Gepant/small molecule CGRP receptor antagonist-Acute & PreventiveEarly CGRP treatment withdrawn from market by its manufacturer, Merck in 2009. A previous safety study showed patients taking it experienced elevated liver enzymes.
TimololBlocadren, Betimol, Betrim, Istalol, TimopticBeta blockerXEye drops, PillPreventiveTimolol is part of a group of drugs called beta blockers. It is used to treat hypertension. Timolol eye drops are used to treat increased pressure in the eye (ocular hypertension) and open-angle glaucoma. It may also be used for other conditions as determined by your doctor.
TizanidineZanaflexMuscle relaxantXInjection, Nasal Spray, PillAcuteTizanidine is a short-acting muscle relaxant. It works by blocking nerve impulses or pain sensations that are sent to your brain. Tizanidine is used to treat spasticity by temporarily relaxing muscle tone.
TopiramateTopamaxAnticonvulsantXPillPreventiveTopiramate is an anticonvulsant that is also helpful to prevent migraine. It works by affecting several chemicals in the brain that help to reduce seizure activity and prevent migraine from occurring. It may be used alone or with other medications.
TramadolConZip, Rybix ODT, Ryzolt, UltramOpioidXInjection, Pill, SuppositoryAcuteTramadol is a centrally-acting, oral opioid-like analgesic and is approved for the treatment of moderate to moderately severe pain in adults. The extended-release form of tramadol is for around-the-clock treatment of pain and not for use on an as-needed basis for pain.
Tramadol & Paracetamol (Acetominophen)Tramacet, UltracetOpioid-like & Analgesic (painkiller)XInjection, PillAcuteThis formulation combines individual ingredients for a stronger effect. See individual active ingredients for mode of action.
Transcranial Magnetic Stimulation (TMS) devicesTMS miniNeuromodulationXDeviceAcute & PreventiveTMS uses magnets to emit a single pulse of electricity. This pulse has been shown to treat cortical spreading depression (CSD), which is the physical change in the brain during aura and migraine. Research shows that daily use of TMS for 3 months or longer can lead to a reduction in acute medication use. eNeura’s sTMS mini is a TMS device available via prescription.
Transcutaneous electrical nerve stimulation (TENS) deviceCefaly, Icy Hot Smart Relief, Omron, truMedicNeuromodulationXDeviceAcuteTENS units are predominately used for nerve-related pain conditions, which may be acute or chronic. TENS machines work by sending stimulating pulses across the surface of the skin and along the nerve strands. The stimulating pulses help prevent pain signals from reaching the brain. TENS devices also help stimulate your body to produce higher levels of endorphins, its natural painkillers.
UbrogepantUbrelvySmall molecule CGRP receptor antagonist (Gepant)XPillAcuteUbrogepant is a gepant designed to treat migraine with or without aura as well as the symptoms of light sensitivity, sound sensitivity, or nausea. Ubrogepant targets CGRP receptors, blocking the CGRP from attaching. CGRP is a brain chemical that causes vasodilation, inflammation and pain at sites along the trigeminovascular pathway. Early studies show promise in the lack of association of gepants with medication overuse headache. It was FDA approved for acute treatment in December 2019.
Vagus Nerve Stimulation (VNS) devicegammaCoreNeuromodulationXDeviceAcute & PreventiveThe vagus nerve runs from the brain stem through the chest and abdomen on each side of the body. Vagus nerve stimulation appears to inhibit cortical spreading depression as well as calm the brain’s excitability. A VNS device stimulates the production of inhibitory neurotransmitters in the brain, including GABA, serotonin, and norepinephrine, which affect migraine and cluster headache. gammaCore is a handheld VNS device that stimulates the nerves noninvasively when placed above the vagus nerve in the neck. It is FDA cleared in the United States for adjunctive use for the preventive treatment of cluster headache in adults; acute treatment of pain associated with episodic cluster headache in adults; acute and preventive treatment of migraine in adolescents (age 12+ years) and adults; and treatment of paroxysmal hemicrania and hemicrania continua in adults.
Valproic AcidDepakene, Valproate Sodium, Depacon, StavzorAnticonvulsantXIV, Liquid, PillPreventiveValproic acid is used to treat various types of seizure disorders, sometimes together with other seizure medications. Valproic acid is also used to treat manic episodes from bipolar disorder and to prevent migraine.
VenlafaxineEffexorAntidepressantXPillPreventiveVenlafaxine is an antidepressant in a group of drugs called selective serotonin and norepinephrine reuptake inhibitors (SNRIs). Venlafaxine affects chemicals in the brain that may become unbalanced and cause depression. Venlafaxine is used to treat major depressive disorder, anxiety, and panic disorder.
VerapamilCalan, IsoptinCalcium channel blockersXInjection, PillPreventiveVerapamil is a calcium channel blocker. It works by relaxing the muscles of your heart and blood vessels. Verapamil is used to treat hypertension, angina (chest pain), and certain heart rhythm disorders.
ZaleplonSonataHypnoticXPillsAcuteZaleplon is a sedative, also called a hynoptic. It affects chemicals in one's brain that may be unbalanced in people with insomnia. Zaleplon causes relaxation to help one fall asleep and stay asleep.
Zavegepant (formerly Vazegepant)-Small molecule CGRP receptor antagonist (Gepant)XNasal Spray, Oral (in testing) AcuteZavegepant (formerly vazegepant) is a gepant currently in clinical trials. Trial participants treated with nasal zavegepant had rapid onset of pain relief at 15 minutes and returned to normal function as early as 30 minutes. The 10 mg and 20 mg zavegepant doses showed therapeutic benefits on both pain relief and return to normal function at 2 hours. Zavegepant is the first and only intranasal CGRP receptor antagonist in late-stage development. In September 2020, zavegepant received the go-ahead from FDA for clinical trials on oral formulations. Not yet FDA appoved as of March 2021.
ZolmitriptanZomigSerotonin 5-HT1 agonists or TriptansXNasal Spray, PillAcuteZolmitriptan is a triptan that works by narrowing blood vessels in the brain, which helps to relieve migraine. It is used to treat migraine with or without aura in adults. It is not intended to prevent migraine attacks.
ZolpidemAmbien, Edluar, Intermezzo, Stilnox, Zonadin, Sanval, Zolpimist HypnogenHypnoticXPill, SuppositoryAcuteZolpidem is a sedative, also called a hypnotic. It affects chemicals in your brain that may become unbalanced and cause sleep problems or insomnia. The immediate-release forms of zolpidem are Ambien, Intermezzo, Edluar, and Zolpimist. The extended-release form of zolpidem is Ambien CR. Ambien, Edluar, and Zolpimist are used to help you fall asleep when you first go to bed. Intermezzo is used to help you fall back asleep if you wake up in the middle of the night.
ZonisamideZonegranAnticonvulsantXPillPreventiveZonisamide is often used in combination with other medications to treat certain types of seizures. Zonisamide is in a class of medications called anticonvulsants. It works by decreasing abnormal electrical activity in the brain.

Treatment Directory – Quick Start

Quick Start Guide

Introduction

While each doctor has their own list of treatments to try for migraine relief, we are all painfully aware that there is no cure. Often, treatments work for a few months or a year and then mysteriously stop working. Other times, treatment side effects simply become intolerable. Or our migraine symptoms change. Each of these circumstances may prompt us to search for a new way to get relief.

No matter what the reason, the words we never want to hear from our doctors are “We’re simply out of options.”

Methodology

That’s why we’ve crowd-sourced more than 300 medicinal and nonmedicinal treatments that those with migraine have self-reported they are using. Several are new in the 2022 edition of the Migraine World Summit Treatment Directory.

Once we identified all the treatments, we then researched the basic information about those treatments. However, this Directory is not designed to be a comprehensive reference for any individual treatment. By including side effects, contraindications, dosages, and more for each treatment, this resource would expand to several hundred pages in length and become unwieldy.

Organization

You’ll find that this guide is divided into two major sections:

1) Medical; and
2) Nonmedical.

1) Medical Treatments

In this section, you’ll find Preventive and Acute treatments that are generally prescribed by or administered by a doctor. Some are available over the counter at drug stores, labeled as “no” in the prescription column.

For Preventive Treatments, you’ll see more “off-label” drugs. Until recently, most preventive medications were NOT developed specifically for migraine. The arrival of the new class of CGRP monoclonal antibodies has changed that and more migraine-specific medications are also on the horizon. 

You’ll find major drug classes of preventives including anticonvulsants, antidepressants, beta blockers, injectables, and calcium channel blockers, among others. 

For Acute Treatments, doctors may prescribe Drugs like analgesics, painkillers, NSAIDs, ergots, triptans, and anti-nausea medications. You’ll also find Devices, such as gammaCore, used for acute treatment in this section. Those not specifically designed for migraine are used for nausea or pain.

2) Nonmedical Treatments

It’s important to recognize that there are many non-medical treatments that have been used for migraine relief over centuries before the latest medical treatments were developed. You may not hear about these from your doctor, but many patients use them.

Always check with your doctor if you choose to try something from this section, unless it’s 100% safe – like water, oxygen, or lying down. Even things labeled as “Natural” are not always safe.

For example, certain supplements proven to be effective in preventing migraine aren’t always produced with consistent quality control. Certain essential oils – like peppermint oil for pregnant women – are contraindicated for some patients. Too much caffeine, while “natural,” can be problematic for people with migraine.

For this reason, it’s wise to discuss everything with your doctor.

In terms of Nonmedicinal Prevention, it’s important to know that effective Behavioral, Physical, Product/Device, Lifestyle, Vitamins/Supplement and Procedure treatments exist that don’t require a prescription. These can be used in addition to or in some cases instead of Medicinal options, depending on the severity and frequency of your migraine disease. Doctors generally endorse healthy lifestyle options, most of which are free.

Nonmedicinal Acute treatments are more limited than other categories with fewer Products/Devices and Vitamins/Supplement options.

How to Use this Treatment Directory

There are a number of ways you can use this guide:

To discover new options. When you think you’ve tried everything, scrolling through this list may narrow down some new choices, treatment types, or perhaps combinations of options to discuss with your doctor during your next appointment. 

To find more medications in a certain class. If you have taken one triptan that didn’t work and want to try another one, you can look find all the other triptans available and find the brand names and  different formats (e.g. injectable, melting tablets, nasal spray) that may work more effectively for you.

To track your history. We strongly encourage you to make notes on what you have tried and have not. It is invaluable when you switch doctors, appeal insurance claims and look for new options. Include the date, duration, doctor, benefits, and side effects. Alternately, you can enter this same information in a digital diary. It can become your checklist of what to try next.

Tips

If you find yourself taking more Acute medications than you’d like, running out of medications in a month, or ending up in the emergency room more often, it’s a sign that you need a better plan. That plan may consist of a different mix of Prevention & Acute treatments – possibly including a combination of Lifestyle, Natural, Behavioral, Drugs, Devices and Procedures.

Give each treatment a fair evaluation. For prevention, that generally means at least several months. For acute treatments, that generally means at least three attacks, since each attack can be different.

Warning

If you are currently taking a medication listed as a Narcotic or Opioid, these medications can be habit-forming. Discuss the maximum number of doses per week or month with your doctor and if there are any non narcotic alternatives that may be appropriate.

Disclaimers

The quality, safety and appropriateness of these listed treatments must be assessed by your doctor and tailored for your own individual health circumstances. Seek medical advice before you change your treatment.

This listing does not constitute medical advice. Only your doctor can provide you with an informed and safe treatment plan. Many treatments may be used to treat other conditions.

We do not endorse any of the brand name treatments herein. The effectiveness of different treatments has not been evaluated for this Directory. There are significant differences in the performance and side effects of specific treatments and for each individual. In many cases, it will depend on your individual health circumstances.

TREATMENT MAP

 

 

Treatment Guidelines

2022 Migraine Treatment Guidelines Summary

Introduction

Many evaluations of migraine treatments use a scale on which to evaluate the quantity and quality of evidence supporting the effectiveness of a particular treatment.

Studies are undertaken; some may be clinical research, others may be less scientifically robust. The quality of these studies is considered by dividing them into Classes.

For example: A Class I study is more rigorous than a Class III study.

If there are more Class I studies for a treatment that demonstrate strong performance then this results in a higher evidence level for that treatment.There are four levels: level A, level B, level C and level U; the highest being level A.

How to read this report

Studies are ranked in terms of “Class” from 1 to 4, in the form of Class I, Class II, etc. with Class I studies being the highest quality and Class IV studies not meeting any quality controls, consensus or expert opinion.

Several studies have reviewed the evidence, graded the studies and summarized many treatments into the following “Levels:”

Level A: established efficacy (at least two Class I trials)
Level B: probably effective (one Class I or at least two Class II studies)
Level C: possibly effective (at least one Class II study)
Level U: inadequate or conflicting data to support or refute use

Other: treatments that are established as possibly or probably ineffective.

Important notes

This list was created because we couldn’t find it anywhere else. It was created specifically for the Migraine World Summit based on official guidelines published by leading medical societies, including the American Headache Society (AHS), the American Academy of Neurology (AAN), the European Headache Foundation (EHF), the US Headache Consortium and the WHO Lifting the Burden Campaign. Some of these guidelines have also been interpreted in Headache: The Journal of Headache and Facial Pain; and the European Journal of Headache. This summary has not been reviewed by any medical society, and it does not constitute medical advice.

Specific doses are not provided, since they vary by country. Ask your physician what’s right for you. If a certain treatment is not available in your country, check for similar medications.

If you’re wondering why some treatments are in our Treatment Directory but are not reflected in these Guidelines (e.g. devices, pediatric acute, or recently approved treatments), it’s often because safety board (e.g. FDA) approval and clinical practice often precede medical society reviews to allow time for additional studies to be completed. Medical societies also review entire classes of treatments every five or ten years, whereas new treatments are approved and enter the market every year.

Be sure to check this list annually to see if your treatments have changed in their classification. That’s a good time to review your treatment plan with your doctor.


Preventive Treatment of Migraine in Adults

Level A: Established as effective

These should be offered to you by your doctor if you require migraine prevention.

Candesartan
Divalproex sodium
Eptinezumab
Erenumab
Fremanezumab
Frovatriptan
Galcanezumab
Metoprolol
Onabotulinum toxin A (for chronic migraine only)
Propranolol
Timolol
Topiramate
Valproate sodium

Notes on behavioral and device therapies:

Four biobehavioral therapies have Grade A evidence supporting their use but are no longer listed in the AHS guidelines specifically:

Cognitive behavioral therapy
EMG Biofeedback
Relaxation training
Thermal biofeedback with relaxation training

Four nerve-modulating devices have been approved by the FDA:

eTNS
nVNS
REN
sTMS

All four devices can be used alone or together with pharmacotherapy for acute treatment. Three devices are cleared for use as monotherapy or adjunctive therapy for preventive migraine treatment: eTNS, nVNS, and sTMS.

Three devices (nVNS, REN, and sTMS) are also cleared for the acute and preventive treatment of migraine in adolescents between 12 and 17 years of age.

Level B: Probably effective

These should be considered to you by your doctor if you require migraine prevention.

Amitriptyline
Atenolol
Behavioral therapy combination with preventive drug therapy
Lisinopril
Memantine
Nadolol
Onabotulinum toxin A combination with CGRP monoclonal antibodies
Venlafaxine


Acute Treatment of Migraine in Adults

Acute treatments for adults with migraine, generally available by prescription for use at home. Scroll down to see acute options administered for Treatment Emergencies. Classification may vary by country.

Level A: Established as effective

Migraine-specific
Almotriptan
Eletriptan
Ergotamine derivatives
Frovatriptan
Lasmiditan
Naratriptan
Rimegepant
Rizatriptan
Sumatriptan (nasal spray, IM, oral)
Sumatriptan with Naproxen
Ubrogepant
Zolmitriptan (oral or nasal spray)

AHS Guidelines recommend considering neuromodulatory devices in patients who prefer nondrug treatments or in whom drug treatment is ineffective, intolerable, or contraindicated.

Nonspecific
Acetaminophen
Aspirin
Celecoxib oral solution
Diclofenac
Ibuprofen
Naproxen
Combination analgesic: Acetaminophen, aspirin, and caffeine

Level B: Probably effective

Migraine-specific
Dihydroergotamine (other forms)
Ergotamine

Nonspecific
Flurbiprofen
Isometheptene-containing compounds
Ketoprofen
Ketorolac (IV and IM formats)
Magnesium (IV) (for migraine with aura only)

Nonspecific antiemetics
Chlorpromazine
Droperidol
Metoclopramide
Prochlorperazine
Promethazine


Migraine with Menstruation

Treatments appropriate for short-term migraine prevention for migraine associated with menstruation:

Level A: Established as effective

Frovatriptan

Note: a loading dose was used where an initial higher dose is given at the beginning of a course of treatment before dropping to a maintenance dose.

Level B: Probably effective

Naratriptan
Zolmitriptan

Level C: Possibly effective

Estrogen


Children & Adolescents

The American Academy of Neurology and American Headache Society updated their guideline-recommended treatments for the Acute Treatment of Children and Adolescents. These have a slightly different format than other categories, using the term ‘Level of Confidence in Evidence’ instead of ‘Level A: Established as Effective.’ These guidelines also differentiate between the effectiveness of therapies for pain response at two hours and nausea/vomiting relief at two hours. In children and adolescents, nausea/vomiting can often be more bothersome than pain, or the only symptom that they experience.

Acute treatments for children and adolescents with migraine: Pain response at 2 hours.

Low confidence in evidence

Ibuprofen OS 7.5-10 mg/kg
Acetaminophen / paracetamol

Very low confidence in evidence

Sumatriptan nasal spray 5-10 mg
Sumatriptan oral tablet 25-50 mg

Acute treatments for children and adolescents with migraine: Relief of nausea and vomiting at 2 hours.

Moderate confidence in evidence
Sumatriptan nasal spray 5 mg (nausea and vomiting)

Low confidence in evidence
Sumatriptan nasal spray 10 mg (vomiting)

Very low confidence in evidence
Sumatriptan nasal spray 10 mg (nausea)

Moderate: Probably no more likely than placebo.

Low: Possibly no more likely than placebo.

Results Summary (2019 AAN)

There is evidence to support the efficacy of the use of ibuprofen, acetaminophen (in children and adolescents), and triptans (mainly in adolescents) for the relief of migraine pain, although confidence in the evidence varies between agents.

There is high confidence that adolescents receiving oral sumatriptan/naproxen and zolmitriptan nasal spray are more likely to be headache-free at 2 hours than those receiving placebo.

No acute treatments were effective for migraine-related nausea or vomiting; some triptans were effective for migraine-related phonophobia and photophobia.


Emergency Treatment

Acute treatments for adults with migraine in a professional health care facility:

Level B: Probably effective

Chlorpromazine IV
Dexamethasone (to prevent recurrence)
DHE IV, IM, SC
Droperidol IV
Ketorolac IV, IM
Metoclopramide IV
MgSO4 IV (migraine with aura)
Prochlorperazine IV
Sumatriptan SC

Level C: Possibly effective

Butorphanol IM
Dexamethasone IV
Meperidine IM
Methadone IM
Tramadol IV
Valproate IV

Level U: inadequate or conflicting data to support or refute use

Lidocaine IV
Hydrocortisone IV

Level B Negative: Medication is probably ineffective

Octreotide SC

Level C Negative: Medication is possibly ineffective

Chlorpromazine IM
Granisetron IV
Acetaminophen IV


SOURCES:
  • AHS Consensus Statement: Update on integrating new migraine treatments into clinical practice. Ailani J, Burch RC, Robbins MS; the Board of Directors of the American Headache Society. Headache. 2021;61:1021–1039. https://doi.org/10.1111/ head.14153
  • AHS/AAN 2012 Migraine Prevention Guidelines: Drugs Recommended for Short-Term Prevention of Migraine Associated With Menstruation
  • AAN 2012 Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults
  • EFNS 2006 Revised Guidelines on the drug treatment of migraine – revised report of an EFNS task force
  • AAN/CNS 2004 evidence-based guideline on the pharmacological treatment of migraine in children and adolescents
  • US Headache Consortium 1999 – Evidenced-Based Guidelines For Migraine Headache: Behavioral and Physical Treatments
  • AAN/AHS 2019 Practice guideline update summary: Acute treatment of migraine in children and adolescents: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology.2019 Sep 10;93(11):487-499. doi: 10.1212/WNL.0000000000008095. Epub 2019 Aug 14

Interview Summaries

Interview Summaries

Enjoy a one-page summary of the key facts and insights from every interview.

    • Save time and discover the important points quickly
    • Uncover essential information in the summaries and get all the details in the full interview

Click to View/Download the summaries (PDF)

TITLEEXPERT
DAY 1
New Research on the Real Migraine Patient ExperienceRebecca Wells, MD, MPH
Expert Tips to Manage Persistent Migraine PainJessica Ailani, MD
Migraine Long Haulers: Lasting EffectsMatthew Robbins, MD
The Latest New Treatments for MigraineDeborah Friedman, MD, MPH, FAAN
DAY 2
Persistent Chronic Migraine Symptoms Between AttacksChristine Lay, MD, FAHS
10 Steps to Migraine Management Your Doctor Should be TakingMessoud Ashina, MD
True Resilience: How a Paralympian Wins With Migraine
Allysa Seely
When Nothing Works: Treatment-Resistant Chronic MigraineAmaal Starling, MD
DAY 3
Complementary and Integrative Treatments for MigraineElizabeth Leroux, MD, FRCPC
Autoimmune Disease and Migraine: A Closer LookPeter McAllister, MD
Inflammation Control as Migraine ControlGretchen Tietjen, MD
Ehlers-Danlos, Connective Tissue Disorders & MigraineVince Martin, MD
DAY 4
Physical Therapy Modalities for Headache & PainAli Ladak, PT, DPT, PhD
Drug-Free Devices for Modulating MigraineDeena Kuruvilla, MD, FAHS
Understanding The Genetics of HeadacheLyn Griffiths, PhD
Techniques for Managing Vestibular Migraine
Michael T. Teixido, MD
DAY 5
Long-Term Effects of New Migraine MedicationsRobert Cowan, MD
Strategies to Boost Brain HealthKrystal L. Culler, DBH, MA
New Daily Persistent Headache: Causes, Symptoms & TreatmentDavid Dodick, MD
Food and Diets: A Nutritionist’s Take On How They Affect MigraineMargaret Slavin, PhD, RDN
DAY 6
Chronic Cluster HeadacheChristopher Gottschalk, MD, FAHS
Learning How to Sleep Better with MigraineAlex Dimitriu, MD
How We Got to Now: A History of MigraineKatherine Foxhall
Navigating COVID with Migraine in EuropePatricia Pozo Rosich, MD, PhD
DAY 7
Osmophobia: Scent-Induced MigraineFrederick Godley, MD
Chronic Disease on Social Media: Helpful or Harmful?Cynthia E. Armand, MD
Best Practices for Treating Children With MigraineScott W. Powers, PhD, ABPP, FAHS
Women’s Health Inequities and MigraineMonica P. Mallampalli, PhD
DAY 8
Staying Hopeful: Treatment Burnout in Chronic DiseaseDawn Buse, PhD
How Women’s Hormones Affect MigraineJelena Pavlovic, MD, PhD
The Latest Cannabis Research for MigraineNathaniel M. Schuster, MD
The Latest Developments in Migraine ResearchRichard Lipton, MD

2022 VIP Pass Add-ons

Welcome to your 2022 VIP Pass add-on package!

The add-ons are granted to both VIP and Box Set Plus members. Below is an overview of the content in your package.

The VIP Access Pass gives you unlimited access via our online portal to all 2022 Expert Videos, Audios, Transcripts, Online Streaming, and Online Downloading. PLUS you also have access to our Private Support Group, a Treatment Directory with a list of over 300 options, and Guideline Recommended Treatment Report, Quarterly Research Reports and New Treatment List.

All Boxed Set Owners will receive a printed copy of the above resources except for the Quarterly Research Reports. These reports are done each quarter throughout the year. You will receive updates via email and announcements here in your member’s area when these become available. The Facebook Private Support Group is the only other resource that remains online. All other documents and materials are delivered in the Boxed Set.

To view your VIP resources, choose from the list of Add-ons linked on this page. The first Quarterly Research Report will be ready by mid April from Quarter 1, 2022.


VIP & Boxed Set Timings:

Add-On resources are double and triple-checked for factual and grammatical errors. Filming this year occurred as recently as last month. Some materials are therefore still being consolidated and will be made available as soon as they are ready. Until everything is completed, materials will be added as they are approved for release. You can view the status of each Add-On by clicking on the item in the Add-On section of this page.

Boxed Set Deliveries:

We are currently preparing your personal Boxed Set for shipping. The set includes a USB stick containing all the video and audio recordings plus the transcript book, interview summaries, and treatment guideline directory.

Our team has been busy finalizing and preparing all the materials before checking all the details from our printers and fulfillment center. The estimated timeline for delivery is outlined below.

Current 2022 Delivery Timeline:

  • March 28: Printer sent materials.
  • March 29- April 6: Printers develop proofs.
  • April 5-18: Proofs and files reviewed and approved.
  • April 19: Boxed Set is shipped today.
  • April 20-30: US orders due for arrival.
  • May 7-28: International orders due for arrival. Timing varies based on global location and COVID interruptions.

A United States Postal Service tracking code will be emailed to you so you can track your order.

Remember, you still have online access to all the interview videos, audio, and transcripts. We appreciate your understanding and patience.

Thank you,
Migraine World Summit Editorial Team

Interview Summaries

Interview Summaries

Enjoy a one-page summary of the key facts and insights from every interview.

    • Save time and discover the important points quickly
    • Uncover essential information in the summaries and get all the details in the full interview

Click to View/Download the summaries (PDF)

To download a compilation of all summaries, click here.

TITLEEXPERT
DAY 1
Why Doesn’t Migraine Have a Cure Yet?Tissa Wijeratne, MD, FRACP, FAAN
Unlocking the Mystery of Migraine PathogenesisPeter Goadsby, MD
Latest Strategies for Chronic Migraine ControlCarrie Dougherty, MD, FAHS
Finding Resilience With Migraine, Its Comorbidities, and COVIDNoah Rosen, MD, FAHS
DAY 2
Discovering New Treatments Worth TryingDavid Dodick, MD
Racial Inequities In Migraine TreatmentSheila L. Thorne
What Causes Migraine and Its Symptoms
Catherine Stark, MD
Moving Through the Pain: Exercise and MigraineRichard Lipton, MD
DAY 3
Preventing Attacks Before They HappenJan Lewis Brandes, MD
How Weight Affects Migraine DiseaseDale Bond, PhD
Light Sensitivity and Therapy for MigraineDeborah Friedman, MD, MPH
How to Manage Weather TriggersJan Hoffmann MD, PhD
Is the Gut-Brain Connection at the Heart of Oral Migraine Treatment Failure?Nada Hindiyeh, MD
DAY 4
How An Integrative Approach Can Help MigraineDeena Kuruvilla, MD, FAHS
Headache and Migraine in Later LifeMatthew Robbins, MD
Recovering From Trauma and ConcussionMorris Levin, MD
Yoga For Migraine: Does It Help?Adriane Dellorco
DAY 5
Migraine Diets and Food TriggersVince Martin, MD
Medications that Make Migraine WorseStewart J. Tepper, MD, FAHS
Finding Work That Works Despite MigraineMelanie Whetzel, MA, CBIS
Difficult Diagnoses: Rare Headache TypesShuu-Jiun Wang, MD
DAY 6
Shortening Attacks With Early Migraine InterventionAndrew Charles, MD
Sex Headaches: Serious or Just Awkward?Katherine Hamilton, MD
Autoimmune Disease and Migraine: What’s the Link?Peter McAllister, MD
Managing Migraine With Little to No InsuranceDavid Watson, MD, FAAN
DAY 7
Juggling Multiple Conditions With MigraineRebecca C. Burch, MD, FAHS
Understanding Treatment Failure and OptionsSimona Sacco, MD
Fighting Migraine With Food and NutritionBelinda Savage-Edwards, MD, FAAN, AQH
When Migraine Starts or Stays in Your NeckSait Ashina, MD
DAY 8
How Your Gut and Sleep Affect MigraineStasha Gominak, MD
COVID in the Real WorldLindsay Videnieks, JD
Understanding Vestibular MigraineShin Beh, MD
Overcoming Monthly Menstrual MigraineChristine Lay, MD, FAHS

2021 VIP Pass Add-ons

Welcome to your 2021 VIP Pass add-on package!

These add-ons are granted to both VIP and Box Set Plus members. Below is an overview of the content in your package.

The VIP Access Pass gives you unlimited access via our online portal to all 2021 Expert Videos, Audios, Transcripts, Online Streaming, and Online Downloading. PLUS you also have access to our Private Support Group, a Treatment Directory with a list of over 300 options, and Guideline Recommended Treatment Report.

All Boxed Set Owners will receive a printed copy of the above resources. Your Facebook Private Support Group is the only resource that remains online.

To view your VIP resources, choose from the list of Add-ons linked on this page.


VIP & Boxed Set Timings:

VIP Add-On resources are double and triple-checked for factual and grammatical errors. Filming for 2021 occurred recently as February 2021. As such we are still in the process of reviewing some materials. This message will be updated as soon as everything is available. Until everything is completed, materials will be added as they are approved for release. You can view the status of each Add-On by clicking on the item in the Add-On section of this page.

Boxed Set Deliveries:

We are currently preparing your personal Boxed Set for shipping. The set includes a USB stick containing all the video and audio recordings plus the transcript book, interview summaries, and treatment guideline directory.

Our team has been busy finalizing and preparing all the materials over the last two weeks with our printers and fulfillment center. The estimated timeline for delivery is outlined below.

Delivery Timeline:

  • March 25: Printer sent materials.
  • March 26- April 2: Printers develop proofs.
  • April 2-15: Proofs and files reviewed and approved.
  • April 16: Boxed Set is shipped today.
  • April 20-30: US orders due for arrival.
  • May 7-28: International orders due for arrival. Timing varies based on global location and COVID interruptions.

A United States Postal Service tracking code will be emailed to you so you can track your order.

Remember, you still have online access to all the interview videos, audio, and transcripts. We appreciate your understanding and patience.

Thank you,
Migraine World Summit Editorial Team.

Treatment Guidelines

2021 Migraine Treatment Guidelines Summary

Introduction

Many evaluations of migraine treatments use a consistent basis on which to evaluate the quantity and quality of evidence supporting the effectiveness of a particular treatment.

Studies are undertaken, some may be clinical research others may be less scientifically robust. The quality of these studies are evaluated into Classes.

For example: A Class I study is better than a Class III study.

If there are more Class I studies for a treatment that demonstrate strong performance then this results in a higher evidence level for that treatment… the highest level is A.

How to read this report

Studies are ranked in terms of “Class” from 1 to 4, in the form of Class I, Class II etc. With Class I studies being the highest quality and Class IV studies not meeting any quality controls, consensus or expert opinion.

Several studies have reviewed the evidence and graded the studies and summarized many treatments into the following “Levels”:

Level A: established efficacy (at least two Class I trials).
Level B: probably effective (one Class I or at least two Class II studies).
Level C: possibly effective (at least one Class II study).
Level U: inadequate or conflicting data to support or refute use.

Other: treatments that are established as possibly or probably ineffective.

Important notes

This list was created because we couldn’t find it anywhere else. It was created specifically for the Migraine World Summit based on official guidelines published by leading medical societies, including the American Headache Society, the American Academy of Neurology, the European Headache Foundation, the US Headache Consortium and the WHO Lifting the Burden Campaign. Some of these guidelines have also been interpreted in Headache: the Journal of Headache and Facial Pain; and the European Journal of Headache. This summary has not been reviewed by any medical society, and does not constitute medical advice.

Specific doses are not provided, since they vary by country. Ask your physician what’s right for you. If a certain treatment is not available in your country, check for similar medications.

If you’re wondering why some treatments are in our Treatment Directory but are not reflected in these Guidelines (e.g. devices, pediatric acute, or recently approved treatments like CGRPs, gepants, ditans, etc), it’s often because safety board (e.g FDA) approval and clinical practice often precede medical society reviews to allow time for additional studies to be completed. Medical societies also review entire classes of treatments every five or ten years, whereas new treatments are approved and enter the market every year.

Be sure to check this list annually to see if your treatments have changed in their classification. That’s a good time to review your treatment plan with your doctor.

* Indicates a difference in recommendation level by country or medical review board.


NOTABLE NEW TREATMENTS

For the full list of the latest new treatments available, please consult the Migraine World Summit Treatment Directory, updated annually. Treatment Guidelines are updated periodically by the medical societies (AHS, HIS, AAN, EHF) and often do not include the most recently approved therapeutic drugs and devices. This is not a full list of the new additions to the Treatment Directory.

New since the last guidelines release

NEW MEDICAL ACUTE TREATMENTS

Lasmiditan (Reyvow)**

Rimegepant (Nurtec ODT)**

Ubrogepant (Ubrelvy)**

Neurolief device (Relivion)***

Remote wearable neuromodulation device (Nerivio)**

Zavegepant (in testing as an acute treatment)

NEW ACUTE AND PREVENTIVE TREATMENTS

Telcagepant

Vazegepant

NEW PREVENTIVE TREATMENTS

Atogepant (in testing as a preventive treatment)

Eptizenumab (Vyepti)**

Erenumab (Aimovig)**

Fremanezumab (Ajovy)**

Galcenezumab (Emgality)**

Rimegepant (Nurtec ODT, acute, in testing as a preventive)

NEW NONMEDICAL PREVENTIVE TREATMENTS

Green-light lamp (Allay lamp)**

Important Notes:

-Approval status varies by date and geography: *Approved by US Food and Drug Administration for migraine. **Recently approved and introduced in US. ***Recently approved and introduced in Europe.

-Even though some of these treatments are commercially available and approved by regulating bodies, they may not be included in the guideline-recommended treatments. Reviews by medical societies often lag approval and availability by one to three or more years.


Preventative treatment of migraine in adults

Preventative treatments for adults with migraine, including prescription, behavioral and complementary therapies:

Level A: Established as effective

These should be offered to you by your doctor if you require migraine prevention.

Cognitive behavioral therapy*
Divalproex sodium
EMG Biofeedback
Frovatriptan^
Metoprolol
Onabotulinum toxin A (Botox)
Petasites (Butterbur)*
Propranolol
Relaxation training*
Sodium Valproate
Thermal biofeedback with relaxation training*
Timolol
Topiramate

Level B: Probably effective

These should be considered to you by your doctor if you require migraine prevention.

Amitriptyline
Atenolol
Behavioral therapy + Preventive Drug Therapy*
Fenoprofen*
Feverfew (MIG-99)*
Fluvoxamine
Fluoxetine
Histamine (Subcutaneous)*
Ibuprofen*
Ketoprofen*
Magnesium*
Nadolol
Naproxen/naproxen sodium*
Protryptiline*
Riboflavin*
Venlafaxine

Level C: Possibly effective

These may be considered to you by your doctor if you require migraine prevention.

Acetylsalicylic Acid (Aspirin) *
Candesartan
Carbamazepine*
Clonidine
Coenzyme Q10 (CoQ10)*
Cyproheptadine
Estrogen*
Flurbiprofen*
Gabapentin*
Guanfacine
Lisinopril*
Magnesium*
Mefenamic acid
Methersygide
Nebivolol
Pindolo
Riboflavin*
Tanacetum Parthenium*

Level U: Treatments for which data are conflicting or inadequate to support or refute use

Acupuncture
Cervical manipulation
Hyperbaric Oxygen
Hypnosis
Indomethacin
Occlusal adjustment
Omega-3
TENS

Other: treatments that are established as possibly or probably ineffective

This category of treatments should not offered or considered for migraine prevention.

Acebutolol
Bisoprolol*
Clomipramine
Clonazepam
Lamotrigine
Leukotriene receptor antagonist
Montelukast
Nabumetone
Oxcarbazepine
Telmisartan


Acute treatment of migraine in adults

Acute treatments for adults with migraine, generally available by prescription for use at home. Scroll down to see acute treatments administered for Emergencies.

Level A: Established as effective

Acetaminophen (for non-incapacitating attacks)
Almotriptan
Aspirin
Butorphanol nasal spray
DHE (nasal spray + inhaler)
Diclofenac
Eletriptan
Frovatriptan
Ibuprofen
Naproxen
Naratriptan
Rizatriptan
Sumatriptan (nasal spray, IM, oral)
Sumatriptan with Naproxen
Zolmitriptan (oral or nasal spray)
Acetaminophen, aspirin, caffeine

Level B: Probably effective

Chlorpromazine
Codeine/acetaminophen
Droperidol
Ergotamine
Ergotamine/Caffeine
Flurbiprofen
Isometheptene-containing compounds
Ketoprofen
Ketorolac (IV and IM formats)
Magnesium (IV)
Metamizol (oral and IV)
Metoclopramide
Phenazon*
Prochlorperazine
Promethazine
Tolfenamic Acid
Tramadol/acetaminophen

Level C: Possibly effective

Phenazone*
Butalbital
Lidocaine intranasal

Level U: inadequate or conflicting data to support or refute use.

Celecoxib
Ketorolac tromethamine nasal spray

Level C Negative

Ketorolac tromethamine nasal spray

*Classification may vary by country


Migraine with Menstruation

Treatments appropriate for short term migraine prevention for migraine associated with menstruation:

Level A: Established as effective

Frovatriptan

Note: a loading dose was used where a initial higher dose is given at the beginning of a course of treatment before dropping to a maintenance dose.

Level B: Probably effective

Naratriptan
Zolmitriptan

Level C: Possibly effective

Estrogen


Children & Adolescents

The American Academy of Neurology and American Headache Society updated their guideline-recommended treatments for the Acute Treatment of Children and Adolescents. These have a slightly different format than other categories, using the term ‘Level of Confidence in Evidence’ instead of ‘Level A: Established as Effective.’ These guidelines also differentiate between the effectiveness of therapies for Pain Response at 2 Hours and Nausea/Vomiting Relief at 2 Hours. In Children and Adolescents, Nausea/Vomiting can often be more bothersome than pain, or the only symptom that they experience.

Acute treatments for children and adolescents with migraine: Pain response at 2 hours.

Low Confidence in Evidence

Ibuprofen OS 7.5-10 mg/kg

Acetaminophen / paracetamol

Very Low Confidence in Evidence

Sumatriptan nasal spray 5-10 mg

Sumatriptan oral tablet 25-50 mg

Acute treatments for children and adolescents with migraine: Relief of nausea and vomiting at 2 hours.

Moderate Confidence in Evidence

Sumatriptan nasal spray 5 mg (nausea and vomiting)

Low Confidence in Evidence

Sumatriptan nasal spray 10 mg (vomiting)

Very Low Confidence in Evidence

Sumatriptan nasal spray 10 mg (nausea)

Moderate: Probably no more likely than placebo.

Low: Possibly no more likely than placebo.

Results Summary (2019 AAN):

There is evidence to support the efficacy of the use of ibuprofen, acetaminophen (in children and adolescents), and triptans (mainly in adolescents) for the relief of migraine pain, although confidence in the evidence varies between agents.

There is high confidence that adolescents receiving oral sumatriptan/naproxen and zolmitriptan nasal spray are more likely to be headache-free at 2 hours than those receiving placebo.

No acute treatments were effective for migraine-related nausea or vomiting; some triptans were effective for migraine-related phonophobia and photophobia.


Emergency Treatment

Acute treatments for adults with migraine in a professional health care facility.

Level B: Probably effective

Chlorpromazine IV
Dexamethasone (to prevent recurrence)
DHE IV, IM, SC
Droperidol IV
Ketorolac IV, IM
Metoclopramide IV
MgSO4 IV (migraine with aura)
Prochlorperazine IV
Sumatriptan SC

Level C: Possibly effective

Butorphanol IM
Dexamethasone IV
Meperidine IM
Methadone IM
Tramadol IV
Valproate IV

Level U: inadequate or conflicting data to support or refute use.

Lidocaine IV
Hydrocortisone IV

Level B Negative: Medication is probably ineffective.

Octreotide SC

Level C Negative: Medication is possibly ineffective.

Chlorpromazine IM
Granisetron IV
Acetaminophen IV


SOURCES:

– AHS. “The American Headache Society Position Statement On Integrating New Migraine Treatments Into Clinical Practice.” Headache: The Journal of Head and Face Pain 59.1 (2019): 1-18.

– AHS 2016 Acute Guidelines Headache: Journal of Headache and Facial Pain

– AHS/AAN 2012 Migraine Prevention Guidelines: Drugs Recommended for Short-Term Prevention of Migraine Associated With Menstruation

– AHS/AAN 2012 Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults

– AAN 2012 Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults

– Journal of Headache and Pain 2010: A Review of Current Treatment Guidelines for Migraine

– EFNS 2006 Revised Guidelines on the drug treatment of migraine – revised report of an EFNS task force

– AAN/CNS 2004 evidence-based guideline on the pharmacological treatment of migraine in children and adolescents

– US Headache Consortium 1999 – Evidenced-Based Guidelines For Migraine Headache: Behavioral and Physical Treatments

– AAN/AHS 2019 Practice guideline update summary: Acute treatment of migraine in children and adolescents: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology.2019 Sep 10;93(11):487-499. doi: 10.1212/WNL.0000000000008095. Epub 2019 Aug 14