2024 VIP Pass Add-ons

Welcome to your 2024 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 2024 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 next Quarterly Research Report will be ready by mid-April from Quarter 1, 2023.


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 2024 Delivery Timeline: 

  • March 21: Printer sent materials.
  • March 21- April 1: Printers develop proofs.
  • April 1-11: Proofs and files reviewed and approved.
  • April 12: Boxed Set is shipped today.
  • April 13-23: US orders due for arrival.
  • April 24-May 1: International orders due for arrival. Timing varies based on global location.

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

* NOTE: We will do our best to exceed this timeline.  Remember, you can still access all the interview videos, audio, and transcripts online. We appreciate your understanding and patience.

Thank you,
Migraine World Summit Editorial Team

2024 Treatment Directory – Quick Start

Quick Start Guide

Introduction

While each healthcare provider 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 while and then mysteriously stop working. Other times, treatment side effects become intolerable, or our migraine symptoms change. No matter the reason, circumstances may prompt us to search for a new way to find relief. And we don’t ever want to hear that we are “out of options.”

That’s why we bring you more than 350 pharmacological and nonpharmacological treatments reviewed and updated annually in the following Directory. The Directory provides a listing of treatments with their basic information and how they may relate to treating migraine. Not all listings have been proven to be effective, and some are ineffective or are no longer available. However, having an extensive list of treatments that may be related to migraine can be a useful tool in our search for relief.

Organization

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

1) Pharmacological Treatments – This section covers preventive and acute medications prescribed by healthcare providers as well as those available over the counter.
Until recently, most preventive medications were not developed specifically for migraine, so many of the drugs listed here are “off-label” migraine medications. For example, you’ll find major drug classes of preventives, including anticonvulsants, antidepressants, and calcium channel blockers, among others. For acute treatments, healthcare providers may prescribe drugs like painkillers, NSAIDs, ergots, triptans, and anti-nausea medications.

The arrival of CGRP inhibitors, including both CGRP monoclonal antibodies (mAbs) and CGRP small-molecule receptor antagonists (gepants), is finally providing migraine-specific preventive medication options. For acute migraine relief, selective 5-HT1F receptor agonists (ditans) and some of the gepants have been approved. Both the acute and preventive migraine-specific treatments are listed in this section and can be found by filtering on the “migraine-specific” column.

2) Nonpharmacological Treatments – A variety of effective preventive treatments exist that are nonpharmacological and complementary to pharmacological options. These can be in the form of behavioral and lifestyle changes, neuromodulation devices, medical procedures, vitamins and supplements, among others. Nonpharmacological acute treatments are more limited than other categories, with fewer options. Nevertheless, over the past few years, several neuromodulation devices have obtained FDA clearance for providing acute migraine relief, these can be found easily by filtering on the “migraine-specific” column. The listings also include simple treatment ideas — anecdotally relied upon by many, for years — like heat or cold therapy, aromatherapy, and acupressure.

You may not hear about many of these nonpharmacological treatments from your healthcare provider, but many patients use them, and some have been used for migraine relief for centuries. Doctors generally endorse healthy lifestyle options and nonpharmacological options that have little to no risk, many of which are free or low-cost. While some have been proven effective for treating migraine, most of them have not. An upside of nonpharmacological treatments is that many can be used in tandem with more traditional pharmacological acute and preventive treatments.

However, always check with your healthcare provider if you want to try a nonpharmacological treatment, as even things labeled as “natural” are not always safe, and some vitamins and supplements have contraindications with certain prescription medications and other medical conditions.

Recently, a new group of treatments has emerged called digital therapeutics. Digital therapeutics include apps and virtual clinics that provide a variety of services, including behavioral therapy, biofeedback coaching, and migraine diary tracking, among others. This is a growing and exciting space, especially for people who may be far from headache specialists or psychology services. Migraine-specific digital therapeutics can be found by filtering on the “migraine-specific” column.

Practical Tips & Ways to Use This Treatment Directory

  • Use this guide to discover new options or combinations of options when you think you’ve tried everything.
  • Use this guide to find more medications in a certain class if you want to try a different brand or format of the same drug class.
  • Track your history and make notes on what you have tried. Include the date, duration, benefits, and side effects. This information will be invaluable if you switch healthcare providers, appeal insurance claims, or look for new options.
  • Consider changing your treatment plan if you find yourself taking more acute medications than you’d like, running out of medications, or ending up in the emergency room too often. That plan may consist of a different mix of prevention and acute treatments, possibly including a combination of nonpharmacological and complementary treatment options.
  • Give each treatment a fair evaluation. For prevention, that generally means 2-4 months, depending on the specific therapy and other personal variables. For acute treatments, that generally means at least three attacks since each attack can be different. Discuss and determine with your healthcare provider.

Warning
If you are currently taking a medication listed as an opioid or narcotic, these medications can be habit-forming and may contribute to medication adaptation headache (also called medication overuse headache) and make migraine attacks less responsive to treatment. Discuss the maximum number of doses per week or month with your healthcare provider, and if there are non-narcotic alternatives, that may be more appropriate.

Disclaimer
This listing does not constitute medical advice. The quality, safety, and appropriateness of these listed treatments must be assessed by your healthcare provider and tailored to your individual health circumstances. Only your healthcare provider 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 treatments has not been evaluated for this directory. This directory has not been reviewed by any medical society or healthcare provider, and it does not constitute medical advice.

2024 Treatment Guidelines

2024 Migraine Treatment Guidelines Summary

TABLE OF CONTENTS

Treatment Guidelines  

      • Migraine Treatment Map
      • Introduction
      • Preventive Treatment of Migraine in Adults
      • Acute Treatment of Migraine in Adults
      • Migraine with Menstruation
      • Children and Adolescents
      • Emergency Treatments
      • References

MIGRAINE TREATMENT MAP

INTRODUCTION

This treatment guidelines summary was created by the Migraine World Summit (MWS) 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), and the US Headache Consortium. These guidelines have also been interpreted in medical journals such as Headache: The Journal of Headache and Facial Pain and the European Journal of Headache.

If you’re wondering why some treatments are in our Treatment Directory but are not reflected in these Guidelines, 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. Our Directory also includes “off-label” options for migraine, many pain management treatments not specific to migraine, as well as simple nonpharmacological options like lifestyle changes and vitamins.

Specific doses are generally not provided since they vary by country and can be highly individualized. Consult with your healthcare provider to determine the right medication and dose for you. If a certain treatment is not available in your country, check with your healthcare provider for similar medications. The MWS Guidelines and Directory is published annually in March and may become outdated during the year. This summary has not been reviewed by any medical society or healthcare provider, and it does not constitute medical advice.

Guideline Rankings & Interpretation

Migraine treatment evaluations commonly employ a scale to assess both the quantity and quality of evidence supporting the efficacy of a specific treatment. This scale factors in various types of studies conducted for each treatment, ranging from robust clinical research trials to those with less scientific rigor. The studies are categorized into different classes based on the AAN designations, with Class I representing more rigorous research compared to Class III. The overall quality of evidence for a treatment is determined by the prevalence of Class I studies demonstrating strong effectiveness. In essence, a higher number of Class I studies contributes to an elevated evidence level for that particular treatment. The studies are then graded, summarized, and placed 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

PREVENTIVE TREATMENT OF MIGRAINE IN ADULTS

This section focuses on preventive treatments for adults with migraine, generally available by prescription, for use at home. Other preventives may be available by purchase or by visiting a healthcare provider. Classification may vary by country. 

In 2024, the American Headache Society (AHS) published a Consensus Position Statement recognizing the transformative impact of CGRP-targeting migraine preventive therapies. These therapies, including monoclonal antibodies and gepants, have demonstrated substantial efficacy, tolerability, and safety in numerous clinical studies and real-world experiences. They surpass previous first-line treatments in evidence and effectiveness. As such, the AHS advocates for the consideration of CGRP-targeting therapies as first-line options for migraine prevention, eliminating the requirement for prior trial and failure of non-specific medications. Medications that are migraine-specific preventive therapies are noted as such in the pharmacological section of the Treatment Directory.

The following classifications are derived from the 2021 AHS Consensus Statement Guidance on preventive migraine treatments. While we recognize that the 2024 Consensus Position Statement may introduce revisions to these guidelines, any pharmacological therapy mentioned in the 2024 statement is incorporated in the subsequent section.

Level A: Established as effective

These may be offered to you by your healthcare provider if you require migraine prevention

      • Behavioral therapy in combination with preventive drug therapy
      • Candesartan
      • Divalproex sodium
      • Eptinezumab
      • Erenumab
      • Fremanezumab
      • Galcanezumab
      • Metoprolol
      • OnabotulinumtoxinA (for chronic migraine only)
      • Propranolol
      • Timolol
      • Topiramate
      • Valproate sodium

Level B: Probably effective

These may be considered for you by your healthcare provider if you require migraine prevention

      • Amitriptyline
      • Atenolol
      • Lisinopril
      • Memantine
      • Nadolol
      • OnabotulinumtoxinA in combination with a CGRP mAB
      • Venlafaxine

Notes on behavioral and device therapies

These biobehavioral therapies have Grade A evidence supporting their use as listed by the 2021 AHS Consensus document

      • Cognitive behavioral therapy
      • Biofeedback
      • Relaxation training

These biobehavioral therapies have growing evidence for use in migraine

      • Mindfulness-based cognitive therapy
      • Mindfulness-based stress reduction
      • Acceptance and commitment therapy

Five neuromodulation devices have been approved or cleared by the FDA

      • eTNS External Trigeminal Nerve Stimulation (Cefaly)
      • nVNS Vagus Nerve Stimulation (gammaCore Sapphire)
      • REN Remote wearable neuromodulation (Nerivio)
      • sTMS Transcranial Magnetic Stimulation (sTMS mini or SAVI Dual)
      • COT-NS External combined occipital and trigeminal neurostimulation (Relivion MG)

Notes:

      1. All five devices can be used alone or together with pharmacotherapy for acute treatment.
      2. Four devices are cleared for use as monotherapy or adjunctive therapy for preventive migraine treatment: eTNS, nVNS, sTMS, and REN.
      3. 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.

ACUTE TREATMENT OF MIGRAINE IN ADULTS

In 2021, AHS updated its guidance on the use of migraine treatments. This section focuses on acute treatments for adults with migraine, generally available by prescription for use at home. Classification may vary by country.

Level A: Established as effective

Migraine-specific

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

Note: 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 (nasal spray, injection, or IV)
      • Ergotamine

Nonspecific

      • Flurbiprofen
      • Isometheptene-containing compounds
      • Ketoprofen
      • Ketorolac (IV or IM)
      • Magnesium (IV) (for migraine with aura only)

Nonspecific antiemetics

      • Chlorpromazine
      • Droperidol
      • Metoclopramide
      • Prochlorperazine
      • Promethazine

MIGRAINE WITH MENSTRUATION

In 2013, AAN and AHS updated guidelines on treatment for episodic migraine prevention. The following treatments are appropriate for short-term migraine prevention of 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 AND ADOLESCENTS

In 2019, AAN and AHS updated the practice guidelines for acute migraine treatment in children and adolescents. They evaluated the efficacy of acute treatments compared to placebo (i.e., a treatment that has no active medication):

Free of headache pain at 2 hours
High Confidence (more likely than placebo)

      • Sumatriptan/naproxen OT 10/60 mg, 30/180 mg, 85/500 mg
      • Zolmitriptan NS 5 mg

Moderate Confidence (probably more likely than placebo)

      • Ibuprofen OS 7.5-10 mg/kg
      • Sumatriptan NS 20 mg

Low Confidence (probably more likely than placebo)

      • Rizatriptan ODT 5 mg, 10 mg

Low Confidence (possibly no more likely than placebo)

      • Almotriptan 12.5 mg

Very Low Confidence (insufficient evidence)

      • Acetaminophen OS 15 mg/kg
      • Almotriptan OT 6.25 mg, 25 mg
      • Eletriptan OT 40 mg
      • Sumatriptan OT 25 mg, 50 mg

Relief of nausea at 2 hours
Moderate Confidence (probably no more likely than placebo)

      • Sumatriptan NS 5 mg, 20 mg
      • Sumatriptan/naproxen OT 85/500 mg

Low Confidence (possibly no more likely than placebo)

      • Eletriptan OT 40 mg

Very Low Confidence (insufficient evidence)

      • Ibuprofen OS 7.5-10 mg/kg
      • Sumatriptan NS 10 mg
      • Sumatriptan/naproxen OT 10/60 mg, 30/180 mg
      • Rizatriptan 5 mg, 10 mg

EMERGENCY TREATMENTS

In 2016, AHS assessed treatments for acute migraine in the emergency room setting and categorized them by levels of efficacy:

Level B (should offer)

      • Metroclopramide IV
      • Prochlorperazine IV
      • Sumatriptan SC
      • Dexamethasone IV, IM

Level C (may offer)

      • Acetaminophen IV
      • Acetylsalicylic acid IV
      • Chlorpromazine IV
      • Dexketoprofen IV
      • Diclofenac IV
      • Dipyrone IV
      • Droperidol IM
      • Haloperidol IM
      • Ketorolac IV
      • Valproate IV

Level U (no recommendation)

      • DHE SC
      • Ergotamine SC
      • Ketamine SC
      • Lysine clonixinate SC
      • Magnesium IV
      • Meperidine IV
      • Nalbuphine IV
      • Propofol IV
      • Promethazine SC
      • Tramadol IV
      • Trimethobenzamide IM

REFERENCES

Ailani, J., Burch, R. C., & Robbins, M. S. (2021). The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache: The Journal of Head and Face Pain, 61(7), 1021–1039. https://doi.org/10.1111/head.14153

Charles, A. C., Digre, K. B., Goadsby, P. J., Robbins, M. S., & Hershey, A. (2024, March 11). Calcitonin generelated peptidetargeting therapies are a firstline option for the prevention of migraine: An American Headache Society position statement update. Headache: The Journal of Head and Face Pain. https://doi.org/10.1111/head.14692

Evers, S., Áfra, J., Frese, A., Goadsby, P. J., Linde, M., May, A., & Sándor, P. S. (2009). EFNS guideline on the drug treatment of migraine – revised report of an EFNS task force. European Journal of Neurology, 16(9), 968–981. https://doi.org/10.1111/j.1468-1331.2009.02748.x

Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. (2013). Neurology, 80(9), 871–871. https://doi.org/10.1212/wnl.0b013e318287dc4e

Orr, S. L., Friedman, B. W., Christie, S., Minen, M. T., Bamford, C., Kelley, N. E., & Tepper, D. (2016). Management of Adults With Acute Migraine in the Emergency Department: The American Headache Society Evidence Assessment of Parenteral Pharmacotherapies. Headache: The Journal of Head and Face Pain, 56(6), 911–940. https://doi.org/10.1111/head.12835

Oskoui, M., Pringsheim, T., Holler-Managan, Y., Potrebic, S., Billinghurst, L., Gloss, D., Hershey, A. D., Licking, N., Sowell, M., Victorio, M. C., Gersz, E. M., Leininger, E., Zanitsch, H., Yonker, M., & Mack, K. (2019). Practice guideline update summary: Acute treatment of migraine in children and adolescents. Neurology, 93(11), 487–499. https://doi.org/10.1212/wnl.0000000000008095

Silberstein, S. D., Holland, S., Freitag, F., Dodick, D. W., Argoff, C., & Ashman, E. (2012). Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults: Table 1. Neurology, 78(17), 1337–1345. https://doi.org/10.1212/wnl.0b013e3182535d20

2024 Treatment Directory – Pharmacological

Pharmacological Treatments

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

Migraine Specific? X for yesGeneric Name (Active Ingredient List)Brand NamesTreatment ClassRXFormatTreatment TypeDescription
Acetaminophen & CodeineTylenol 3 or 4, PanadeineCombination - OpioidXLiquid, PillAcuteAcetaminophen/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 & OxycodonePercocetCombination - OpioidXLiquid, TabletsAcutePercocet is used to relieve moderate-to-severe pain. It contains a combination of oxycodone (an opioid pain medication that works in the brain to change how your body feels and responds to pain) and acetaminophen (a less powerful pain reliever that increases the effects of oxycodone).
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, 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, 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 and 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 cerebrospinal 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.
XAlmotriptanAlmogran, AxertSerotonin 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. Amitriptyline has evidence of efficacy in the prevention of migraine.
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.
Angiotensin-converting enzyme (ACE) inhibitorsAltace, Epanded, Prinivil, Qbrelis, Vasotec, ZestrilAntihypertensivexPillPreventiveAngiotensin-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 from other migraine treatments, but the evidence did not otherwise support use of it as a preventive. See entry: Lisinopril.
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).
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; 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. Atenolol has evidence of efficacy in the prevention of migraine.
XAtogepantQulipta, AquiptaSmall molecule CGRP receptor antagonist (Gepant)XPillPreventiveAtogepant is an oral CGRP receptor antagonist used for the preventive treatment of episodic and chronic migraine. Atogepant has a longer half-life than another similar gepant (ubrogepant), making it suitable for preventive treatment. It was approved by the US FDA in September 2021 for episodic migraine prevention and in April 2023 for chronic migraine prevention.
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, VeronalBarbiturateXPillPreventiveAs barbital is a controlled substance, other substances have largely replaced barbital-based medications. When barbital was first introduced, it was considered a great improvement over the existing hypnotics (sleeping aids). It was used as a hypnotic from 1903 until the mid-1950s. Barbiturates, in general, have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment.
BudesonideEntocort, Pulmicort, Rhinocort Allergy, UcerisSteroidXInhaler, Nasal Spray, Pill, EnemaAcute & PreventiveBudesonide is a steroid that reduces inflammation in the body. The inhaled form is used to treat asthma and chronic obstructive pulmonary disease; the nasal spray treats allergic rhinitis and nasal polyps; and the extended-release pills and enemas treat Crohn's disease, ulcerative colitis, and microscopic colitis.
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 the high risk for addiction and medication overuse headache. 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.
CandesartanAtacand, Amias, Blopress, RatacandAntihypertensiveXPillPreventiveCandesartan 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. Candesartan has been established as effective in the prevention of migraine.
Cannabidiol oil (CBD)EpidiolexPhytocannabidiolXOral
Acute & PreventiveCBD is the nonpsychoactive part of the cannabis, or marijuana, plant. CBD oil is made by extracting CBD from the cannabis plant and 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 epilepsy. See also: Cannabidiol oil (CBD) in Nonpharmocological Treatments.
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 the 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. 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, SuppositoryPreventiveThe 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.
ClonazepamKlonopinBenzodiazepinesXPillAcuteClonazepam 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, KapvayAntihypertensiveXPillPreventiveClonidine 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 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.
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, Voltaren-XR, Zipsor, ZorvolexNonsteroidal anti-inflammatory drugs (NSAIDs)Injection, Gel, Oral, 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.
XDihydroergotamine mesylate (DHE)Dihydergot, DHE 45, Migranal, TrudhesaErgot alkaloid - derivativeXInjection, IV, 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, SuppositoryAcuteDimenhydrinate is an antiemetic used to prevent and treat nausea, vomiting, and dizziness due to motion sickness. It is used to control vomiting associated with migraine, but it has largely been replaced by Zofran (ondansetron).
DiphenhydramineBenadryl, Nytol, Simply Sleep & othersAntihistaminePillAcuteDiphenhydramine is to control high levels of histamine. It 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 has been established as effective in the prevention of migraine.
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/DothiepinDopress, Dothep, Prothiaden, ThadenAntidepressantXPillPreventiveDosulepin 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.
DoxylamineDozile, RestavitAntihistaminePillAcuteDoxylamine 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.
XEletriptanRelert, RelpaxSerotonin 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 treat a migraine attack that is already in progress.
XEptinezumabVyeptiCGRP monoclonal antibodyXIV InfusionPreventiveEptinezumab is a preventive CGRP monoclonal antibody approved by the FDA in February 2020, and also approved for prevention in other countries including Australia, Canada, England, and Ireland. 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 with few side effects for most people.
XErenumabAimovigCGRP 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. Ergotamine derivatives have been established as effective for acute treatment of migraine.
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 & othersOther - hormonesXTransdermal patchPreventiveAn estrogen patch, using estradiol hormone, 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.
EszopicloneLunestaHypnoticXPillAcuteEszopiclone 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.See also: Timolol.
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).
XFremanezumabAjovyCGRP monoclonal antibodyXInjectionPreventiveFremanezumab is a preventive monoclonal antibody approved by the US FDA in September 2018 for the prevention of migraine and is now available in many other countries. This CGRP monoclonal antibody attaches to CGRP and inactivates it. Ajovy is self-administered monthly or quarterly, as your physician advises.
XFrovatriptanFrova, 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 except for short-term prevention ("mini-prevention") in menstrual migraine.
GabapentinGabarone, Gralise, Horizant, NeurontinAnticonvulsantXPillPreventiveGabapentin 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.
XGalcanezumabEmgalityCGRP monoclonal antibodyXInjectionPreventiveGalcanezumab is a CGRP monoclonal antibody approved by the US 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 headache, 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.
Hormonal ContraceptivesVariousOther - HormonesXIntradermal, Intrauterine Device, Patch, Pill, Vaginal RingPreventiveHormonal contraceptives are birth control that use hormones to prevent pregnancy. They contain estrogen and progesterone, or progesterone only. They prevent pregnancy by blocking the release of eggs from the ovaries, thinning the lining of the uterus, or thickening the mucus in the cervix to help keep sperm from reaching the egg. Hormonal contraceptives may be taken by mouth, injected or inserted under the skin, placed on the skin as a patch, or placed in the vagina or uterus. Dips in estrogen are most commonly associated with migraine onset, which may lead menstruating persons to seek out hormonal balancing methods as a form of treatment.
Hormone replacement therapy (HRT)-Other - hormonesXCream, Patch, PillPreventiveHormone replacement therapy (HRT), also known as hormone therapy, or menopausal hormone therapy (MHT), depending on the country you are in, is typically prescribed for those experiencing natural or surgically-induced menopause. Hormones commonly involved are estrogens, progesterone or progestins, and sometimes testosterone. These hormones can either be bioidentical or synthetic. Hormones, and major changes in them, can be a trigger for many people so HRT can help balance hormones in an aim to reduce 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, 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, Panafen Plus, Nurofen Plus, Rafen 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.
IndomethacinIndocid, IndocinNonsteroidal anti-inflammatory drugs (NSAIDs)XPillAcuteIndomethacin is an NSAID used to relieve pain for various conditions including for swelling, and joint stiffness from arthritis, gout, bursitis and tendonitis. It is the treatment of choice for hemnicrania continua and is also used for acute treatment of migraine.
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, AvaproAntihypertensiveXPillPreventiveIrbesartan 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.
XLasmiditanReyvow5-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. Lasmiditan was FDA-approved in 2019, is not available in Canada, and approved for medical use in the European Union in 2022.
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.
LisinoprilPrinivil, Qbrelis, ZestrilAntihypertensiveXPillPreventativeSee entry on Angiotensin-converting enzyme (ACE) inhibitors.
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, 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.
LorazepamAtivanBenzodiazepinesXInjection, PillAcuteLorazepam 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)--XEdibles, Oils, Pill, TeaAcuteThe 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. See entry: Marijuana in Nonpharmacological.
MeclizineAntivert, Bonine, Dramamine Less DrowsyAntiemeticsPillAcute & 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. Memantine has evidence of efficacy in the prevention of migraine.
Menopausal Replacement Therapy (MHT)VariousOther - HormonesXCream, Patch, PillPreventiveMenopausal hormone therapy (MHT), also known as hormone therapy, or hormone replacement therapy (HRT), depending on the country you are in, is typically prescribed for those experiencing either natural or surgically induced menopause. Hormones commonly involved are estrogens, progesterone or progestins, and sometimes testosterone. These hormones can either be bioidentical or synthetic. Hormones, and major changes in them, can be a trigger for many people so MHT can help balance hormones in an aim to reduce migraine.
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, Metonia, 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. Metoprolol has been established as effective in the prevention of 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.
MoxonidinePhysiotensAntihypertensiveXPillPreventiveMoxonidine 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. Nadolol has evidence of efficacy in migraine prevention.
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.
XNaratriptanAmerge, NaramigSerotonin 5-HT1 agonists or TriptansXPillAcuteNaratriptan is a serotonin 5-HT1 receptor agonist (also known as a triptan). It works by narrowing blood vessels in the brain. It is used to relieve certain types of migraine attacks.
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, Aleve, Bayer Aspirin, 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.
OnabotulinumtoxinABotoxMuscle relaxantXInjectionPreventiveOnabotulinumtoxinA (Botox) 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. Botox can be combined with many other types of treatments. Botox has evidence of efficacy in the prevention of chronic migraine.
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). It can be taken prior to acute migraine medications to increase medication absorption and to decrease nausea and vomiting from migraine.
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.
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 helps relieve congestion, improve drainage of mucus, and improve 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.
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.
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.
ProchlorperazineBuccastem, Compazine, Phenotil, Stemzine, StemetilAntiemetic & 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 attacks 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.
QuetiapineSeroquelAntipsychoticXPillPreventiveQuetiapine 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.
XRimegepantNurtec ODT, VyduraSmall 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. As of September 2023, rimegepant is for acute and preventive treatment of migraine on the NHS in England. Approval is pending in Canada; it is expected to be in 2024.
XRizatriptanMaxalt, Rizalt, RizaFilmSerotonin 5-HT1 agonists or TriptansXOral Film, Pill, 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. RizaFilm is rizatriptan in an oral film form and was FDA-approved in 2023.
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.
XSumatriptanImigran, Imitrex, Onzetra XSail, Sumavel DosePro, Tosymra, Treximet, Zembrace SymtouchSerotonin 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.
XTelcagepant-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.
TimololBetimol, Betrim, Blocadren, 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. Timolol has been established as effective in the prevention of migraine. See also: Eye drops (glaucoma).
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 established as effective in the prevention of 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.
XUbrogepantUbrelvySmall molecule CGRP receptor antagonist (Gepant)Small 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.
Valproic AcidDepacon, Depakene, Stavzor, Valproate Sodium AnticonvulsantXIV, 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 is established as effective in the prevention of migraine.
VenlafaxineEffexorAntidepressantXPillPreventiveVenlafaxine is an antidepressant in a group of drugs called selective serotonin and norepinephrine reuptake inhibitors (SNRIs). Venlafaxine is used to treat major depressive disorder, anxiety, and panic disorder. Venlafaxine has evidence of efficacy in the prevention of migraine.
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.
XZavegepantZavzpretSmall molecule CGRP receptor antagonist (Gepant)XNasal Spray, OralAcuteZavegepant (formerly vazegepant) is a gepant for the acute treatment of migraine, approved by the FDA in a nasal spray in March 2023. It is the first and only CGRP receptor antagonist as a nasal spray formulation. It is meant to have quick absorption, and provide possible pain relief in as little as 15 minutes, for up to 48 hours, and provide an alternative to oral medications. Zavegepant is also in clinical trials as an oral formulation.
XAscoTop, Zomig, Zomigon, ZomigoroZomigSerotonin 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, Sanval, Stilnox, Zonadin, 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.

2024 Treatment Directory – NonPharmacological

NonPharmacological Migraine Treatments

Treatments are listed in alphabetical order.

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

Migraine Specific? XNon pharmacological TreatmentTreatment TypeCostFormatDescription
5-HTP (5 Hydroxytryptophan)PreventivePaidVitamin/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).
Acceptance and Commitment Therapy (ACT)PreventivePaidBehavioral 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. There is growing evidence for the use of ACT for migraine.
AcupressureAcute & PreventivePaidPhysical therapyA Traditional Chinese Medicine technique that involves the insertion of very fine, solid needles into certain pressure points of the body. It is believed that acupuncture activates pathways in the brain that are responsible for turning off pain.
Acupressure braceletsAcute & PreventivePaidProduct/DeviceAcupressure bracelets are bands that apply pressure on the meridian point on the inside of the wrist; this meridian point 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.
AcupuncturePreventivePaidLifestyleA Traditional Chinese Medicine technique that involves the insertion of very fine, solid needles into certain pressure points of the body. It is believed that acupuncture activates pathways in the brain that are responsible for turning off pain.
AdvocacyPreventiveFreeLifestyleAdvocacy 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.
Air Filter (in home)PreventivePaidProduct/DeviceAir filters are used to reduce the pollen, smoke, pet dander, bacteria, dust, and more from a building. For people with migraine who have allergies, respiratory illnesses, or are triggered by things like pollen or smoke, a clean high-functioning air filter is a simple way to improve air quality and reduce environmental triggers. HEPA filters are the most effective type of filter, eliminating 99.97% of airborne particles with a size of 0.3 microns or greater.
Alexander TechniquePreventivePaidPhysical therapyThe 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.
AltruismPreventiveFreeLifestyleAltruism, 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.
Applied Kinesiology (AK)PreventivePaidPhysical 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.
AromatherapyAcute & PreventivePaidProduct/DeviceSee entry: Essential oils.
AshwaghandhaPreventivePaidVitamin/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.
Avoid bright screensAcute & PreventiveFreeLifestyleBright 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.
Avoid fluorescent lightingAcute & PreventiveFreeLifestyleFluorescent lights emit a particular spectrum of light. People with migraine may be sensitive to the spectrum of light emitted by fluorescent lights.
Avoid loud, sustained noiseAcute & PreventiveFreeLifestyleLoud 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.
Avoid odors/smokeAcute & PreventiveFreeLifestyleStrong 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.
Avoid processed foodsPreventiveFreeLifestyleProcessed 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.
AyurvedaAcute & PreventiveFreeLifestyleAyurveda 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. 
Bariatric surgeryPreventivePaidProcedureBariatic surgery, including gastric bypass, is a weight-loss surgical procedure. Weight reduction 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.
BarometerPreventivePaidProduct/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.
Behavioral therapy apps & online toolsAcute & PreventivePaidBehavioral therapy, Digital TherapeuticsThere 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.
Biobehavioral therapyAcute & PreventivePaidBehavioral therapyBiobehavioral 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.
BiofeedbackAcute & PreventiveFree & PaidBehavioral 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. Devices like fitness watches that have heart rate monitors can be helpful tools for people practicing biofeedback. There is scientific evidence that supports the use of biofeedback for migraine.
Black cohoshPreventivePaidVitamin/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.
Blood test - Food sensitivities/nutritionPreventivePaidDiagnosticsA 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. A 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.
Blood test – Genetic dysfunctionPreventivePaidDiagnosticsTesting 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.
Blue menthol gelAcutePaidProduct/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.
Boswellia / Indian frankincensePreventivePaidVitamin/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.
Bowen therapyPreventivePaidPhysical 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.
Breathing relaxation techniquesAcute & PreventiveFreeBehavioral therapyDeep breathing is a simple way to relax and reduce stress. For example, taking deep, slow breaths can help reduce anxiety and control stress. Also, alternate-nostril breathing, called nadi shodhana pranayama in yoga, can help control anxiety.
ButterburPreventivePaidVitamin/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. See entry: Petadolex.
CaffeineAcute & PreventivePaidLifestyleCaffeine is a stimulant found in coffee, tea, chocolate, and soft drinks. Caffeine is addictive. If used in excess, caffeine can be overstimulating and cause anxiety and sleep problems; for people with migraine consuming less than 200mg/day is recommended. Caffeine can help the body absorb some medications faster, some sources suggest it can assist pain relievers by up to 40 percent. Any change in caffeine levels can contribute to an attack in some people whether by consuming too much, too little, or skipping a day.
CalciumPreventivePaidVitamin/SupplementCalcium is essential for building and maintaining bone, and is required for the healthy functioning of the heart, muscles, blood, and nerves.
Cannabidiol oil (CBD)Acute & PreventivePaidVitamin/ SupplementCBD 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 epilepsy.
CapsaicinAcutePaidVitamin/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.
XCEFALYAcute & PreventivePaidNeuromodulation, Product/DeviceCEFALY is a Supraorbital TNS unit or External Trigeminal Nerve Stimulation (eTNS) device that is 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. CEFALY is FDA-approved for acute and preventive migraine treatment.
Cervical tractionPreventivePaidProduct/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.
Chinese herbal medicinePreventivePaidVitamin/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.
ChiropractorPreventivePaidPhysical 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.
XClick TherapeuticsPreventivePaidDigital therapeutics, Product/DeviceClick Therapeutics has a prescription behavioral health device in development as a clinically-validated digital program for episodic migraine that combines multiple mechanisms of actions with Click's adaptive patient engagement platform. In late 2022, this device received a "Breakthrough Device" designation from the FDA, which helps speed up the FDA clearance process for devices.
Coenzyme Q10 (CoQ10)/ UbiquinolPreventivePaidVitamin/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. Sources of CoQ10 can be found as a supplement and naturally in most foods, with the 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. A more concentrated form of CoQ10 is known as ubiquinol.
Cognitive Behavioral Therapy (trauma focused)AcutePaidBehavioral 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.
Cognitive behavioral therapy (CBT)Acute & PreventiveFree & PaidBehavioral 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.
Cognitive behavioral therapy for insomnia (CBT-I)PreventivePaidBehavioral 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.
Combination TherapyAcute & PreventivePaid & FreeBehavioral therapyCombination 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.
Cooling gel sheetAcutePaidProduct/DeviceApplying cold items or ice packs to the head helps promote circulation and reduces the inflammation in the head caused by migraine.
XCoveAcute & PreventivePaidDiagnostics, Digital therapeuticsCove is a telehealth company that offers migraine care. Users can complete an online consultation to help the medical provider find the best treatment plan for them. The provider-recommended treatment is delivered directly to them on the schedule they choose. If adjustments need to be made, the Cove team claims that they will work with them to make sure they get the care they need.
CPAP machinePreventivePaidDeviceContinuous 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.
Craniosacral Therapy (CST)Acute & PreventivePaidPhysical therapyCraniosacral therapy (CST) is a gentle hands-on treatment that may provide relief from a variety of symptoms including headaches, neck pain, and side effects of cancer treatment. CST uses a light touch to examine membranes and movement of fluids in and around the central nervous system, which can promote a feeling of well-being by eliminating pain. Efficiacy has not been scientifically established despite usage among people who experience migraine.
Creative therapyPreventiveFreeBehavioral 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.
XCtrl M Health appPreventivePaidDigital therapeuticsDeveloped by Jefferson Headache Center, Ctrl M Health provides active support by establishing regular accessible guidance through their mobile app. The app links users to the knowledge, tools, and support that enable them to better manage headache and migraine. It claims to integrate the latest science with the best practices of health psychology to help improve users' quality of life.
CurcuminPreventivePaidVitamin / SupplementCurcumin is the main active ingredient in turmeric. Preliminary research has shown that it may reduce inflammation, reduce the risk of chronic diseases by increasing antioxidants, ease symptoms of anxiety and depression, and improve memory and general brain health. Longvida® is a patented curcumin extract supplement that was developed by neuroscientists to ensure that efficacious levels of curcumin are delivered to the blood stream and target areas.
Daith piercingPreventivePaidLifestyleThe 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.
Dark, quiet roomAcuteFreeLifestyleNormal sensory inputs such as light, sound, or smell can cause pain during migraine attacks. Removing yourself from these irritants can expedite your recovery; many people find moderate-to-major relief in a dark, quiet room.
Decrease Toxin ExposurePreventiveFreeLifestyleA toxin is a poisonous substance that is a specific product of the metabolic activities of a living organism and is usually very unstable, notably toxic when introduced into the tissues, and typically capable of inducing antibody formation. Most alternative-health and everyday references to toxins would not fit the official definition of a toxin. There are some exceptions including tobacco smoke, some airborne particles, and alcohol. Claims of "detoxifying" and "cleansing" products are often misleading and deceptive and are generally not recommended by most qualified healthcare professionals. A HEPA air filter, however, can improve your home air quality and reduce some possible toxin exposure.
Detoxification (Detox)PreventiveFree & PaidLifestyleA 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 claim to remove environmental and dietary toxins from the body. There is no evidence supporting its benefits or its use for migraine prevention.
Dialectical Behavior Therapy (DBT)PreventivePaidBehavioral therapyDialectical behavior therapy (DBT) is a modified type of cognitive behavioral therapy (CBT). Its main goals are to teach people how to live in the moment, develop healthy ways to cope with stress, regulate their emotions, and improve their relationships with others.
Diet - 5:2 dietPreventiveFreeLifestyleThe 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, however, for people with migraine who typically respond better to a diet regimen that promotes regular meals.
Diet - Anti-inflammatory dietPreventiveFreeLifestyleAn 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.
Diet - Elimination dietPreventiveFreeLifestyleAn elimination diet is often conducted under the guidance of a doctor or dietitician to establish which foods are triggering migraine attacks. An elimination diet requires an individual to scale 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 that food is removed from the diet.
Diet – Gluten-free dietPreventiveFreeLifestyleGoing 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.
Diet - High in omega-3/low in omega-6PreventiveFreeLifestyleEating 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.
Diet - Increase fiber intakePreventivePaidVitamin / SupplementFiber is important for the health of the digestive system and lowering cholesterol. The average American diet does not provide adequate levels of fiber. Good sources of fiber include whole grains, fresh fruits and vegetables, beans and other legumes, and nuts and seeds. Increasing fiber intake in your diet appears to reduce the risk of developing various conditions, including heart disease, diabetes, and colon cancer. A 2023 study specifically showed an association between increased fiber intake and reduced migraine attacks; more research, however, is needed to confirm the results.
Diet - Ketogenic dietPreventiveFreeLifestyleThis 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. 
Diet - Mediterranean dietPreventiveFreeLifestyleThe 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.
Diet - Paleo dietPreventiveFreeLifestyleThe 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.
Diet - Vegan dietPreventiveFreeLifestyleVegans, 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.
Diet - Vegetarian dietPreventiveFreeLifestyleVegetarians do not eat meat, fish, or poultry. There is no evidence linked to migraine improvement.
Diet - Whole FoodsPreventiveFreeLifestyleA whole-foods diet focuses on eating foods as close to their natural form as possible. They do not have added sugars, starches, flavorings, or other manufactured ingredients. A whole-foods diet includes fruits and vegetables; nuts, seeds, and beans; milk and some dairy products; lean meats, poultry, and seafood; and minimally processed foods. Things to avoid are prepared and ready-to-eat foods, heavily processed foods, refined carbohydrates, and foods with added sugars.
Dietary changesPreventiveFreeLifestyleWhat and how you eat can play a significant role in your migraine. Most migraine specialists recommend that those with migraine to eat healthy, whole (unprocessed) foods, eat regularly, and not skip meals. One should also identify and avoid food triggers and identify possible premonitory cravings. Identifying and avoiding your specific allergens and sensitivities can also help with migraine. Education around nutrition and vitamins that are helpful with migraine could also be useful. Guidance from a qualified headache specialist can help educate people about migraine management and diets. Guidance from a qualified dietician can help educate those with migraine, and develop individualized nutrition plans that are tailored to your specific needs. See entries on: Alcohol, SEEDS, entries around avoiding or eliminating certain foods, and the entries on specific diet types.
Digital TherapeuticsAcute & PreventiveFree & PaidDigital TherapeuticsDigital Therapeutics are therapeutic treatment options driven by software programs that can be accessed online or on your phone. They can include biofeedback and behavioral therapy apps and virtual therapy (e.g., BetterHelp, Happify, Juva), telehealth offerings (e.g., Cove, NeuraHealth), mindfulness apps (e.g., Calm, Headspace), diary tracking apps (e.g., Migraine Buddy), and more. They can be especially helpful for people who are not able to access in-person medical and psychological services, and can be a complement to other therapies.
D-Ribose (Beta-D-ribofuranose)PreventivePaidVitamin/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.
Dry needlingAcute & PreventivePaidPhysical 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.
XEar insufflation therapyAcutePaidNeuromodulation, ProcedureEar 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.
Electrolyte DrinksAcutePaidProduct/DeviceElectrolyte drinks like Pedialyte, sport drinks like Gatorade and Powerade, and electrolyte powders like LiquidIV and nuun aid in rehydration and 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.
Eliminate cigarette smokingPreventiveFreeLifestyleCigarette 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.
Eliminating alcoholPreventiveFreeLifestyleAlcohol can be a trigger for migraine attacks among some people living with migraine. If alcohol is a confirmed trigger for your migraine, then avoiding alcohol is the best solution. If you are consuming alcohol, be mindful about the amount that you consume and pay attention to how and when your migraine symptoms flare up in relation to drinking.
Eliminating caffeinePreventiveFreeLifestyleWhile 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. If maintaining some caffeine intake, try to limit the amount, avoid it in the afternoon, and be consistent with your daily amount and timing.
Eliminating chocolatePreventiveFreeLifestyleSome 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.
Eliminating dairyPreventiveFreeLifestyleDairy 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.
Eliminating glutenPreventiveFreeLifestyleSee entry: Diet – Gluten-Free.
Eliminating MSGPreventiveFreeLifestyleMSG, 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.
Eliminating nitrates/nitritesPreventiveFreeLifestyleNitrates 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.
Eliminating soyPreventiveFreeLifestyleSoy 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.
Eliminating sulfates/sulfitesPreventiveFreeLifestyleSulfates 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.
Eliminating tyraminePreventiveFreeLifestyleTyramine 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.
Emotional freedom technique (EFT)AcuteFreeBehavioral 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.
XeNeura SAVI DualAcute & PreventivePaidNeuromodulation, Product/DeviceeNeura SAVI Dual (called the sTMS mini in some countries) is a Transcranial Magnetic Stimulation (TMS) device. TMS uses magnets to emit a single pulse of electricity. This pulse has been shown to treat cortical spreading depression (CSD), which is the phsyical 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 SAVI Dual (previously known as eNeura's sTMS device) is a TMS device available via prescription. eNeura SAVI Dual is FDA-approved for acute migraine treatment, FDA-cleared for migraine prevention, and FDA-cleared for preventive treatment in adolescents aged 12-17.
Epidural blood patchAcutePaidProcedureAn epidural blood patch is an injection of one's own blood into the epidural space (i.e., the area outside of the "sack" that contains cerebrospinal fluid, or CSF). It is used to treat headaches resulting from a CSF leak, also known as persistent or spinal headaches.
Epsom salt bathsAcute & PreventivePaidVitamin/ SupplementMagnesium 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.
Essential oilsPreventivePaidProduct/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 suggested for migraine include lavendar, peppermint, eucalyptus, citrus, ginger, and Damascus rose. See also: Aromatherapy.
Evening primrose oilAcutePaidVitamin/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.
ExercisePreventiveFreeLifestyleExercise 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. Yoga, Pilates, or t’ai chi are effective low-impact choices, while more intense and aerobic exercises are recommended for those with the capacity to tolerate them.
Exogenous Ketone SupplementsPreventivePaidVitamin / SupplementThe liver naturally produces (endogenous) ketones while in the metabolic state of ketosis, while exogenous ketones are those provided from supplements. Ketosis is a metabolic state where your body uses ketones, produced from fat, as its main energy source. The ketogenic diet is a high-fat, moderate-protein, low-carb diet that is intended to encourage the state of ketosis and the use of ketones. However, it is highly restrictive and difficult to follow. Exogenous ketones are intended to help a person achieve ketosis while being less strict in their diet. Researchers are unsure whether exogenous ketones have the same effect as ketones that are produced by the body naturally.
FeverfewPreventivePaidVitamin/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.
XFL-41 Tinted GlassesPreventivePaidProduct/DeviceFL-41 glasses (also called migraine glasses) are a type of specialty eyewear with tinted lenses designed to block specific light wavelengths (480 - 520nm). This wavelength has been shown to trigger or worsen photophobia, eye strain, and blinking. FL-41 tinted glasses are commonly recommended for patients with migraine, post-concussion syndrome, and other light-sensitive conditions.
FolatePreventivePaidVitamin/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.
Folic acid / Vitamin B9PreventivePaidVitamin/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.
Forest bathingPreventiveFreeLifestyleForest 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.
XgammaCore SapphireAcute & PreventivePaidNeuromodulation, Product/DeviceGammaCore Sapphire is a Vagus Nerve Stimulation (VNS) device. 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 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.
GingerAcute & PreventivePaidVitamin/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.
GinkgoPreventivePaidVitamin / SupplementGinkgo is a large tree with fan-shaped leaves. The leaves are commonly included in supplements and taken by mouth for memory concerns, anxiety, vision issues, and other conditions. There is, however, no conclusive evidence that ginkgo is helpful for any health condition.
GlucosaminePreventivePaidVitamin/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.
Green-Light Lamp, The Allay Lamp AcutePaidProduct/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.
XHeadache Diary/TrackingPreventiveFreeDiagnosticsA headache diary is a generic term for tracking your migraine in some form. At its most basic, a headache diary is noting which days you had headache or not on a piece of paper, calendar, or app. There are a variety of headache and pain tracking apps, including Migraine Buddy, Manage My Pain, and more. A person can track their level of pain or disability, their symptoms, triggers, and medications used, among other things. This can be helpful for both patients and healthcare providers to see the effectiveness of medication, the severity of disability, and the state of disorder over time.
Heat therapyAcuteFreeLifestyleHeat 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.
Herbal teasAcute & PreventivePaidVitamin/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.
HomeopathyPreventivePaidLifestyleHomeopathy 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.
HydrationAcute & PreventiveFreeLifestyleDehydration is a common migraine trigger. Keeping water on hand throughout the day helps ensure you get the recommended eight glasses per day. In hospital settings, hydration is often provided via IV fluids.
HydrotherapyAcute & PreventiveFreeLifestyleHydrotherapy 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.
Hyperbaric oxygen therapyPreventivePaidLifestyleHyperbaric oxygen therapy (HBOT) is an immersive, enclosed chamber where 100% 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.
Hypnotherapy/ HypnosisPreventivePaidBehavioral TherapyHypnosis 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.
Ice/cold therapyAcuteFreeLifestyleCold 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.
Improving posturePreventiveFreeLifestylePoor 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.
Iron supplementsPreventivePaidVitamin/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.
IsoflavonesPreventivePaidVitamin/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.
Juva Health AppPreventivePaidDigital therapeutics, behavioral therapyThe Juva app provides clinician-developed biofeedback coaching that helps you control your nervous system. The 20-minute sessions occur five times per week, and the app monitors your vital signs and provides real-time feedback using your phone's camera. Calming the nervous system and relaxation training have been shown to reduce migraine frequency and severity.
Krill oilPreventivePaidVitamin/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).
Lavender oilAcute & PreventivePaidVitamin/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.
L-carnitinePreventivePaidVitamin/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. Acetyl-l-carnitine is a type of l-carnitine that is thought to cross the blood-brain barrier more effectively and be more absorbable.
L-methylfolate / Levomefolic acidPreventivePaidVitamin/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.
Lysergic Acid Diethylamide (LSD)Acute & PreventivePaidPsychedelicsLysergic acid diethylamide (LSD) is a type of psychedelic--a type of drug that can alter perception, emotion, and cognition without impairing memory or inducing delirium. LSD, and other psychedelics, have been reported to abort attacks and to decrease frequency and intensity of attacks in people suffering from cluster headaches. LSD is in clinical trials and not yet available outside trials.
MagnesiumPreventivePaidVitamin/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 (including magnesium citrate, glycinate, and threonate oxide). Some migraine experts recommend a higher doses of magnesium to help prevent migraine attacks. Magnesium threonate may be used to improve sleep if one has trouble falling asleep.
MagnotherapyPreventivePaidLifestyleAlso 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.
Marijuana (nonmedical)AcutePaidLifestyleMarijuana is a dried mixture of the Cannabis sativa plant. It is used as a recreational drug and medically for a variety of ailments, including chronic pain, nausea from chemotherapy, and multiple sclerosis spasticity. It can be smoked, vaped, eaten, or drunk as tea. Its legality varies around the world. Within the US, many states have legalized the use for medical and/or recreational use or decriminalized it, but it is still federally illegal to possess. See entry: Marijuana (medical) in pharmacological.
MeditationAcute & PreventiveFreeBehavioral therapyMeditation is a practice in which an individual uses a technique to train attention, awareness and achieve a mentally clear and emotionally calm state. Techniques include focusing the mind on a particular object, thought, or activity (mindfulness) or being gently guided by an expert into a meditative state (guided meditation). Research has shown promising results for meditation, with participants reporting less severe migraines as well as other benefits including lower stress, less anxiety, better sleep, and better general health, concentration, self-awareness, and self-control.
MelatoninPreventivePaidVitamin/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.
Menthol/Mint, CamphorAcutePaidVitamin/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.
Mescaline or PeyotePreventivePaidPsychedelicsMescaline is a hallucinogenic substance found within the Peyote cactus. Mescaline can be taken from the Peyote cactus or created synthetically. Throughout history, Peyote and mescaline have been used by some Native American communitites for traditional religious rites.There have been anecdotal reports of people with cluster headaches using mescaline as a treatment.
XMigraine and Headache TelehealthAcute & PreventiveFree & PaidDiagnostics, Digital therapeuticsMigraine and headache telehealth-services allows people who are not easily able to see migraine specialists (whether due to location or health reasons) the ability to get migraine specific care from the comfort of their home. Diagnosing migraine, prescription renewals, diary tracking, referrals, and behavior and lifestyle coaching can all be done with telehealth services. Cove & Neura Health are two migraine-specific telehealth services.
XMigraine BuddyPreventiveFree & PaidDigital TherapeuticsMigraine Buddy is a migraine tracking app. Using a migraine app can help those with migraine understand their migraine attacks better and communicate their symptoms, severity, frequency, and triggers with their healthcare provider.
X"Migraine Cocktail"AcutePaidProcedureCombinations of medications and treatments for severe migraine attacks are informally referred to as a “migraine cocktail.” Treatment can occur at an urgent care, in an outpatient infusion center, in an emergency department, or when someone is admitted to hospital for treatment of migraine. The exact combination could be different for every patient, but the treatment often includes nonsteroidal anti-inflammatory drugs (NSAIDs) such as ketorolac. A person may also receive magnesium, certain medications to reduce nausea or vomiting, diphenhydramine (Benadryl®), dihydroergotamine (DHE), steroids, and/or IV fluids.
XMigraine Support FormulaPreventivePaidVitamin/SupplementThis is a multivitamin product designed specifically for people with migraine that combines into one pill 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 and black pepper.
MindfulnessAcute & PreventiveFree & PaidLifestyleA 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.
Mindfulness-Based Cognitive Therapy (MBCT)PreventivePaidBehavioral TherapyMindfulness-based cognitive therapy (MBCT) is a modified form of cognitive behavioral therapy (CBT). MBCT incorporates mindfulness practices that include present moment awareness, meditation, and breathing exercises. Using these tools, MBCT teaches one how to be in the here-and-now as well as how to break away from negative thought patterns. There is growing evidence for the use of MBCT for migraine.
Mini-preventionAcute & PreventivePaid & FreeBehavioral therapy, Diagnostics Mini-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.
MovementPreventiveFreeLifestyleMovement involves moving your body in any way that feels good including stretching, strength training, aerobic exercise, or whatever is possible. Movement can release certain neurotransmitters called endorphins. Endorphins interact with the receptors in the brain that reduce perception of pain and can also trigger a positive feeling in the body similar to that of morphine.
Myofascial releasePreventivePaidPhysical 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.
N-Acetyl Cysteine (NAC)PreventivePaidVitamin / SupplementN-acetyl-cysteine (NAC) in dietary supplement form may help with chronic respiratory conditions, fertility, and brain health. Prescription strength NAC treats acetaminophen/paracetamol poisoning. The US FDA is currently undergoing a full safety review to determine if NAC can continue to be sold as a dietary supplement or if it must be designated as a prescription drug.
XN1-Headache appPreventivePaidDigital TherapeuticsN1-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.
NaturopathyPreventivePaidLifestyleNaturopathy 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.
XNerivioAcute & PreventivePaidNeuromodulation, Product/DeviceNerivio is a wireless non-invasive remote electrical stimulation wearable (REN) 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. Nerivio was FDA cleared for acute use in adults in October 2020 and for adolescents in January 2021. In March 2023, it was FDA-approved for preventive use in people 12 or older.
Neuroplasticity TrainingPreventivePaidBehavioral TherapyNeuroplasticity is the brain's ability to rewire itself in order to improve functioning in daily life. Neuroplasticity training is anything that helps create or change neural connections in the brain. Examples of neuroplasticity training include occupational therapy, mindfulness and meditation, and brain training. Pain Reprocessing Theory is a specific type of neuroplasticity training that retrains the brain to interpret and respond to signals from the body properly, subsequently breaking the cycle of chronic pain. See entry: Pain Reprocessing Therapy.
XNeura HealthAcute & PreventivePaidDiagnostics, Digital therapeuticsNeura Health is a virtual headache and migraine clinic which aims to provide quality care to anyone, anywhere. Membership with Neura Health includes same or next-day headache neurologist video visits; unlimited 24/7 in-app chat with headache care team; headache tracker & insights into triggers and trends; and personalized treatment plan and dedicated care coach.
Niacin / Vitamin B3PreventivePaidVitamin/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.
Night or Mouth guardPreventivePaidProduct/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.
XNociraAcutePaidNeuromodulation, Product/DeviceNocira is an air pressure modulation device that delivers controlled puffs of air into the ear, which stimulates pressure-activated sensory neurons to reset the brain's pain response. It was designated by the FDA as a "Breakthough Device" in April of 2022 for the acute treatment of migraine, which can help speed up FDA-approval. As of March 2024, it is not yet FDA-approved or available for use.
Noise-cancelling headphonesAcute & PreventivePaidProduct/DeviceNoise-canceling headphones and earplugs 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, Loop etc.
NutraceuticalsPreventivePaidVitamin/supplementNutraceuticals are products derived from food sources that provide nutrition and medicinal benefits. Examples of nutraceuticals include dietary supplements, diets, herbal products, and vitamins.
Occipital lift techniqueAcute & PreventivePaidPhysical 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.
Omega-3PreventivePaidVitamin/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.
XOmega ProcedurePreventivePaidNeuromodulation, ProcedureThe 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. See also: Reed Procedure®.
OsteopathyPreventivePaidPhysical 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.
OxygenAcute & PreventivePaidDeviceOxygen has been showen to cause 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.
Pacing YourselfAcute & PreventiveFreeLifestylePacing is a strategy that is often used by people with chronic illness to allow them to complete activities without significantly worsening their symptoms. Pacing may also positively impact people’s confidence in their ability to manage their condition (also known as self-efficacy). In migraine, pacing is used to maintain a level of functional independence without causing an undue increase in migraine intensity and associated migraine symptoms.
Pain Reprocessing Theory (PRT)PreventiveFree & PaidBehavioral therapyPain Reprocessing Therapy (PRT) is a system of psychological techniques that retrains the brain to interpret and respond to signals from the body properly, subsequently breaking the cycle of chronic pain. A randomized controlled study at the University of Colorado Boulder validated PRT as the most effective current treatment for chronic pain.
Passage of timeAcuteFreeLifestyleWhile 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.
PedialyteAcute & PreventivePaidVitamin/SupplementPedialyte is designed to promote rehydration and electrolyte replacement in ill children. It is also available in adult formulations. Compared to Gatorade, Pedialyte contains more sodium and potassium, and does not contain sucrose, but may contain synthetic sweeteners.
PeppermintPreventivePaidVitamin/SupplementPeppermint is used for a variety of health conditions and can be taken orally in dietary supplements or as a tea, 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.
PERMA™ Theory of Well-BeingPreventiveFreeBehavioral 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.
Personal TrainerPreventivePaidPhysical TherapyA personal trainer works with individuals or small groups to help people achieve their health and fitness goals through personalized fitness plans. Personal trainers guide clients through exercises, ensuring proper form and technique to prevent injuries and maximize results. They can also help people stay accountable and motivated. People with chronic conditions, physical limitations, or those needing introductions to new forms of exercise may benefit from personal trainers.
PetadolexPreventivePaidVitamin/SupplementPetadolex is a brand of butterbur extract. It 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. See entry: Butterbur.
Pet / Animal TherapyAcute & PreventiveFreeBehavioral Therapy, LifestylePet therapy, animal therapy, or animal-assisted therapy is the use of animals as a way to help people cope with and recover from certain physical and mental health conditions. Common animals used for pet therapy include dogs, cats, horses, and birds. For many people, ineracting with a friendly animal can create a bond with the animal, and produce a calming state in the person, reduce stress, and provide an improved sense of well-being. Pets in the home can also encourage movement, socialization, exposure to the outdoors, and provide a sense of purpose. People with chronic pain, including chronic migraine, may benefit from this type of therapy or from having pets.
PFO valve closurePreventivePaidProcedureMultiple 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.
Physiotherapy / Physical TherapyPreventivePaidPhysical 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.
PilatesPreventiveFree & PaidLifestylePilates 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.
Pillow (Shaped or Cooling)Acute & PreventivePaidLifestyleA 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.
Placebo responseAcute & PreventivePaidBehavioral TherapyPlacebo response occurs when a person perceives an improvement 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.
PotassiumAcute & PreventivePaidVitamin/ SupplementPotassium 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.
PrayerAcute & PreventiveFreeLifestylePrayer 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.
ProbioticsPreventivePaidVitamin/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 supplements or naturally in many fermented foods including certain yogurts, pickles, sauerkraut, miso, tempeh, kombucha, sourdough bread, and some cheeses.
Progressive muscle relaxation therapyAcute & PreventiveFree & PaidBehavioral 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.
PsilocybinAcutePaidPsychedelicsPsilocybin 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.
PsychotherapyPreventivePaidBehavioral 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.
QigongAcute & PreventiveFree & PaidLifestyleQigong 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.
Radiofrequency ablationPreventivePaidProcedureRadiofrequency 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.
XReed Procedure PreventivePaidNeuromodulation, ProcedureThe 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. See also: Omega Procedure.
ReflexologyPreventiveFree & PaidPhysical 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.
ReikiPreventivePaidPhysical 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 as a supplement to standard medical treatment.
Relaxation techniquesAcute & PreventiveFree & PaidBehavioral therapyRelaxation techniques help control stress, and they can also help you fall asleep faster. There are many common relaxation techniques, including meditation, t’ai chi, massage, and deep breathing. There are also everyday activities like gardening, art, and pets that people find relaxing. Stress is a well-known contributing factor to migraine, so finding ways to control it is worth trying. Most relaxation techniques are safe to do in tandem with your medication, and you can practice many different forms of relaxation techniques. People with migraine should look for a relaxation technique that works for them, as there is scientific evidence that supports its use for migraine.
XRelivion MGAcutePaidNeuromodulation, Product/DeviceRelivion MG is a smartphone-controlled, cloud-connected external combined and trigeminal neurostimulation device (COT-NS). It delivers stimulation to six branches of the occipital and trigeminal nerves via three adaptive output channels. This releases neurotransmitters in the brain stem and modulates brain networks associated with control of pain and mood. Cleared by FDA in March 2021 it is available with a prescription in the U.S. for acute treatment and is being studied for the prevention of migraine.
Remedial massagePreventivePaidPhysical 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.
ResiliencePreventiveFreeLifestyleResilience 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.
Retrying TreatmentsAcute & PreventiveFreeDiagnosticsRetrying treatments and medications is the concept of looking back at treatments tried in the past and considering whether it might be helpful to retry some. When people are struggling to find a treatment plan that works, it can be helpful to do a detailed review of past medications and treatment plans to see if any prior attempts are worth retrying in a different way. There are many reasons why a treatment may not have worked at one point but may work at a different point in time: hormonal changes, dosing levels, lifestyle changes, and combining various treatments together, among others.
Rub/pressure templesAcuteFreeLifestyleRubbing 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.
SaffronPreventivePaidVitamin/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.
Salt Crystals/Salt lampsAcutePaidVitamin/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.
XSEEDSPreventiveFreeLifestyleSEEDS is a mnemonic acronym encapsulating essential lifestyle recommendations, frequently advocated by speakers at the Migraine World Summit and migraine specialists. Here's a breakdown of SEEDS: 1. Sleep: Prioritize both the quality and quantity of sleep, maintaining consistency in your sleep schedule. 2. Eating: Adopt a regular and health-conscious eating routine, emphasizing hydration and minimizing caffeine intake. 3. Exercise: Aim for 30 to 50 minutes of moderate-intensity aerobic activity three to five times a week. However, any form of movement is beneficial, so engage in activities that suit your capabilities. 4. Drinking water: Ensure proper hydration by consuming an adequate amount of water and limiting caffeine and alcohol intake. 5. Diary: Keep a detailed record of your migraine attacks and associated symptoms for better understanding and management. 6. Stress Management: Integrate stress reduction techniques into your daily life, such as mindfulness, cognitive behavioral therapy, and biofeedback.
Self-acupressureAcute & PreventiveFreePhysical 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.
Self-CareAcute & PreventiveFreeLifestyleSelf-care is a broad term that is defined by the World Health Organization (WHO) as being able to promote health, prevent disease, maintain health, and cope with illness and disability with or without the support of a healthcare provider. According to the WHO, many facets of a person's life can be included in self-care, including hygiene, nutrition, lifestyle factors like exercise and leisure, a person's living conditions and social habits, socioeconomic factors, and medication and treatment for illness. Prioritizing one's health and well-being is important to all, including those who have migraine.
ShiatsuPreventivePaidPhysical 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.
SleepAcute & PreventiveFreeLifestyleSleep 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.
Sleeping maskAcute & PreventivePaidProduct/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.
Smartphone and computer-screen filtersAcute & PreventivePaidProduct/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.
Smell retraining therapyPreventiveFreePhysicalSmell 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.
Social connectionPreventiveFreeLifestyleSocial 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.
Social supportAcute & PreventiveFreeLifestyleSocial 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.
Somatic TrackingAcute & PreventiveFreeBehavioral therapyA technique for attending to painful sensations by using nonjudgmental mindfulness, safety reappraisal, and an objective lens to help deactivate the pain signal.
XSphenopalatine ganglion (SPG) deviceAcute & PreventivePaidNeuromodulation, ProcedureThe 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. Three forms of this procedure include Allevio, SphenoCath, and Tx360.
St. John’s WortPreventivePaidVitamin/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. It can also be used to treat menopause symptoms. The evidence for migraine is inconclusive. Consult your Doctor before taking it as many contraindications exist for St. John's Wort.
Stress managementPreventiveFreeLifestyleStress 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.
StretchingPreventiveFreeLifestyleStretching 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.
T’ai ChiPreventiveFree & PaidLifestyleT’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.
THCAcute & PreventivePaidVitamin/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.
Tinted glasses and contactsPreventivePaidProduct/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.
Transcutaneous electrical nerve stimulation (TENS) deviceAcutePaidNeuromodulation, Product/DeviceTENS 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. IcyHot, SmartRelief, Omron, truMedic are a few of the brand names of existing TENS devices.
Trigger point injectionsAcute & PreventivePaidPhysical 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.
TriphalaPreventivePaidVitamin/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.
TurmericPreventivePaidVitamin/SupplementTurmeric is an herb that contains curcumin, a substance with powerful anti-inflammatory and antioxidant properties.
ValerianPreventivePaidVitamin/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.
Vapor inhaler stickAcute & PreventivePaidProduct/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.
Vestibular rehabilitation therapy (VRT)PreventivePaidPhysical therapyFor people who experience severe dizziness or vertigo with migraine, vestibular rehabilitation therapy 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.
Visceral manipulationPreventivePaidPhysical 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.
Vision Therapy / Eye ExercisesPreventivePaidPhysical 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.
Vitamin B complexPreventivePaidVitamin/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.
Vitamin B12/CobalaminPreventivePaidVitamin/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.
Vitamin B2/RiboflavinPreventivePaidVitamin/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.
Vitamin B6/PyridoxinePreventivePaidVitamin/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.
Vitamin D3 / CholecalciferolPreventivePaidVitamin/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.
Vitex agnus-castus PreventivePaidVitamin/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, including during perimenopause for premenstrual syndrome (the dosage used in clinical trials for premenstrual syndrome is 20 mg, equivalent to 400mg of the dried product).
Walking in naturePreventiveFreeLifestyleA 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.
Wearing sunglassesAcute & PreventiveFreeLifestyleGlare 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.
Water Filter (in home)PreventivePaidProduct/DeviceWater filters (or purifiers) are used to remove unnecessary particles and contaminants from your water as well as improve the taste and smell. There are different types of filters, including simple pitchers (eg., Brita), faucet-mounted filters, reverse osmosis filters, and whole-house filters. Depending on the type, a filter can reduce PFAs (per- and polyfluoroalkyl substances), chlorine, lead, and other contaminants to certified standard levels. If you think your migraine attacks are triggered by environmental factors, purchasing a water filter to improve your water quality can be an easy addition to your home. There is no evidence that water quality impacts migraine.
Weight lossPreventiveFreeLifestyleObesity 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.
White willowPreventivePaidVitamin/SupplementWhite willow bark is an anti-inflammatory supplement that is thought to restrict prostaglandins and reduce pain.
YogaPreventiveFree & PaidLifestyleYoga is a 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 with minimal equipment. There are various forms of yoga including restorative, Hatha, Vinyasa, Yin, Iyengar, Nidra, chair, and hot yoga.
ZincPreventivePaidVitamin/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.

2024 New Treatments List

New Treatments List

The table below summarizes significant medical treatments newly available in various regions since 2017. These include preventive and acute therapies approved for the treatment of migraine or certain types of headaches by the regulatory authority of at least one of these regions. Please consult the complete Treatment Directory for additional information.

NEW MEDICAL TREATMENTS (as of March 2024)
Anti-CGRPsBrand NameClassUSAAUSCANENGIRE
EptinezumabVyeptiCGRP monoclonal antibodyPreventivePreventivePreventivePreventivePreventive
ErenumabAimovigCGRP monoclonal antibodyPreventivePreventivePreventivePreventivePreventive
FremanezumabAjovyCGRP monoclonal antibodyPreventivePreventivePreventivePreventivePreventive
GalcanezumabEmgalityCGRP monoclonal antibodyPreventivePreventivePreventivePreventivePreventive
DitansBrand NameClassUSAAUSCANENGIRE
LasmiditanReyvow5-HTIF receptor agonistAcuteN/AN/AN/AN/A
Ergot alkaloid-derivativesBrand NameClassUSAAUSCANENGIRE
Dihydroergotamine mesylate (DHE)TrudhesaErgot alkaloid-derivativeAcuteN/AN/AN/AN/A
GepantsBrand NameClassUSAAUSCANENGIRE
AtogepantAquipta, QuliptaCGRP receptor antagonistPreventivePreventivePreventiveN/AN/A
RimegepantVydura, Nurtec ODTCGRP receptor antagonistBothBothN/ABothN/A
UbrogepantUbrelvyCGRP receptor antagonistAcuteN/AAcuteN/AN/A
ZavegepantZavzpretCGRP receptor antagonistAcuteN/AN/AN/AN/A
Neuromodulation DevicesBrand NameClassUSAAUSCANENGIRE
External combined occipital and trigeminal neurostimulationRelivion MGNeuromodulationAcuteN/AN/AN/AN/A
Remote wearable neuromodulation (REN)NerivioNeuromodulationBothN/AN/AN/AN/A
Supraorbital TNS unit or externalCefalyNeuromodulationBothBothBothBothBoth
Transcranial magnetic stimulation (TMS) deviceSAVI Dual, sTMS MiniNeuromodulationBothN/AN/ABothN/A
Vagus nerve stimulation (VNS)gammaCore SapphireNeuromodulation deviceBothBothBothBoth (cluster)Both (cluster)
Nonsteroidal Anti-inflammatory DrugBrand NameClassUSAAUSCANENGIRE
Celecoxib liquidElyxybNSAIDAcuteN/AN/AN/AN/A
TriptansBrand NameClassUSAAUSCANENGIRE
Sumatriptan (as nasal spray)TosymraSerotonin 5-HTI agonistAcuteN/AN/AN/AN/A
Rizatriptan benzoate (as oral film)RizaFilmSerotonin 5-HTI agonistAcuteN/AN/AN/AN/A

© Copyright 2024 Migraine World Summit. All Rights Reserved. Consult your healthcare provider for personal medical advice or more information.

2024 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
Controlling Chronic MigraineJessica Ailani, MD, FAHS, FAAN
Best Exercise Options for People With MigraineElizabeth (Betsy) Seng, PhD
Beginner's Guide to Headache TypesCourtney Seebadri-White, MD
Neurological Research PrioritiesWalter Koroshetz, MD
DAY 2
Migraine Biochemistry: CGRP & BeyondPeter Goadsby, MD, PhD, FRS
How Much Is Too Much Excedrin Migraine?Paul G. Mathew, MD, DNBPAS, FAAN, FAHS
The Gut Factor: Exploring the Role of Digestive Health in Migraine
Vince Martin, MD, AQH
Menopause, Perimenopause & MigraineChristine Lay, MD, FAHS
DAY 3
Supplements & Foods That Ease MigraineRobert Bonakdar, MD
Balancing Risks & Benefits of Migraine TreatmentsAmaal J. Starling, MD, FAHS, FAAN
Is Migraine a Brain Energy Problem?Elena Gross, PhD
Migraine FOMO: Are You Missing Out?Katie MacDonald
DAY 4
What To Expect from Nurtec ODT, Ubrelvy, Qulipta & ZavzpretMatthew Robbins, MD
New Daily Persistent Headache: Pain That Won't StopAndrew D. Hershey MD, PhD, FAAN, FAHS
The Nervous System, Stored Trauma & Migraine Aimie Apigian, MD, MS, MPH
When Headache Starts Behind the EyesDeborah Friedman, MD, MPH, FAAN, FAHS
DAY 5
Unofficial Side Effects of CGRP Monoclonal AntibodiesRobert P. Cowan, MD
Migraine, TMD & Neck PainRashmi B. Halker Singh, MD, FAHS, FAAN
Neuromodulation Devices: Proven Drug-Free Treatment for MigraineFred Cohen, MD
Advocacy, Access & Migraine at WorkRob Music
DAY 6
Beyond 50: Insights Into Migraine That Ages With UsMessoud Ashina, MD, PhD, DMSc
How Migraine & Chronic Fatigue Syndrome (ME/CFS) Are ConnectedJames Baraniuk, MD
Tension Headache or Migraine? Differences and MisdiagnosesRebecca C. Burch, MD, FAHS
How To Manage Migraine Stigma at WorkOlivia Begasse de Dhaem, MD, FAHS
DAY 7
Inflammation & Chronic MigraineGretchen E. Tietjen, MD
Brain-Related Comorbidities of MigraineDawn C. Buse, PhD
Could Biomarkers Improve Migraine Diagnosis?Patricia Pozo-Rosich, MD, PhD
Protecting Our Kids: Navigating Migraine at SchoolAmy Graham
DAY 8
Is Migraine Linked With Cognitive Decline or Dementia?Richard B. Lipton, MD
Finding Migraine ReliefElizabeth Leroux, MD, FRCPC
Finding Balance in Vestibular Migraine Diagnosis & TreatmentKristen K. Steenerson, MD
Genetics Research: Hope for a Future of Personalized Migraine CareDale Nyholt, PhD

2023 VIP Pass Add-ons

Welcome to your 2023 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 2023 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 next Quarterly Research Report will be ready by mid-April from Quarter 1, 2023.


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 2023 Delivery Timeline:

  • March 21: Printer sent materials.
  • March 21- April 1: Printers develop proofs.
  • April 1-11: Proofs and files reviewed and approved.
  • April 12: Boxed Set is shipped today.
  • April 13-23: US orders due for arrival.
  • May 1-21: 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

Quarterly Research Reports

Introduction

Welcome to 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, 2023 Quarterly Research Report Download >>

2023 New Treatments List

New Treatments List

The table below summarizes significant medical treatments newly available in various regions since 2017. These include preventive and acute therapies approved for the treatment of migraine or certain types of headaches by the regulatory authority of at least one of these regions. Please consult the complete Treatment Directory for additional information.

NEW MEDICAL TREATMENTS (as of March 2023)
Anti-CGRPsBrand NameClassUSAAUSCANENGIRE
EptinezumabVyeptiCGRP monoclonal antibodyPreventivePreventivePreventivePreventiveN/A
ErenumabAimovigCGRP monoclonal antibodyPreventivePreventivePreventivePreventivePreventive
FremanezumabAjovyCGRP monoclonal antibodyPreventivePreventivePreventivePreventivePreventive
GalcanezumabEmgalityCGRP monoclonal antibodyPreventivePreventivePreventivePreventivePreventive
DitansBrand NameClassUSAAUSCANENGIRE
LasmiditanReyvow5-HTIF receptor agonistAcuteN/AN/AN/AN/A
Ergot alkaloid-derivativesBrand NameClassUSAAUSCANENGIRE
Dihydroergotamine mesylate (DHE)TrudhesaErgot alkaloid-derivativeAcuteN/AN/AN/AN/A
GepantsBrand NameClassUSAAUSCANENGIRE
AtogepantQuliptaCGRP receptor antagonistPreventiveN/APreventiveN/AN/A
RimegepantNurtec ODTCGRP receptor antagonistBothN/AN/AN/AN/A
UbrogepantUbrelvyCGRP receptor antagonistAcuteN/AAcuteN/AN/A
ZavegepantZavzpretCGRP receptor antagonistAcuteN/AN/AN/AN/A
Neuromodulation DevicesBrand NameClassUSAAUSCANENGIRE
External combined occipital and trigeminal neurostimulationRelivion MGNeuromodulationAcuteN/AN/AN/AN/A
Remote wearable neuromodulation (REN)NerivioNeuromodulationBothN/AN/AN/AN/A
Supraorbital TNS unit or externalCefalyNeuromodulationBothBothBothBothBoth
Transcranial magnetic stimulation (TMS) deviceSAVI DualNeuromodulationBothN/AN/ABothN/A
Vagus nerve stimulation (VNS)gammaCoreNeuromodulation deviceBothBothBothBoth (cluster)Both (cluster)
Nonsteroidal Anti-inflammatory DrugBrand NameClassUSAAUSCANENGIRE
Celecoxib liquidElyxybNSAIDAcuteN/AN/AN/AN/A
TriptansBrand NameClassUSAAUSCANENGIRE
Sumatriptan (as nasal spray)TosymraSerotonin 5-HTI agonistAcuteN/AN/AN/AN/A

© Copyright 2023 Migraine World Summit. All Rights Reserved. Consult your healthcare provider for personal medical advice or more information.

Treatment Directory – Complementary & NonMedical

Complementary & NonMedical Migraine Treatments

Treatments are listed in alphabetical order.

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

Complementary & Nonmedical TreatmentTreatment TypeCostFormatDescription
5-HTP (5 Hydroxytryptophan)PreventivePaidVitamin/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).
Acceptance and Commitment Therapy (ACT)PreventivePaidBehavioral 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.
AcupressureAcute & PreventivePaidPhysical 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.
Acupressure braceletsAcute & PreventivePaidProduct/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.
AcupuncturePreventivePaidLifestyleA 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.
AdvocacyPreventiveFreeLifestyleAdvocacy 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.
Alexander TechniquePreventivePaidPhysical therapyThe 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.
AltruismPreventiveFreeLifestyleAltruism, 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.
Applied Kinesiology (AK)PreventivePaidPhysical 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.
AromatherapyAcute & PreventivePaidProduct/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.
AshwaghandhaPreventivePaidVitamin/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.
Avoid bright screensAcute & PreventiveFreeLifestyleBright 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.
Avoid fluorescent lightingAcute & PreventiveFreeLifestyleFluorescent lights emit a particular spectrum of light. People with migraine may be sensitive to the spectrum of light emitted by fluorescent lights.
Avoid loud, sustained noiseAcute & PreventiveFreeLifestyleLoud 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.
Avoid odors/smokeAcute & PreventiveFreeLifestyleStrong 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.
Avoid processed foodsPreventiveFreeLifestyleProcessed 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.
AyurvedaAcute & PreventiveFreeLifestyleAyurveda 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. 
BarometerPreventivePaidProduct/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.
Behavioral therapy apps & online toolsAcute & PreventivePaidBehavioral therapy, Digital TherapeuticsThere 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.
Bio-behavioral therapyAcute & PreventivePaidBehavioral 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.
BiofeedbackAcute & PreventiveFree & PaidBehavioral 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.
Black cohoshPreventivePaidVitamin/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.
Blood test - Food sensitivities/nutritionPreventivePaidDiagnosticsA 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. A 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.
Blood test – Genetic dysfunctionPreventivePaidDiagnosticsTesting 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.
Blue menthol gelAcutePaidProduct/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.
Boswellia / Indian frankincensePreventivePaidVitamin/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.
Bowen therapyPreventivePaidPhysical 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.
Breathing relaxation techniquesAcute & PreventiveFreeBehavioral 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.
ButterburPreventivePaidVitamin/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.
CaffeineAcute & PreventivePaidLifestyleCaffeine is a stimulant found in coffee, tea, chocolate, and soft drinks. Caffeine is addictive. If used in excess, caffeine can be overstimulating and cause anxiety and sleep problems; for people with migraine consuming less than 200mg/day is recommended. Caffeine can help the body absorb some medications faster, some sources suggest it can assist pain relievers by up to 40 percent. Any change in caffeine levels can contribute to an attack in some people whether by consuming too much, too little, or skipping a day.
CalciumPreventivePaidVitamin/SupplementCalcium is essential for building and maintaining bone, and is required for the healthy functioning of the heart, muscles, blood and nerves.
CapsaicinAcutePaidVitamin/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.
Cervical tractionPreventivePaidProduct/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.
Chinese herbal medicinePreventivePaidVitamin/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.
ChiropractorPreventivePaidPhysical 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.
Ctrl M Health appPreventivePaidDigital therapeuticsDeveloped by Jefferson Headache Center, Ctrl M Health provides active support by establishing regular accessible guidance through their mobile app. The app links users to the knowledge, tools, and support that enable them to better manage headache and migraine. It claims to integrate the latest science with the best practices of health psychology to help improve users' quality of life.
Coenzyme Q10 (CoQ10)/ UbiquinolPreventivePaidVitamin/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.
Cognitive Behavior Therapy (trauma focused)PreventivePaidBehavioral 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.
Cognitive behavioral therapy (CBT)Acute & PreventiveFree & PaidBehavioral 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.
Cognitive behavioral therapy for insomnia (CBT-I)PreventivePaidBehavioral 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.
Combination TherapyAcute & PreventivePaid & FreeBehavioral therapyCombination 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.
Cooling gel sheetAcutePaidProduct/DeviceApplying cold items or ice packs to the head helps promote circulation and reduces the inflammation in the head caused by migraine.
CoveAcute & PreventivePaidDiagnostics, Digital therapeuticsCove is a telehealth company that offers migraine care. Users can complete an online consultation to help the medical provider find the best treatment plan for them. The provider-recommended treatment is delivered directly to them on the schedule they choose. If adjustments need to be made, the Cove team claim they will work with them to make sure they get the care they need.
Craniosacral Therapy (CST)Acute & PreventivePaidPhysical therapyCraniosacral therapy (CST) is a gentle hands-on treatment that may provide relief from a variety of symptoms including headaches, neck pain, and side effects of cancer treatment. CST uses a light touch to examine membranes and movement of fluids in and around the central nervous system, which can promote a feeling of well-being by eliminating pain. Efficiacy has not been scientifically established despite usage among people who experience migraine.
Creative therapyPreventiveFreeBehavioral 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.
Daith piercingPreventivePaidLifestyleThe 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.
Dark, quiet roomAcuteFreeLifestyleWhen 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.
Detoxification (Detox)PreventiveFree & PaidLifestyleA 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.
Dialectical Behavior Therapy (DBT)PreventivePaidBehavioral therapyDialectical behavior therapy (DBT) is a modified type of cognitive behavioral therapy (CBT). Its main goals are to teach people how to live in the moment, develop healthy ways to cope with stress, regulate their emotions, and improve their relationships with others.
Diet - 5:2 dietPreventiveFreeLifestyleThe 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.
Diet - Anti-inflammatory dietPreventiveFreeLifestyleAn 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.
Diet - Elimination dietPreventiveFreeLifestyleAn 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.
Diet – Gluten-free dietPreventiveFreeLifestyleGoing 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.
Diet - High in omega-3/low in omega-6PreventiveFreeLifestyleEating 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.
Diet - Ketogenic dietPreventiveFreeLifestyleThis 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. 
Diet - Mediterranean dietPreventiveFreeLifestyleThe 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.
Diet - Paleo dietPreventiveFreeLifestyleThe 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.
Diet - Vegan dietPreventiveFreeLifestyleVegans, 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.
Diet - Vegetarian dietPreventiveFreeLifestyleVegetarians do not eat meat, fish, or poultry. There is no evidence linked to migraine improvement.
Dietary changesPreventiveFreeLifestyleWhat 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.
Digital TherapeuticsAcute & PreventiveFree & PaidDigital TherapeuticsDigital Therapeutics are therapeutic treatment options driven by software programs that can be accessed online or on your phone. They can include biofeedback and behavioral therapy apps and virtual therapy (e.g., BetterHelp, Happify, Juva), telehealth offerings (e.g., Cove, NeuraHealth), mindfulness apps (e.g., Calm, Headspace), diary tracking apps (e.g., Migraine Buddy), and more. They can be especially helpful for people who are not able to access in-person medical and psychological services, and can be a complement to other therapies.
D-Ribose (Beta-D-ribofuranose)PreventivePaidVitamin/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.
Dry needlingAcute & PreventivePaidPhysical 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.
Electrolyte DrinksAcutePaidProduct/DeviceElectrolyte drinks like Pedialyte or sport drinks like Gatorade and Powerade aid in rehydration and 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.
Eliminate cigarette smokingPreventiveFreeLifestyleQuitting 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.
Eliminating alcoholPreventiveFreeLifestyleAlcohol 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.
Eliminating caffeinePreventiveFreeLifestyleWhile 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.
Eliminating chocolatePreventiveFreeLifestyleSome 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.
Eliminating dairyPreventiveFreeLifestyleDairy 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.
Eliminating glutenPreventiveFreeLifestyleSee ‘Diet – Gluten-Free’
Eliminating MSGPreventiveFreeLifestyleMSG, 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.
Eliminating nitrates/nitritesPreventiveFreeLifestyleNitrates 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.
Eliminating soyPreventiveFreeLifestyleSoy 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.
Eliminating sulfates/sulfitesPreventiveFreeLifestyleSulfates 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.
Eliminating tyraminePreventiveFreeLifestyleTyramine 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.
Emotional freedom technique (EFT)AcuteFreeBehavioral 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.
Epsom salt bathsAcute & PreventivePaidVitamin/ SupplementMagnesium 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.
Essential oilsPreventivePaidProduct/deviceSee Aromatherapy.
Evening primrose oilAcutePaidVitamin/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.
ExercisePreventiveFreeLifestyleExercise 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.
FeverfewPreventivePaidVitamin/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.
FolatePreventivePaidVitamin/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.
Folic acid / Vitamin B9PreventivePaidVitamin/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.
Forest bathingPreventiveFreeLifestyleForest 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.
GingerAcute & PreventivePaidVitamin/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.
GlucosaminePreventivePaidVitamin/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.
Green-Light Lamp, The Allay Lamp AcutePaidProduct/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.
Heat therapyAcuteFreeLifestyleHeat 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.
Herbal teasAcute & PreventivePaidVitamin/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.
HomeopathyPreventivePaidLifestyleHomeopathy 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.
HydrationAcute & PreventiveFreeLifestyleDehydration is a common migraine trigger. Keeping water on hand throughout the day helps ensure you get the recommended eight glasses per day. In hospital settings, hydration is often provided via IV fluids.
HydrotherapyAcute & PreventiveFreeLifestyleHydrotherapy 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.
Hyperbaric oxygen therapyPreventivePaidLifestyleHyperbaric 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.
Hypnotherapy/ HypnosisPreventivePaidBehavioral TherapyHypnosis 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.
Ice/cold therapyAcuteFreeLifestyleCold 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.
Improving posturePreventiveFreeLifestylePoor 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.
Iron supplementsPreventivePaidVitamin/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.
IsoflavonesPreventivePaidVitamin/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.
Juva Health AppPreventivePaidDigital therapeutics, behavioral therapyThe Juva app provides clinician-developed biofeedback coaching that helps you control your nervous system. The 20-minute sessions occur five times per week, and the app monitors your vital signs and provides real-time feedback using your phone's camera. Calming the nervous system and relaxation training have been shown to reduce migraine frequency and severity.
Krill oilPreventivePaidVitamin/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).
Lavender oilAcute & PreventivePaidVitamin/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.
L-carnitinePreventivePaidVitamin/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.
L-methylfolate / Levomefolic acidPreventivePaidVitamin/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.
Magnesium (including variants i.e., citrate, glycinate, threonate oxide)PreventivePaidVitamin/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.
MagnotherapyPreventivePaidLifestyleAlso 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.
Manage stressPreventiveFreeLifestyleStress 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.
MeditationAcute & PreventiveFreeBehavioral therapyMeditation is a practice in which an individual uses a technique to train attention, awareness and achieve a mentally clear and emotionally calm state. Techniques include focusing the mind on a particular object, thought, or activity (mindfulness) or being gently guided by an expert into a meditative state (guided meditation). Research has shown promising results for meditation, with participants reporting less severe migraines as well as other benefits including lower stress, less anxiety, better sleep, and better general health, concentration, self-awareness, and self-control.
MelatoninPreventivePaidVitamin/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.
Menthol/Mint, CamphorAcutePaidVitamin/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.
Mescaline or PeyotePreventivePaidPsychedelicsMescaline is a hallucinogenic substance found within the Peyote cactus. Mescaline can be taken from the Peyote cactus or created synthetically. Throughout history, Peyote and mescaline have been used by some Native American communitites for traditional religious rites.There have been anecdotal reports of people with cluster headaches using mescaline as a treatment.
Migraine BuddyPreventiveFree & PaidDigital TherapeuticsUsing 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.
Migraine Support FormulaPreventivePaidVitamin/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.
MindfulnessAcute & PreventiveFree & PaidLifestyleA 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.
Mindfulness-Based Cognitive Therapy (MBCT)PreventivePaidBehavioral TherapyMindfulness-based cognitive therapy (MBCT) is a modified form of cognitive behavioral therapy (CBT). MBCT incorporates mindfulness practices that include present moment awareness, meditation, and breathing exercises. Using these tools, MBCT teaches one how to be in the here-and-now as well as how to break away from negative thought patterns.
Mini-preventionAcute & PreventivePaid & FreeBehavioral therapy, Diagnostics Mini-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.
MovementPreventiveFreeLifestyleMovement involves moving your body in any way that feels good -- be it stretching, strength training, cardio, or anything else. Movement can release certain neurotransmitters called endorphins. Endorphins interact with the receptors in the brain that reduce perception of pain and can also trigger a positive feeling in the body similar to that of morphine.
Myofascial releasePreventivePaidPhysical 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.
N1-Headache appPreventivePaidDigital TherapeuticsN1-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.
NaturopathyPreventivePaidLifestyleNaturopathy 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.
Neura HealthAcute & PreventivePaidDiagnostics, Digital therapeuticsNeura Health is a virtual headache and migraine clinic which aims to provide quality care to anyone, anywhere. Membership with Neura Health includes same or next-day headache neurologist video visits; unlimited 24/7 in-app chat with headache care team; headache tracker & insights into triggers and trends; and personalized treatment plan and dedicated care coach.
Niacin / Vitamin B3PreventivePaidVitamin/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.
Night or Mouth guardPreventivePaidProduct/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.
Noise-cancelling headphonesAcute & PreventivePaidProduct/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.
NutraceuticalsPreventivePaidVitamin/supplementNutraceuticals are products derived from food sources that provide nutrition and medicinal benefits. Examples of nutraceuticals include dietary supplements, diets, herbal products, and vitamins.
Occipital lift techniqueAcute & PreventivePaidPhysical 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.
Omega-3PreventivePaidVitamin/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.
OsteopathyPreventivePaidPhysical 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.
Pain Reprocessing Theory (PRT)PreventiveFree & PaidBehavioral therapyPain Reprocessing Therapy (PRT) is a system of psychological techniques that retrains the brain to interpret and respond to signals from the body properly, subsequently breaking the cycle of chronic pain. A randomized controlled study at the University of Colorado Boulder validated PRT as the most effective current treatment for chronic pain.
Passage of timeAcuteFreeLifestyleWhile 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.
PedialyteAcute & PreventivePaidVitamin/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.
PeppermintPreventivePaidVitamin/SupplementPeppermint is used for a variety of health conditions and can be taken orally in dietary supplements or as a tea, 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.
PERMA™ Theory of Well-BeingPreventiveFreeBehavioral 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.
Petadolex (butterbur extract)PreventivePaidVitamin/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.
Physiotherapy / Physical TherapyPreventivePaidPhysical 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.
PilatesPreventiveFree & PaidLifestylePilates 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.
Pillow (Shaped or Cooling)Acute & PreventivePaidLifestyleA 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.
Placebo responseAcute & PreventivePaidBehavioral TherapyOccurs when a person perceives an improvement 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.
PrayerAcute & PreventiveFreeLifestylePrayer 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.
ProbioticsPreventivePaidVitamin/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.
Progressive muscle relaxation therapyAcute & PreventiveFree & PaidBehavioral 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.
PsilocybinAcutePaidPsychedelicsPsilocybin 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.
PsychotherapyPreventivePaidBehavioral 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.
QigongAcute & PreventiveFree & PaidLifestyleQigong 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.
ReflexologyPreventiveFree & PaidPhysical 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.
ReikiPreventivePaidPhysical 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.
Relaxation techniquesAcute & PreventiveFree & PaidBehavioral 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.
Remedial massagePreventivePaidPhysical 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.
ResiliencePreventiveFreeLifestyleResilience 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.
Rub/pressure templesAcuteFreeLifestyleRubbing 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.
SaffronPreventivePaidVitamin/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.
Salt Crystals/Salt lampsAcutePaidVitamin/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.
SEEDSPreventiveFreeLifestyleSEEDS 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.
Self-acupressureAcute & PreventiveFreePhysical 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.
ShiatsuPreventivePaidPhysical 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.
SleepAcute & PreventiveFreeLifestyleSleep 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.
Sleeping maskAcute & PreventivePaidProduct/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.
Smartphone and computer-screen filtersAcute & PreventivePaidProduct/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.
Smell retraining therapyPreventiveFreePhysicalSmell 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.
Social connectionPreventiveFreeLifestyleSocial 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.
Social supportAcute & PreventiveFreeLifestyleSocial 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.
Somatic TrackingAcute & PreventiveFreeBehavioral therapyA technique for attending to painful sensations by using non-judgmental mindfulness, safety reappraisal, and an objective lens to help deactivate the pain signal
St. John’s WortPreventivePaidVitamin/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. It can also be used to treat menopause symptoms. The evidence for migraine is inconclusive. Consult your Doctor before taking it as many contraindications exist for St. John's Wort.
StretchingPreventiveFreeLifestyleStretching 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.
T’ai ChiPreventiveFree & PaidLifestyleT’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.
THCAcute & PreventivePaidVitamin/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.
Tinted migraine glasses and contactsPreventivePaidProduct/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.
Trigger point injectionsAcute & PreventivePaidPhysical 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.
TriphalaPreventivePaidVitamin/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.
TurmericPreventivePaidVitamin/SupplementTurmeric is an herb that contains curcumin, a substance with powerful anti-inflammatory and antioxidant properties.
ValerianPreventivePaidVitamin/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.
Vapor inhaler stickAcute & PreventivePaidProduct/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.
Vestibular rehabilitationPreventivePaidPhysical 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.
Visceral manipulationPreventivePaidPhysical 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.
Vision Therapy / Eye ExercisesPreventivePaidPhysical 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.
Vitamin B complexPreventivePaidVitamin/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.
Vitamin B12/CobalaminPreventivePaidVitamin/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.
Vitamin B2/RiboflavinPreventivePaidVitamin/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.
Vitamin B6/PyridoxinePreventivePaidVitamin/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.
Vitamin D3 / CholecalciferolPreventivePaidVitamin/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.
Vitex agnus-castus PreventivePaidVitamin/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, including during perimenopause for premenstrual syndrome (the dosage used in clinical trials for premenstrual syndrome is 20 mg, equivalent to 400mg of the dried product).
Walking in naturePreventiveFreeLifestyleA 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.
Wearing sunglassesAcute & PreventiveFreeLifestyleGlare 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.
Weight lossPreventiveFreeLifestyleObesity 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.
White willowPreventivePaidVitamin/SupplementWhite willow bark is an anti-inflammatory supplement that is thought to restrict prostaglandins and reduce pain.
YogaPreventiveFree & PaidLifestyleYoga is a 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 with minimal equipment. There are various forms of yoga including restorative, Hatha, Vinyasa, Yin, Iyengar, Nidra, chair, and hot yoga.
ZincPreventivePaidVitamin/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

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Generic Name (Active Ingredient List)Brand NamesTreatment ClassRXFormatTreatment TypeDescription
Acetaminophen & CodeineTylenol 3 or 4, PanadeineCombination - OpioidXLiquid, PillAcuteAcetaminophen/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 & OxycodonePercocetCombination - OpioidXLiquid, TabletsAcutePercocet is used to relieve moderate to severe pain. It contains a combination of oxycodone (an opioid pain medication that works in the brain to change how your body feels and responds to pain) and acetaminophen (a less powerful pain reliever that increases the effects of oxycodone).
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 a new device that delivers controlled puffs of air into the ear (Automated Variable Pulse Insufflation), which stimulates pressure-activated sensory neurons to reset the brain's pain response. It was designated by the FDA as a "Breakthough Device" in April of 2022 for the acute treatment of migraine, which can help speed up FDA-approval. As of March 2023, it is not yet FDA-approved or available for use.
AlmotriptanAlmogran, AxertSerotonin 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) inhibitorsAltace, Epanded, Prinivil, Qbrelis, Vasotec, ZestrilHypertensionxPillPreventiveAngiotensin-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 has a longer half-life than another similar gepant (ubrogepant), making it suitable for preventive treatment. It was approved by the FDA in September 2021 for episodic migraine prevention, and awaiting approval for chronic migraine as of March 2023.
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.
Behavioral Health DeviceClick TherapeuticsDeviceTBDDevicePreventiveClick Therapeutics has a device in development as a clinically-validated digital program for migraine that combines multiple mechanisms of actions with Click's adaptive patient engagement platform. In late 2022, this device received a Breakthrough Device designation from the FDA, which helps speed up the FDA clearance process for devices.
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.
CandesartanAtacand, Amias, Blopress, 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)VariousPhytocannabidiolEdibles, Oils, Topicals, Sublingual, & Vapors
Acute & 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 epilepsy.
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.
ClonazepamKlonopinBenzodiazepinesXPillAcuteClonazepam 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 machineFisher & Paykel, Philips, RESmart, ResMedVentilatorXDevicePreventiveContinuous 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, Voltaren-XR, Zipsor, ZorvolexNonsteroidal 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, IV, 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/DothiepinDopress, Dothep, Prothiaden, ThadenAntidepressantXPillPreventiveDosulepin 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.
DoxylamineDozile, RestavitAntihistaminePillAcuteDoxylamine 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.
Epidural blood patch--XPatchAcuteAn epidural blood patch is an injection of one's own blood into the epidural space (i.e., the area outside of the sack that contains cerebrospinal fluid, or CSF). It is used to treat headaches resulting from a CSF leak, also known as persistent or spinal headaches.
EptinezumabVyeptiCGRP monoclonal antibodyXIV InfusionPreventiveEptinezumab is a preventive CGRP monoclonal antibody approved by the FDA in February 2020, and also approved for prevention in other countries including Australia, Canada, and England. 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 with few sideeffects for most people.
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 & othersOther - hormonesXTransdermal patchPreventiveAn estrogen patch, using estradiol hormone, 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.
EszopicloneLunestaHypnoticXPillAcuteEszopiclone 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.
External combined occipital and trigeminal neurostimulation (COT-NS) deviceRelivion MGNeuromodulationXDeviceAcuteRelivion is a smartphone-controlled, cloud-connected neuromodulation device. It delivers stimulation to six branches of the occipital and trigeminal nerves via three adaptive output channels. This releases neurotransmitters in the brain stem and modulates brain networks associated with control of pain and mood. Cleared by FDA in March 2021 and is available with a prescription in the U.S. for acute treatment. It is being studied for the prevention of migraine.
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.
GabapentinGabarone, Gralise, Horizant, NeurontinAnticonvulsantXPillPreventiveGabapentin 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.
Hormonal ContraceptivesVariousOther - HormonesXIntradermal, Intrauterine Device, Patch, Pill, Vaginal RingPreventiveHormonal contraceptives are birth control that use hormones to prevent pregnancy. They contain estrogen and progesterone, or progesterone only. They prevent pregnancy by blocking the release of eggs from the ovaries, thinning the lining of the uterus, or thickening the mucus in the cervix to help keep sperm from reaching the egg. Hormonal contraceptives may be taken by mouth, injected or inserted under the skin, placed on the skin as a patch, or placed in the vagina or uterus. Dips in estrogen are most commonly associated with migraine onset, which may lead menstruating persons to seek out hormonal balancing methods as a form of treatment.
Hormone replacement therapy (HRT)-Other - hormonesXCream, Patch, PillPreventiveHormone replacement therapy (HRT), also known as hormone therapy, or menopausal hormone therapy (MHT), depending on the country you are in, is typically prescribed for those experiencing natural or surgically-induced menopause. Hormones commonly involved are estrogens, progesterone or progestins, and sometimes testosterone. These hormones can either be bioidentical or synthetic. Hormones, and major changes in them, can be a trigger for many people so HRT can help balance hormones in an aim to reduce 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, 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, Panafen Plus, Nurofen Plus, Rafen 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.
IndomethacinIndocid, IndocinNonsteroidal anti-inflammatory drugs (NSAIDs)XPillAcuteIndomethacin 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, 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.
LorazepamAtivanBenzodiazepinesXInjection, PillAcuteLorazepam 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.
Lysergic Acid Diethylamide (LSD)N/APsychedelicsTBDOralAcute & PreventiveLysergic acid diethylamide (LSD) is a type of psychedelic--a type of drug that can alter perception, emotion, and cognition without impairing memory or inducing delirium. LSD, and other psychedelics, have been reported to abort attacks and to decrease frequency and intensity of attacks in people suffering from cluster headaches. LSD is in clinical trials and not yet available outside trials.
Marijuana/Medical cannabis--XEdibles, Oils, Pill, TeaAcuteThe 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 DrowsyAntiemeticsPillAcute & 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.
Menopausal Replacement Therapy (MHT)VariousOther - HormonesXCream, Patch, PillPreventiveMenopausal hormone therapy (MHT), also known as hormone therapy, or hormone replacement therapy (HRT), depending on the country you are in, is typically prescribed for those experiencing either natural or surgically induced menopause. Hormones commonly involved are estrogens, progesterone or progestins, and sometimes testosterone. These hormones can either be bioidentical or synthetic. Hormones, and major changes in them, can be a trigger for many people so MHT can help balance hormones in an aim to reduce migraine.
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.
Migraine and Headache TelehealthCove, Neura HealthDiagnostics-Digital TherapeuticsAcute & PreventiveMigraine and headache telehealth-services allows people who are not easily able to see migraine specialists (whether due to location or health reasons) the ability to get migraine specific care from the comfort of their home. Diagnosing migraine, prescription renewals, diary tracking, referrals, and behavior and lifestyle coaching can all be done with telehealth services.
Migraine Cocktail-XIntramuscular, Intraveneous, PillAcuteCombinations of medications and treatments for severe migraine attacks are informally referred to as a “migraine cocktail.” Treatment can occur at an urgent care, in an outpatient infusion center, in an emergency department, or when someone is admitted to hospital for treatment of migraine. The exact combination could be different for every patient, but the treatment often includes nonsteroidal anti-inflammatory drugs (NSAIDs) such as ketorolac. A person may also receive magnesium, certain medications to reduce nausea or vomiting, diphenhydramine (Benadryl®), dihydroergotamine (DHE), steroids, and/or IV fluids.
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, Aleve, Bayer Aspirin, 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), 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. Botox can be combined with many other types of treatment.
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). It can be taken prior to acute migraine medications to increase medication absorption and to decrease nausea and vomiting from migraine.
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 helps relieve congestion, improve drainage of mucus, and improve 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.
ProchlorperazineBuccastem, Compazine, Phenotil, Stemzine, StemetilAntiemetic & 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.
PsilocybinN/APsychedelicsTBDOralPreventivePsilocybin 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. It is in clinical trials and not yet medically available.
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, Onzetra XSail, Sumavel DosePro, Tosymra, Treximet, Zembrace SymtouchSerotonin 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.
TimololBetimol, Betrim, Blocadren, 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.Timolol 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) deviceeNeura SAVI Dual™NeuromodulationXDeviceAcute & PreventiveTMS uses magnets to emit a single pulse of electricity. This pulse has been shown to treat cortical spreading depression (CSD), which is the phsyical 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 SAVI DualTM (previously known as eNeura's sTMS device) 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)Small 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 AcidDepacon, Depakene, Stavzor, Valproate Sodium AnticonvulsantXIV, 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, OralAcuteZavegepant (formerly vazegepant) is a gepant currently in development for the treatment of migraine. As of March 2023, Zavegepant, as a nasal spray, is awaiting FDA approval for the acute treatment of migraine. It would provide possible relief in as little as 15 minutes, for up to 48 hours. If approved, it will be the only CGRP medication offered as a nasal spray. In September 2020, zavegepant received the go-ahead from FDA for clinical trials on oral formulations.
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, Sanval, Stilnox, Zonadin, 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.