Medical Migraine Treatments

Medical Migraine Treatments

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

How to use this reference:

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

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

Generic Name (Active Ingredient List)Brand NamesDrug ClassPrescription?FormatPreventative or Acute TreatmentDescription
Acetaminophen or ParacetamolPanadol, TylenolAnalgesic (painkiller)NoTablets, CapsulesAcuteAcetaminophen is the same as Paracetamol. Your location will determine whether you refer to this treatment as one or the other. Acetaminophen is a pain reliever and a fever reducer. The exact mechanism of action is not known.

Acetaminophen is used to treat many conditions such as headache, muscle aches, arthritis, backache, toothaches, colds and fevers. It relieves pain in mild arthritis but has no effect on the underlying inflammation and swelling of the joint.
Acetaminophen, butalbital, caffeineAlagesic, Anolor 300, Dolgic LQ, Dolgic Plus, Esgic, Fioricet, Geone, Margesic, Medigesic, Orbivan, Repan, ZebutalBarbiturateYesTabletsAcuteAcetaminophen is a pain reliever and fever reducer. Butalbital is in a group of drugs called barbiturates. It relaxes muscle contractions involved in a tension headache. Caffeine is a central nervous system stimulant. It relaxes muscle contractions in blood vessels to improve blood flow.

Fioricet is used to treat tension headaches that are caused by muscle contractions. Fioricet contains a combination of acetaminophen, butalbital and caffeine.
Acetaminophen, CodeineTylenol 3 or 4NarcoticYesTabletsAcuteAcetaminophen/codeine is a narcotic and analgesic/antipyretic combination. It works in the brain and nervous system to decrease pain.

It helps to relieve mild to moderately severe pain.
Acetaminophen, dichloralphenazone & isomethepteneDuradrin, MidrinAnalgesic (painkiller)YesCapsulesAcuteAcetaminophen, dichloralphenazone, 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 certain types of headaches (tension, vascular). It may also be used to treat migraine headaches. It may also be used for other conditions as determined by your doctor.
AgomelatineValdoxanAnti-depressantYesTabletsPreventativeAgomelatine 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. Agomelatine is the only antidepressant that acts on melatonin receptors.
AlmotriptanAxert, AlmogranSerotonin (5-HT1) agonists or
‘Triptans’
YesTabletsAcuteAlmotriptan is a 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 in the brain and thereby reducing pressure and pain in the brain. A migraine headache is thought to be hyper sensitive to widened blood vessels exerting pressure on the brain.
AlprazolamNiravam, XanaxBenzodiazepinesYesTabletsPreventativeAlprazolam 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.
Amidrine-Isometheptene, Dichloralphenazone, AcetaminophenDiacetazone, Duradrin, Epidrin, Iso-Acetazone, Midrin, Migquin, Migratine, Migrazone, Migrin-A, Nodolor, Va-ZoneOther-painkillerYesCapsulesAcuteIsometheptene, dichloralphenazone, and acetaminophen is a combination used to treat certain kinds of headaches, such as tension headaches and migraine headaches. This combination is not used to prevent headaches. It should be taken only after headache pain begins, or after a warning sign that a migraine is coming.

Isometheptene helps to relieve throbbing headaches, but it is not an ordinary pain reliever. Dichloralphenazone helps you to relax, and acetaminophen relieves pain.
AmitriptylineElavil, EndepAnti-depressantYesTabletsPreventativeAmitriptyline is a tricyclic antidepressant. It affects chemicals in the brain that may become unbalanced.

Amitriptyline is used to treat symptoms of depression.
AsenapineSaphrisOther-schizophrenic & bi-polarYesTabletsPreventativeTreats 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 & Combination AspirinsAsproClear, Arthritis Pain, Ascriptin Enteric, Aspir 81, Aspir-Low, Bayer Aspirin, Bayer Children’s Aspirin, Bufferin, Easprin, Ecotrin, Ecpirin, Excedrin, Fasprin, Halfprin, Miniprin, St. JosephAsproClear, Arthritis Pain, Ascriptin Enteric, Aspir 81, Aspir-Low, Bayer Aspirin, Bayer Children’s Aspirin, Bufferin, Easprin, Ecotrin, Ecpirin, Excedrin, Fasprin, Halfprin, Miniprin, St. Joseph Aspirin
Ecotrin, Ecpirin,Excedrin, Fasprin, Halfprin, Miniprin,
St. Joseph Aspirin
Non-steroidal anti-inflammatory drugs
(NSAIDs)
NoTabletsAcuteAspirin works by reducing substances in the body that cause pain, fever and inflammation.

Aspirin is used to treat pain and reduce fever or inflammation. It is sometimes used to treat or prevent heart attacks, strokes, and chest pain (angina). Aspirin should be used for cardiovascular conditions only under the supervision of a doctor.

Some, like Excedrin, also contain Acetaminophen and Caffeine. Check the label to be sure.
Aspirin, Caffeine, OrphenadrineNorgesicNSAID-
combination
YesTabletsAcuteOrphenadrine, Aspirin, Caffeine is a muscle relaxant and stimulant combination. It works by decreasing pain and inflammation, which helps muscles to relax.

It relieves mild to moderate pain from certain muscle problems.
Aspirin, CodeineAspalgin, Disprin ForteAnalgesic (painkiller)YesTablets,
Capsules
AcuteAspirin 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.
Aspirin, Sodium Bicarbonate, Citric AcidArthritis Pain, Ascriptin Enteric, Aspir 81, Aspir-Low, Bayer Aspirin, Bayer Children’s Aspirin, Bufferin, Easprin, Ecotrin, Ecpirin, Fasprin, Halfprin, Miniprin, St. Joseph AspirinNSAID-
combination
NoTabletAcuteAspirin, sodium bicarbonate and citric acid combination is used to relieve pain occurring together with heartburn, sour stomach or acid indigestion.

The aspirin in this combination is the pain reliever. Aspirin belongs to the group of medicines known as salicylates and to the group of medicines known as anti-inflammatory analgesics. The sodium bicarbonate is an antacid. It neutralizes stomach acid by combining with it to form a new substance that is not an acid.

Aspirin, sodium bicarbonate and citric acid combination may also be used to lessen the chance of heart attack, stroke or other problems that may occur when a blood vessel is blocked by blood clots. Aspirin, sodium bicarbonate and citric acid can help prevent dangerous blood clots from forming. However, this effect of aspirin may increase the chance of serious bleeding in some people.
AtenololTenorminBeta-blockerYesTabletsPreventativeAtenolol is in 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 (high blood pressure). It may also be used to treat or prevent heart attack.
BaclofenLioresal, GablofenMuscle RelaxantYesTabletsAcuteBaclofen 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/ BarbitoneVeronal, MedinalBarbiturateYesCapsule, CachetsPreventativeAs barbital is a controlled substance, other substances have largely replaced barbital-based buffers. Barbitone was considered to be a great improvement over the existing hypnotics. It was used as a sleeping aid (hypnotic) from 1903 until the mid-1950s.
BudesonideEntocort, Pulmicort, Rhinocort AquaSteroidYesCapsule,
Intranasal
PreventativeBudesonide is a steroid that reduces inflammation in the body.

Budesonide is primarily used to treat mild to moderate Crohn's disease.
BuprenorphineBuprenex, TemgesicNarcoticYesInjection
/ Tablets
AcuteBuprenorphine is a narcotic analgesic. It works by working in the brain and nervous system to decrease pain. It can help relieve moderate to severe pain.
CandesartanBlopress, Atacand, Amias, RatacandHypertensionYesTabletsPreventativeCandesartan is an angiotensin II receptor blocker (ARB). It works by relaxing blood vessels. This helps to lower blood pressure.

It 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.
CarbamazepineCarbatrol, Epitol, Equetro, TEGretol, TEGretol XRAnti-convulsantYesTabletsPreventativeCarbamazepine is an anticonvulsant. It works by decreasing nerve impulses that cause seizures and pain.

It is used to treat seizures and nerve pain such as trigeminal neuralgia and diabetic neuropathy. It is also used to treat bipolar disorder.
CarvedilolCoregBeta-blockerYesTabletsPreventativeCarvedilol is a beta-blocker. Beta-blockers affect the heart and blood circulation.

Carvedilol is used to treat heart failure and hypertension (high blood pressure). It is also used after a heart attack that has compromised your heart’s ability to function effectively.
CelecoxibCelebrexNon-steroidal anti-inflammatory drugs (NSAIDs)YesTabletsAcuteCelecoxib is a nonsteroidal anti-inflammatory drug (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.
CetirizineZyrtecAnti-histamineNoTabletsAcuteCetirizine is an antihistamine that reduces the natural chemical histamine in the body. Histamine can produce symptoms of sneezing, itching, watery eyes and runny nose. It is used to treat cold or allergy symptoms such as sneezing, itching, watery eyes or runny nose.

Cetirizine is also used to treat itching and swelling caused by hives.
ChlorpromazineLargactil, ThorazineOther-schizophrenic & bi-polarYesCapsule, tablet, injection, suppositoryPreventativeChlorpromazine 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 behavioural and conduct disorders in children, nausea and vomiting and severe hiccups. It is also used with other medicines to treat symptoms associated with tetanus.
ClonidineCatapres, Dixarit, KapvayHypertensionYesTabletsPreventativeClonidine 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 (high blood pressure). The Kapvay brand of clonidine is used to treat attention deficit hyperactivity disorder (ADHD).
CodeineMigraleveNarcoticYesCapsule, tablet, rectal supposito
ry
AcuteClonidine 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 (high blood pressure). The Kapvay brand of clonidine is used to treat attention deficit hyperactivity disorder (ADHD).
CPAP MachineRESmart, ResMed Philips, Fisher & Paykeln/aYesDevicePreventativeContinuous 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 relaxantYesTabletsAcuteCyproheptadine is an antihistamine. It works by blocking the action of histamine to reduce allergy symptoms.

It 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.
CyproheptadinePeriactinAnti-histamineYesTabletsPreventativeCyproheptadine is an antihistamine. It works by blocking the action of histamine to reduce allergy symptoms.

It 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, PristiqAnti-depressantYesTabletsPreventativeDesvenlafaxine is an oral drug that is used for treating depression. It is in a 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 benzodiazepineYesTablets, injection, suppositoryAcuteDiazepam is a benzodiazepine. It affects chemicals in the brain that may become unbalanced and cause anxiety.

Diazepam is used to treat anxiety disorders, alcohol withdrawal symptoms or muscle spasms. Diazepam is sometimes used with other medications to treat seizures.
DiclofenacCambia, Cataflam, Voltaren-XR, Zipsor, Zorvolex, VoltarenNon-steroidal anti-inflammatory drugs (NSAIDs)NoTablets, injection, gel, suppositoryAcuteDiclofenac is a nonsteroidal anti-inflammatory drug (NSAID). This medicine works by reducing substances in the body that cause pain and inflammation.

Diclofenac 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 a migraine headache attack. Cambia will only treat a headache that has already begun. It will not prevent headaches or reduce the number of attacks.
Dihydroergotamine MesylateDihydergot, DHE 45, MigranalErgot Alkaloid-derivativeYesInjection, Nasal SprayAcuteIt is used to treat acute migraine headache with or without aura and cluster headaches.

Dihydroergotamine is an ergot derivative. It works by constricting blood vessels in the brain, which helps to relieve migraine headaches.
DiltiazemCardizem, Cartia XT, Dilacor XR, Dilt-CD, Dilt-XR, Diltia XT, Diltiazem Hydrochloride CD, Diltiazem, Diltzac, Flunarizine,Taztia XT, Tiazac, Cardizem Monovial, Matzim LACalcium channel blockersYesTabletsPreventativeDiltiazem is in 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 (high blood pressure), angina (chest pain) and certain heart rhythm disorders.
Divalproex sodiumDepakote, Depakote ER, Depakote SprinklesAnti-convulsantYesTabletsPreventativeDivalproex sodium affects chemicals in the body that may be involved in causing seizures.

Divalproex sodium 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 (manic depression) and to prevent migraine headaches.
DomperidoneMolax, Motilium, Motinorm Costi, NomitAnti-emetic (anti-nausea)YesTablets, injection, suppositoryPreventativeAnti-emetics help relieve the nausea associated with migraine attacks. Domperidone helps increase the transit of food through the stomach which helps facilitate its anti-nausea properties.
Dosulepin / DothiepinProthiaden, Dothep, Thaden, DopressAnti-depressantYesTabletsPreventativeThis is a tricyclic antidepressant. They are named after their chemical structure, which contains three rings of atoms. They are prescribed typically for antidepressant disorders. Today they have largely been replaced in clinical use by newer antidepressants such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs) and norepinephrine reuptake inhibitors (NRIs).
DoxylamineRestavit, DozileAnti-histamineNoTabletsAcuteDoxylamine is an antihistamine. It works by depressing the central nervous system to produce drowsiness.

It is used to treat occasional sleeplessness and reducing difficulty falling asleep.
Doxylamine, Paracetamol, CodeineMersyndolAnti-histamineNoTabletsAcuteHelps produce drowsiness with two active painkiller ingredients. See Codeine & Paracetamol.
DuloxetineCymbaltaAnti-depressantYesTabletsPreventativeDuloxetine 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.
EletriptanReplaxSerotonin (5-HT1) agonists or
‘Triptans’
YesTabletsAcuteEletriptan is a second-generation triptan drug intended for the treatment of migraine headaches. It is used as an abortive treatment to help block a migraine attack, which is already in progress.
Ergotamine tartrateCafergot, Ergomar, MigrilErgot Alkaloid-derivativeYesTablets, SuppositoriesAcuteErgotamine is an ergot derivative. It works by narrowing blood vessels in the brain, which helps to relieve migraine headaches. Some brands, like Cafergot, also contain caffeine.
EscitalopramLexaproAnti-depressantYesTabletsPreventativeEscitalopram is a selective serotonin reuptake inhibitor (SSRI). It works by restoring the balance of serotonin, a natural substance in the brain, which helps to improve certain mood problems. It is used to treat depression or generalized anxiety disorder.
Eye Drops – Dry EyesArtificial Tears, Cyclosporine, RestasisImmuno-suppressantNo/ YesEye DropsPreventativeBecause dry eye symptoms are prevalent in people with migraines, doctors may prescribe artificial tears. Non-prescription eye drops contain preservatives, while prescription formulas like cyclosporine/Restasis do not. Both decrease inflammation that can cause dry eyes and can cause discomfort for people with migraine.
Eye Drops – GlaucomaTimolol, LevobunololBeta-BlockersYesEye DropsAcute / PreventativeBeta-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.
FludrocortisoneFlorinef AcetateOther-corticosteriodYesTabletsPreventativeFludrocortisone is a corticosteroid, which is a steroid hormone. 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 disease and for treating salt-losing adrenogenital syndrome.
FlunarizineSibeliumCalcium channel blockersYesTablets,
Capsules
PreventativeFlunarizine is in 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, SarafemAnti-depressantYesCapsulesPreventativeFluoxetine is a selective serotonin reuptake inhibitors (SSRI) antidepressant. Fluoxetine affects chemicals in the brain that may become unbalanced and cause depression, panic, anxiety or obsessive-compulsive symptoms.

Fluoxetine is used to treat major depressive disorder, bulimia nervosa (an eating disorder) obsessive-compulsive disorder, panic disorder and premenstrual dysphoric disorder (PMDD).

Fluoxetine is sometimes used together with another medication called olanzapine (Zyprexa) to treat depression caused by bipolar disorder (manic depression). This combination is also used to treat depression after at least 2 other medications have been tried without successful treatment of symptoms.
FluvoxamineLuvoxAnti-depressantYesTabletsPreventativeFluvoxamine 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). It may also be used for other conditions as determined by your doctor.
FrovatriptanFrova, MigardSerotonin (5-HT1) agonists or
‘Triptans’
YesTabletsAcuteFrovatriptan is a serotonin 5-HT1 receptor agonist, also known as a ‘triptan’. It works by narrowing the blood vessels in the brain, which helps to relieve migraines. It is used to treat acute migraine headache with or without aura in adults. It should not be used as a migraine preventative.
GabapentinGralise, Horizant, Neurontin, GabaroneAnti-convulsantYesTablets,
Capsules
PreventativeGabapentin is an antiepileptic or 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.
Greater Occipital Nerve BlockSteriod/ LidocaineOther-steriod & anaestheticYesInjectionPreventativeThe occipital nerves are the two pairs of nerves that originate in the area of the second and third vertebrae of the neck. The greater occipital nerve (GON) is located just beneath the scalp in the back of the head over the occipital lobe of the brain. This region of the brain deals with vision including color recognition, spatial awareness and word recognition.

Most people who experience migraine and headache syndrome on a regular basis also have tenderness in the sub-occipital region of their skulls. The objective of a GON block is to block the pain messages sent to the brain along the GON.

In cases where migraine is resistant to medication or where treatment is hindered by adverse effects, a GON block may be explored.
Hormone Replacement Therapy/Contraceptive pills-Other-hormonesYesTabletsPreventativeHormone replacement therapy (HRT) refers to any form of hormone therapy wherein the patient, in the course of medical treatment, receives hormones, either to supplement a lack of naturally occurring hormones, or to substitute other hormones for naturally occurring hormones.

Hormone replacement therapy for menopause is based on the idea that the treatment may prevent discomfort caused by diminished circulating estrogen and progesterone hormones, or in the case of the surgically or prematurely menopausal, that it may prolong life and may reduce incidence of dementia. It involves the use of one or more of a group of medications designed to artificially boost hormone levels. The main types of hormones involved are estrogens, progesterone or progestins, and sometimes testosterone. It often referred to as "treatment" rather than therapy.

For pre-menopausal use, Contraceptive Pills containing hormones may be used to skip periods (and often, Menstrual Migraines) if your physician believes this will benefit the patient.
HydrocodoneHysingla ER, Zohydro ERNarcoticYesTablets, Suppository, IntranasalAcuteHydrocodone is an opioid pain medication. An opioid is also referred to as a narcotic.

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.
HydromorphoneDilaudid-HP, JurnistaNarcoticYesTabletsAcuteHydromorphone is an opioid (narcotic) analgesic. It works in the brain and nervous system to reduce pain.

It is used to treat moderate to severe pain in narcotic-tolerant patients who require larger than usual doses to provide adequate pain relief.
HydroxyzineAtarax, Alamon, Aterax, Durrax, Equipose, Masmoran Vistaril, Vistaril IM, Hyzine, Vistaject-50, Rezine, Tran-Q, Orgatrax,
Quiess, Tranquizine,
Anti-histamineYesTablets, Capsules InjectionAcuteHydroxyzine reduces activity in the central nervous system. It also acts as an antihistamine that reduces the 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 together with other medications given for anaesthesia. Hydroxyzine may also be used to control nausea and vomiting.

Hydroxyzine is also used to treat allergic skin reactions such as hives or contact dermatitis.
IbuprofenAdvil, Genpril, IBU, Midol, Motrin,Non-steroidal anti-inflammatory drugs (NSAIDs)
inflammatory
NoTablets, Suppository, Injection, Topical
Suppository,
AcuteIbuprofen is a nonsteroidal anti-inflammatory drug (NSAID). It works by reducing hormones that cause inflammation and pain in the body.

Ibuprofen is used to reduce fever and treat pain or inflammation caused by many conditions such as headache, toothache, back pain, arthritis, menstrual cramps, or minor injury.
Ibuprofen, CodeineProVen Plus, Rafen Plus, Panafen Plus, Nurofen PlusNon-steroidal anti-inflammatory drugs (NSAIDs)NoTabletsAcuteIn this combination formula Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), is combined with Codeine to reduce pain and inflammation. See Ibuprofen and Codeine for their separate descriptions.
IndomethacinIndocin, IndocidNon-steroidal anti-inflammatory drugs (NSAIDs)YesCapsules Suppository, Injection, TopicalAcuteIt is used to treat patent ductus arteriosus (PDA) in certain premature infants.

Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID). It is thought to work by blocking the action of a certain chemical in the body called prostaglandin.
IrbesartanAbisart, AvaproBlood pressureYesTabletsPreventativeIrbesartan is an angiotensin II receptor blocker (ARB). It works by relaxing blood vessels. This helps to lower blood pressure. It is used to treat high blood pressure alone or with other medicines. It is also used in certain patients to treat kidney problems caused by diabetes (diabetic nephropathy).
Isometheptene mucateMidrin, DuradrinOtherNoCapsulesAcuteIsometheptene 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 headaches. It is often used in combination with active ingredients. The British National Formulary state that as more effective preparations are now available, this is not widely used.
KetamineKetalarAnestheticYesInjection, 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, OruvailNon-steroidal anti-inflammatory drugs (NSAIDs)YesCapsules Injection, 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.

It is used to treat rheumatoid arthritis or osteoarthritis. It is also used to treat menstrual cramps and pain. It may also be used for other conditions as determined by your doctor.
KetorolacToradolanti-
inflammatory
YesTablets,
Injection,
AcuteKetorolac is an NSAID. Ketorolac is indicated for short-term management of moderate to severe pain. Concerns about the high incidence of reported side effects led to restriction in its dosage and maximum duration of use. In the UK, treatment should be initiated only in a hospital. Maximum duration of treatment should not exceed five days for tablets (per package insert), or two days for continuous daily dosing with intravenous or intramuscular formulations. May be used intravenously in hospital or emergency settings.

It is used in the short-term (up to 5 days) treatment of moderately severe pain (usually after surgery), alone or in combination with other medicines.
LamotrigineLamictalAnti-convulsantYesTabletsPreventativeLamotrigine is an anticonvulsant. Exactly how it works is not known. It is used to treat certain types of seizures. It may be used alone or with other medicines. It may also be used to delay the occurrence of mood problems in certain patients with bipolar
disorder.
LevetiracetamKeppraAnti-convulsantYesTabletsPreventativeLevetiracetam is an anticonvulsant. Exactly how it works is not known, but it may work by slowing abnormal nerve impulses in the brain.

It is used to treat partial-onset, myoclonic or seizures in patients with epilepsy. It may be used in combination with other medicines.
LoratadineAlavert, Alavert Allergy, Claritin, lear-Atadine, Clear-Atadine Children's, Dimetapp ND, Loratadine Reditab, Tavist ND, Wal-itinAnti-histamineNoTabletsAcuteLoratadine 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.
Marijuana/ Medicinal Cannabis-Other-YesTea, Edibles, Capsule OilsAcuteThe use of medical marijuana for the management of chemotherapy-induced nausea, glaucoma, spasticity in multiple sclerosis and neuropathic pain has been clinically demonstrated to some extent. The likelihood of undesirable adverse reactions limits its applications, and therapeutic use may be limited to either concomitant therapy or when conventional therapy has failed.
Mefenamic acidPonstan, PonstelNon-steroidal anti-inflammatory drugs (NSAIDs)NoCapsulesAcuteMefenamic 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.

It is used for menstrual pain. It may be used for short term (not more than 7 days) treatment of mild to moderate pain.
MeloxicamMobic, MovalisNon-steroidal anti-inflammatory drugs (NSAIDs)YesTabletsAcuteMeloxicam (Mobic) is a nonsteroidal anti-inflammatory drug (NSAID). It 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 agentYesTabletsPreventativeMemantine 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.
MeperidineDemerolNarcoticYesTablets,
Injection
AcuteMeperidine is a narcotic analgesic. It works in the brain and nervous system to decrease pain.

It is used as a 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.
Methocarbamol, AcetaminophenRobaxin, RobaxacetMuscle relaxantNoTablets,
Injection
AcuteMethocarbamol is a central muscle relaxant used to treat skeletal muscle spasms.
Methyl SalicylateMenthoderm, Thera-Gesic Plus, Salonpas Pain PatchOther-topical rubefacientNoTopicalAcuteMethyl salicylate/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 the temporary relief of minor aches and pains caused by arthritis, simple backache, strains, sprains and bruises.
MethysergideDeseril, SansertAnti-serotonergic (Anti 5-HT)YesTabletsPreventativeThe 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, which 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 the potential side effects (retroperitoneal fibrosis and fibrosis of heart values and pleura).
MetoclopramideMaxolon, Metozolv ODT, Pramin, ReglanAnti-emetic (anti-nausea)YesTablets,
Injection
AcuteMetoclopramide increases muscle contractions in the upper digestive tract. This speeds up the rate at which the stomach empties into the intestines.

Metoclopramide is used short-term to treat heartburn caused by gastroesophageal reflux in people who have used other medications without relief of symptoms.

Metoclopramide is also used to treat slow gastric emptying in people with diabetes (also called diabetic gastro paresis) which can cause nausea, vomiting, heartburn, loss of appetite and a feeling of fullness after meals.
Metoclopramide, ParacetamolAnagrain, Metomax, ParamaxOther-combination analgesic & anti-emetic (anti-nausea)NoTabletsAcuteThe combination is used to treat the symptoms of migraine, both to relieve headache (the Paracetamol) and to treat associated nausea and vomiting (the anti-emetic). In addition to its direct anti-emetic effect metoclopramide also stimulates gastric emptying (prokinetic), which is often delayed during migraine attacks, and accelerates the absorption of paracetamol.
MetoprololDutoprol, Betaloc, LopressorBeta-blockerYesTabletsPreventativeMetoprolol is a beta-blocker that affects the heart and circulation.

Metoprolol is used to treat angina (chest pain) and hypertension (high blood pressure). It is also used to treat or prevent heart attack.
MirtazapineRemeronAnti-depressantYesTabletsPreventativeMirtazapine 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, NasonexSteroidNoTopical,
Intranasal
AcuteMometasone cream is a topical corticosteroid (a steroid hormone). It 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).

Mometasone spray is a corticosteroid. It works by reducing inflammatory reactions in the nasal airway in response to allergens and irritants in the air. Treating itching, redness and swelling of many skin conditions.
MorphineAVINza, Kadian, MS ContinNarcoticYesTablets, Injection, Suppository, InhalationAcuteMorphine is an opioid or narcotic 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. This form of morphine is not for use on an as-needed basis for pain.
MoxonidinePhysiotensHypertensionYesTabletsPreventativeMonoxidine 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-blockerYesTabletsPreventativeNadolol 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.

It 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, Anaprox-DS, EC-Naprosyn, Leader Naproxen Sodium, Midol Extended Relief, Naprelan 375, Naprosyn, SynflexNon-steroidal anti-inflammatory drugs (NSAIDs)NoTabletsAcuteNaproxen is a nonsteroidal anti-inflammatory drug (NSAID). It 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.

It is the preferred NSAID for long-term use in people with a high risk of cardiovascular (for example, heart attacks or strokes) complications, due to its relatively low risk of causing such complications.
NaratriptanAmerge, NaramigSerotonin (5-HT1) agonists or
‘Triptans’
YesTabletsAcuteNaratriptan 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 headaches.
NimodipineNimotopCalcium channel blockersYesCapsules InjectionPreventativeNimotop is a calcium channel-blocking agent. Exactly how Nimotop 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, Arem, Insoma, Insomin, Mogadon, Nitrados, Nitrazadon, Nitrosun, Ormodon, Paxadorm, Remnos,
Somnite
HypnoticYesTabletsAcuteNitrazepam 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.
NortriptylineAllegron, PamelorAnti-depressantYesCapsulePreventativeNortriptyline 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.
Onabotulinumtoxin ABOTOXMuscle relaxantYesInjectionPreventativeOnabotulinumtoxinA (Botox), also called botulinum toxin type A, is made from the bacteria that causes botulism. Botulinum toxin blocks nerve activity in the muscles, causing a temporary reduction in muscle activity.

Botox can be used to prevent chronic migraine headaches in adults who have migraines for more than 15 days per month, each lasting 4 hours or longer. Botox should not be used to treat a common tension headache.

In the doctor’s office, multiple Botox injections are inserted into the muscles of the forehead and neck and treatment is repeated every 12 weeks if successful. However, there are maximum dose limits to be aware of when using Botox. Botox is also used for other conditions and cosmetic purposes such as to smooth wrinkles or for an overactive bladder.
OndansetronZofran, Zofran ODT, ZuplenzAnti-emetic (anti-nausea)YesTablets,
Injection
AcuteOndansetron 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).

Ondansetron is not for preventing nausea or vomiting that is caused by factors other than cancer treatment or surgery.
OxycodoneEndone, Oxecta, OxyCONTIN,
Oxyfast, Roxicodone
NarcoticYesTablets, Injection, suppositoryAcuteOxycodone is an opioid/ narcotic pain medication. It is used to treat moderate to severe pain.
Oxygen--Inhalant / DeviceYes/ NoCannula / MaskAcute / PreventionDecreased oxygen levels and restricted blood flow to the brain are two conditions often identified by medical researchers as factors in migraine attacks. It has been shown that oxygen causes a marked decrease in cerebral blood flow that is coincident with the reduced degree of pain in cluster headache.

There are two high-flow oxygen delivery methods for migraines:

• Normobaric (NBOT) – Oxygen delivered from a portable tank using a face mask or nasal cannula. It typically requires a prescription.

• Hyperbaric (HBOT) – Immersive, enclosed chamber where 100 percent oxygen flows – no mask or cannula. It does not require a prescription.

Hyperbaric wasn’t shown to be as effective for migraine as it was for cluster headache relief. Normobaric offered relief to 3/4 of the migraine patients to whom it was administered.
Oxymetazoline nasalAllerest, Afrin, Mucinex, Nostrilla, SinexDecongestantNoIntranasal SprayAcuteRelieving nasal congestion due to the common cold, hay fever, other upper respiratory tract allergies, or sinus infection. It may also be used to treat other conditions as determined by your doctor.

Oxymetazoline solution is a decongestant. It works by shrinking swollen and congested nasal tissues (mucous membranes) by constricting blood vessels. This results in relief of congestion, improved drainage of mucus, and improved breathing through the nose. Local application using nose drops or sprays causes more intense and rapid vasoconstriction than oral medicines such as tablets or syrups.
PFO Valve Closure--ProcedureYes--PreventativeMultiple 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.
PantoprazoleProtonix, Protonix IV, SomacProton pump inhibitorsYesTablets,
Injection
AcutePantoprazole is a proton pump inhibitor that decreases the amount of acid produced in the stomach.

Pantoprazole is used to treat erosive esophagitis (damage to the esophagus from stomach acid), and other conditions involving excess stomach acid such as Zollinger-Ellison syndrome.

Pantoprazole is not for immediate relief of heartburn symptoms.
Paracetamol, CodeineParacodolNarcoticYesTabletsAcuteThis treatment contains the active ingredients paracetamol and codeine phosphate. It is used for the relief of moderate to
severe pain when milder painkillers are not effective. Paracetamol belongs to a group of medicines called analgesics (painkillers). Analgesics are used to block pain. It is also an antipyretic, which means that it helps reduce your body temperature if you have a fever.

Codeine phosphate also belongs to the group of medicines called analgesics and it acts by blocking pain and your emotional response to pain. See Codeine for more detail.
Paracetamol, IbuprofenMaxigesicCombination-Analegsic & NSAIDNoTabletsAcuteFor the temporary relief of mild to moderate pain associated with migraine, headache, backache, period 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.
Phenylephrine hydrochloride, IbuprofenSudafed PECombination-Decongestant & NSAIDNoTabletsAcuteContains 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.

Ibuprofen belongs to a group of medicines known as non-steroidal anti-inflammatory drugs (NSAIDs) and is effective against aches and pains (including headache), swelling and can also reduce a fever.

Phenylephrine hydrochloride (nasal decongestant) reduces swelling in the passages of the nose, relieving nasal congestion and reducing the pressure, which may cause a headache.
Phenylephrine hydrochloride, ParacetamolDimetapp PE Sinus Pain, Lemsip Cold & Flu, Panadol Cold & Flu, SudafedCombination-Decongestant & AnalgesicNoTabletsAcuteContains a decongestant & analgesic (Paracetamol), which can help ease symptoms such as blocked or runny nose, sore throat and body aches and headaches.
PizotifenSandomigranAnti-serotonergic (Anti 5-HT)YesTabletsAcuteSerotonin (5-HT) is a chemical occurring in the body, which is thought to play a key role in migraine. These drugs block 5-HT2 receptors to inhibit the effects of 5-HT. Pizotifen also has anti-histamine properties and is related to the tricyclic antidepressants.
PrednisoneRayos, SterapredSteriodYesTablets, Injection, suppository, NasalAcutePrednisone is a corticosteroid. It prevents the release of substances in the body that cause inflammation. It also suppresses the immune system.

Prednisone 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 or breathing disorders.
PregabalinLyricaAnti-convulsantYesCapsulesPreventativePregabalin 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.

It 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.
ProchlorperazineCompazine, Stemzine, Buccastem, Stemetil, PhenotilAnti-emetic (anti-nausea) & Anti-psychoticYesTablets, Injection, 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 treating schizophrenia. It is also used to treat migraine headaches. Intravenous administration can be used to treat status migrainosus.
PromethazinePhenergan, Promethegan, Romergan, Fargan, Farganesse, Fenazin, Prothiazine, Avomine, Atosil, Receptozine, Lergigan,
Pipolphen, Sominex
Anti-histamine & Anti-emetic (anti-nausea)YesTablets, Injection, 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-blockerYesTablets, Injection, suppositoryPreventativePropranolol is a beta-blocker. Beta-blockers affect the heart and blood circulation.
Propranolol is used to treat tremors, angina (chest pain), hypertension (high blood pressure), 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 headaches.
PseudoephedrineContac Cold, Drixoral Decongestant Non-Drowsy, Elixsure Decongestant, Entex, Genaphed, Kid Kare Drops, Nasofed, Seudotabs, Silfedrine, Sudafed, Sudodrin, SudoGest, Suphedrin, Triaminic Softchews Allergy Congestion, UnifedDescongestantNoTablets,
Capsules
AcutePseudoephedrine 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-psychoticYesTabletsPreventativeQuetiapine 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.
RizatriptanMaxaltSerotonin (5-HT1) agonists or
‘Triptans’
YesTablets, Sub-lingualAcuteRizatriptan is a serotonin 5-HT1 receptor agonist or "triptan". It works by narrowing dilated blood vessels in the brain, relieving migraine headaches. It is used to treat migraine headaches with or without aura. It should not be used to prevent migraines or to treat cluster headaches.
SertralineZoloftAnti-depressantYesTabletsPreventativeSertraline is an antidepressant in a group of drugs called selective serotonin reuptake inhibitors (SSRIs). Sertraline affects chemicals in the brain that may become unbalanced and cause depression, panic, anxiety or obsessive-compulsive symptoms.

Sertraline is used to treat depression, obsessive-compulsive disorder, panic disorder, anxiety disorders, post-traumatic stress disorder (PTSD) and premenstrual dysphoric disorder (PMDD).
Sphenopalatine Ganglion (SPG) DeviceSphenocath, Allevio, and Tx360Neuromod-ulationYesDevicePreventativeThe 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, this 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.
Sodium ValproateEpilimAnti-convulsantYesTablets, Capsules InjectionPreventativeValproate is an anticonvulsant. It works by increasing a certain chemical in the brain. It is used to control certain types of seizures in the treatment of epilepsy in patients who are unable to take the oral form of valproate.
SumatriptanImigran, Imitrex, Treximet, Zembrace Symtouch,
Onzetra XSail, Sumavel DosePro,
Serotonin (5-HT1) agonists or
‘Triptans’
YesTablets, Injection, Needle-less Injection, Nasal SprayAcuteSumatriptan is a serotonin 5-HT1 receptor agonist ("triptan"). It works by narrowing blood vessels in the brain, which helps to relieve migraine and cluster headaches.

Sumatriptan is used to treat migraine headaches with or without aura. It is one of the most common treatments with numerous high quality studies demonstrating it’s scientific efficacy for the treatment of acute migraine. It is also used to treat cluster headaches.

The Treximet brand is a combination of Sumatriptan and Naproxyn Sodium, both of which are available as generics.
TimololBlocadren, Betimol, Betrim, Istalol, TimopticBeta-blockerYesTablets, Eye DropsPreventativeTimolol is in a group of drugs called beta-blockers. Beta-blockers affect the heart and circulation. It is used to treat hypertension (high blood pressure). Timolol 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 drops are a beta-blocker. It works to decrease fluid production and pressure inside the eye.

(See Eye Drops).
TizanidineZanaflexMuscle relaxantYesTablets, Injection IntranasalAcuteTizanidine is a short-acting muscle relaxer. 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.
TopiramateTopamaxAnti-convulsantYesTabletsPreventativeTopiramate is an anticonvulsant that is also helpful to prevent migraine headaches. It works by affecting several chemicals in the brain that help to reduce seizure activity and prevent migraine headaches from occurring.

It is used to treat seizures in certain patients. It may be used alone or with other medicines.
TramadolConZip, Rybix ODT, Ryzolt, UltramNarcotic-like painkillerYesTablets, Injection, suppositoryAcuteTramadol is a narcotic-like pain reliever. Tramadol is used to treat moderate to severe pain. Tramadol is a centrally acting, oral narcotic-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/ AcetaminophenTramacet, UltracetNarcotic-like & Analgesic (painkiller)YesTablets,
Injection
AcuteThis formulation combines individual ingredients for a stronger effect. See individual active ingredients for mode of action.
Transcranial Magnetic Stimulation (TMS) deviceSpringTMSNeuromod-ulationYesDeviceAcuteTMS uses magnets to emit just a single pulse of electricity. This pulse has been shown to treat cortical spreading depression (CSD), which is the physical change in the brain during aura and migraine.
Research shows that daily use of TMS for 3 months or longer can lead to a reduction in acute medication use.
eNeura’s SpringTMS is a TMS device available via prescription.
Transcutaneous electrical nerve stimulation (TENS) deviceCefalyNeuromod-ulationYesDevicePreventativeTMS uses magnets to emit just a single pulse of electricity. This pulse has been shown to treat cortical spreading depression (CSD), which is the physical change in the brain during aura and migraine.

Research shows that daily use of TMS for 3 months or longer can lead to a reduction in acute medication use.

eNeura’s SpringTMS is a TMS device available via prescription.
Vagus Nerve Stimulation (VNS) deviceGammacoreNeuromod-ulationYesDeviceAcuteThe vagus nerve runs from the brainstem 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.

It stimulates the production of inhibitory neurotransmitters in the brain, including GABA, serotonin and norepinephrine, which affect migraine and cluster headaches. GammaCore, is a handheld VNS device that stimulates the nerves non-invasively when placed above the vagus nerve in the neck.
VenlafaxineEffexorAnti-depressantYesTablets,
Capsules
PreventativeVenlafaxine is an antidepressant in a group of drugs called selective serotonin and norepinephrine reuptake inhibitors (SSNRIs). 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.
VerapamilIsoptin, CalanCalcium channel blockersYesTablets,
Injection
PreventativeVerapamil is a calcium channel blocker. It works by relaxing the muscles of your heart and blood vessels.

Verapamil is used to treat hypertension (high blood pressure), angina (chest pain) and certain heart rhythm disorders.
ZolmitriptanZomigSerotonin (5-HT1) agonists or
‘Triptans’
YesTablets, Nasal SprayAcuteZolmitriptan is a serotonin 5-HT1 receptor agonist or "triptan". It works by narrowing blood vessels in the brain, which helps to relieve migraines. It is used to treat migraine headaches with or without aura in adults. It is not intended to prevent migraines.
ZolpidemAmbien, Edluar, Intermezzo, Stilnox, Zonadin, Sanval, Zolpimist HypnogenHypnoticYesTablets, Suppos-itoryAcuteZolpidem is a sedative, also called a hypnotic. It affects chemicals in your brain that may become unbalanced and cause sleep problems or insomnia.

Zolpidem is used to treat insomnia. The immediate-release forms of zolpidem are Ambien, Intermezzo, Edluar and Zolpimist, which are used to help you fall asleep. The extended-release form of zolpidem is Ambien CR, which has a first layer that dissolves quickly to help you fall asleep, and a second layer that dissolves slowly to help you stay asleep.

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 to sleep if you wake up in the middle of the night and then have trouble sleeping.
ZonisamideZonegranAnti-convulsantYesCapsulesPreventativeZonisamide 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.

Quick Start Guide

Quick Start Guide

Introduction

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

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

Methodology

That’s why we’ve crowd-sourced over 300 medicinal and non-medicinal treatments that migraine patients have self-reported they’re using. Patients just like you. Unless you’ve tried all of these treatments, you haven’t tried everything yet. Several are new in this 2017 edition of the Migraine World Summit Treatment Directory.

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

Organization

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

1) Medicinal; and
2) Non-Medicinal.

1) Medical Treatments

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

For Preventive Treatments, you’ll see Drugs, Devices and Procedures. Most medical devices, such as Cefaly or Gammacore, are developed just for migraine. Preventive procedures are typically performed by a health care professional, such as nerve blocks, Botox or surgery.

However, most preventive medications are NOT developed specifically for migraine. Here, you’ll see more “off-label” drugs than those designed specifically for migraine (although more are in the research pipeline today).

Major classes of off-label preventive drugs you’ll find here:
– Anticonvulsants – Originally designed to prevent seizures, these include topirimate and valporic acid for migraine prevention.
– Antidepressants – Developed as a therapy for depression, amitriptyline and nortriptyline are often prescribed for migraine.
– Beta-Blockers – These are designed to relax the blood vessels, including propranolol and metoprolol, for example.
– Botulinum Toxin – This injectable medication is approved for over a dozen uses from sweaty palms to wrinkle reduction. The FDA has approved it for Chronic Migraine only.
– Calcium Channel blockers – Your doctor may prescribe diltiazem or verapamil for migraine prevention, although they were designed to narrow blood vessels for other conditions.

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

2) Non-Medical Treatments

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

Always check with your doctor if you choose to try something from this Section 2, unless it’s 100% safe – like water, oxygen or lying down. Even things labelled as “Natural” are not always safe.

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

For this reason, it’s wise to discuss everything with your doctor, even if you don’t get a strong endorsement from your health care provider.

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

Non-Medicinal Acute treatments are limited to fewer Products/Devices and Vitamins/Supplement options, but may work for some people at least some of the time. Many people will reach for these at the first sign of an attack before more powerful Medical Acute treatments. Others use them in addition to prescription treatments. The choice is yours.

Tips

If you find yourself taking more Acute medications that you’d like, or running out of medications before you run out of days of the month, it’s a sign that you need a better plan. That plan will likely consist of a more effective Prevention regimen – including some combination of Lifestyle, Natural, Behavioral, Drugs, Devices and Procedures.

If you find yourself going to the Emergency Room frequently because your Acute medication is failing, you also need a stronger plan, including a different mix of Prevention + Acute treatments.

Note some of your alternatives in this guide, and discuss with your personal physician.

How to Use this Treatment Directory

There are a number of ways you can use this Guide to make progress in your Migraine journey.

To discover new options. When you think you’ve tried everything, scrolling through this list may narrow down some new choices to discuss with your doctor during your next appointment. For example, you may discover that you can use a device daily instead of oral medications for prevention. Or that Cognitive Behavioral Therapy is a non-medicinal alternative to drugs. You might even discover treatments that are just as effective with fewer side effects or less expensive than your current treatment.

To find a medical or brand name. When you hear of an unfamiliar treatment from a friend or expert, chances are, it’s in here. In this case, an electronic search using Command-F will help you find it quickly. If it sounds like “numbers” you may find “Namenda,” for example.

To find all medications in a certain class. If you know you’ve taken one triptan that didn’t work and want to try another one, you can simply use Command-F to search for all triptans and find the brand names and formats (e.g. injectable, melting tablets, nasal spray) that may work faster.

To track your history. We strongly encourage you to make notes in this Directory on what you’ve tried and haven’t. It’s invaluable when you switch doctors, appeal insurance claims and are looking for new options. Include the date, duration, doctor, benefits and side effects. Alternately, you can enter this same information in a digital diary. It becomes your checklist of what to try next.

Tips

Change just one thing at a time. That way, you’ll be able to isolate the one variable you’ve changed to know if it’s working. If you start taking five new supplements at one time, you’ll never know which one actually helped.

Give each treatment a good test. For prevention, that generally means at least 60-90 days of use. For acute treatments, that generally means at least 3 attacks, since every attack can be different.

Warning

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

Disclaimers

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

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

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

Treatment Guidelines

2017 Migraine Treatment Guidelines Summary

Introduction

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

Studies are undertaken, some may be clinical research others may be less scientifically robust. The quality of these studies are evaluated into Classes. Appendix A goes into detail of the different classes of studies.

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

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

How to read this report

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

See appendix A for more details on each class criteria.

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

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

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

Important notes

While this list does not exist in any one place, it’s been created just for The Migraine World Summit based on official guidelines published by leading medical societies, including the American Headache Society, the American Academy of Neurology, the European Headache Foundation, the US Headache Consortium and the WHO Lifting the Burden Campaign. Some of these guidelines have also been interpreted in Headache: the Journal of Headache and Facial Pain; and the European Journal of Headache. This summary has not been reviewed by any medical society, and does not constitute medical advice.

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

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

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

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


Preventative treatment of migraine in adults

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

Level A: Established as effective

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

Divalproex/sodium valproate
Metoprolol
Petasites (Butterbur)*
Propranolol
Timolol
Topiramate
Relaxation training
Soduim Valproate
Thermal biofeedback with relaxation training
EMG biofeedback
Cognitive behavioral therapy

Level B: Probably effective

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

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

Level C: Possibly effective

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

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

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

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

Other: treatments that are established as possibly or probably ineffective

This category of treatments should not offered or considered for migraine prevention.
Acebutolol
Clomipramine
Clonazepam
Lamotrigine
Montelukast
Nabumetone
Oxcarbazepine
Telmisartan
Bisoprolol*
Gabapentin*
Leukotriene receptor antagonist


Acute treatment of migraine in adults

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

Level A: Established as effective

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

Level B: Probably effective

Ergotamine/Caffeine
Flurbiprofen
Ketoprofen
Isometheptene
Codeine/Acetaminiphen
Tramadol/acetaminophen

Metamizol (oral and IV)
Phenazon*
Tolfenamic Acid

Level C: Possibly effective

Ergotamine
Phenazone*
Butalbital
Lidocaine intranasal

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

Celexcoxib

Level C Negative

Ketorolac tromethamine nasal spray

*Classification may vary by country


Migraine with Menstruation

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

Level A: Established as effective

Frovatriptan

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

Level B: Probably effective

Naratriptan
Zolmitriptan

Level C: Possibly effective

Estrogen


Children & Adolescents

Acute treatments for children and adolescents with migraine

Level A: Established as effective

Ibuprofen
Sumatriptan Nasal Spray

Level B: Probably effective

Acetaminpohen / Paracetamol

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

Triptans
Sumatriptan injection

Preventive treatments for children and adolescents with migraine

Level B: Probably effective

Flunarizine

Level B: Negative

Pizotifen
Nimopidine
Clonidine

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

Cyproheptadine
Amitryptiline
Divalproex Sodium
Topirimate
Levatiracitam
Propranolol
Trazodone


Emergency Treatment

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

Level B: Probably effective

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

Level C: Possibly effective

Valproate IV
Butophanol IM
Meperidine IM
Methadone IM
Tramadol IV
Dexamethazone IV

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

Lidocaine IV
Hydrocortisone IV
Level B Negative: Medication is probably ineffective.
Octreotide SC

Level C Negative: Medication is possibly ineffective.

Chlorpromazine IM
Granisetron IV
Acetaminophen IV


SOURCES:

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

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

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

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

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

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

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

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

Emergency Guide & Protocol

Emergency Guide & Protocol

Click to View/Download the Emergency Guide & Protocol (PDF)

Introduction

Acute medications that fail … New, strange and scary symptoms … Attacks that last for days and simply won’t stop … there are so many varied reasons that may lead us to seek migraine care in the hospital emergency department.

There’s hardly a less migraine-friendly place, unless it’s a construction site. Bright fluorescent lighting, loud noises, strange smells, uncomfortable seating, and long waits are the norm. It’s an unpleasant environment that is often staffed by skeptical nurses and doctors, trained to screen out drug seekers.

Why do we wind up here? It’s rarely because we’re seeking drugs we’ve never tried before. Many of us deserve a frequent visitor discount card from our local hospitals.

We’re usually here because our Prevention and Acute treatments failed to relieve our symptoms, and we need Rescue-level attention.

“When disaster strikes, the time to prepare has passed.”

Isn’t that the truth? Stephen Cyros, an author who writes about emergency preparedness, might have said this about migraine if he had experienced the pain of the Emergency Department at the local hospital.

What this Emergency Guide & Protocol includes:

  • When to Go to the Emergency Department
  • 3 Step Plan to Avoid Migraine Emergencies
  • What is an Emergency Protocol?
  • Guideline-Recommended Treatment for Migraine Emergencies
  • Your Own Emergency Migraine Treatment Protocol (Template)

What this Emergency Guide & Protocol Does Not Include:

  • Detailed Treatments Used in Emergencies (See our Treatment Directory)

As Dr. Richard Lipton said in his Migraine World Summit interview on this topic, “I do everything I can to keep my patients OUT of the Emergency Room.” Be sure to listen to his entire talk, which is full of insights you can share with your own doctor.

The best way to avoid a painful Emergency Room experience is to develop a strong plan with your doctor that reflects your most common emergency patterns and your entire health history.

Together, you may be able to save yourself another trip to the hospital the next time an emergency arises.


When to Go to the Emergency Department

When you’re in the middle of a migraine attack, it’s not easy to think clearly. So making a decision on whether to seek emergency medical care requires help.

People go to the emergency room for headache for a number of reasons, said Dr. Richard Lipton in his Migraine World Summit talk.

First Syndrome – It’s the first attack of its kind, with new symptoms you’ve never had before. If someone has never had a headache before and they feel overwhelmed in pain with nausea and vomiting, that’s pretty frightening and that’s a good reason to go the emergency department.

Worst Syndrome – It’s the worst attack you’ve ever experienced. The sudden onset of excruciating headache that’s different than prior headaches can be a red flag. That might be a sign of something serious that requires immediate medical attention.

Last Straw Syndrome – When an attack continues day after day without any relief from treatments you’re taking at home, you’ve reached the last straw. It’s no longer tolerable. You need help to break an intractable attack.

Complex Diagnosis – Occasionally, people go to the emergency department when you have an especially complex case, such as cancer or HIV, and a difficult attack occurs with symptoms that could be migraine or could be something else. In this case, expert diagnosis is needed quickly.

All of these are good reasons to seek emergency medical care. Yet some of them, especially the Last Straw Syndrome, can be avoided with a three-step plan


3 Step Plan to Manage Migraine Emergencies

Given what an unpleasant, expensive and inconvenient thing it is to trek to the Emergency Department (often at 3am), it’s worth it to have a good emergency plan in place with your doctor.

1 – Prepare in Advance – That means packing your Emergency Protocol documents and your “Ready Bag” with items to make your wait in the ED more tolerable: an eye mask, ear plugs, two frozen ice packs, neck pillow, warm socks, a small blanket, and anything else that gives you comfort.

2 – Onset Treatments at Home – Treating an attack early is advisable, with some combination of triptans, NSAIDs and Analgesics for pain, and anti-emetics or ginger for nausea. (See Treatment Directory for Acute options). You may also want to try some of the non-medicinal natural options if they’re effective for you. Work with your doctor to choose your best first-line treatment.

3 – Rescue Treatments at Home – It’s also a good idea to have non-oral formulations, like suppositories, nasal sprays and injection medications, available in your home arsenal if you’re too nauseous to keep oral medications down, or your first line treatment doesn’t work. When your rescue medication fails and your attack is getting worse, you may need Emergency attention.

Finally, if you find yourself going to the Emergency Department more than twice a year and experiencing attacks several days each month, it’s time to revisit your Prevention plan with your doctor. That may include certain medicines, devices, behavioral and physical therapies, lifestyle and dietary changes, and vitamins/supplements.

See our Treatment Directory for Preventative treatments for ideas.

What is an Emergency Protocol for Migraine?

The longer a migraine attack continues, the more difficult it becomes to treat. That’s when many people with migraine go to the Emergency Department for care.

Inconsistencies in emergency care for migraine led two top headache neurologists to create a “best practices” approach for emergency room physicians.

In a review of emergency department practices and treatment, Dr. Amy Gelfand reported that the typical patient has presented symptoms for 24 to 72 hours and taken at least one rescue medication without adequate relief.

As a result of this investigation, Drs. Gelfand and Goadsby recommended a protocol for emergency room physicians to follow when someone with migraine arrives for urgent care.


Recommended Emergency Migraine Treatment Protocol (for ER Doctors)

  1. Reassurance, assuming one is confident of the diagnosis, that this is migraine and can be controlled;
  2. Ensure adequate hydration;
  3. Control headache; and
  4. Control associated features, particularly nausea, while also considering photophobia (light sensitivity) and phonophobia (sound sensitivity) through treatment in an appropriate environment.

Source: Gelfand, A. A., & Goadsby, P. J. (2012, April). A Neurologist’s Guide to Acute Migraine Therapy in the Emergency Room. Retrieved May 10, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3737484/

Many seasoned migraine warriors have experienced the pain of an emergency department once too often, and drafted their own Emergency Protocol for Migraine Care. With it, people often feel empowered to manage their own care, freed from ‘drug-seeking’ skepticism, and grateful for a slightly more expedited admission process.

Some protocols are a single sheet of paper, signed by your doctor. Others are binders including your personal protocol, list of medications and allergies, past visit summaries, and upcoming appointments. No matter which format you choose, it goes with you every time you go to the local Emergency Department or Urgent Care. Just hand the doctor your protocol and with few questions asked, you should be given exactly what is on that sheet of paper.

Guideline Recommended Treatments for Migraine Emergencies

Until recently, many patients going to hospital emergency rooms were administered what the hospital administration deemed best. That’s often a function of the emergency room attending physician, who very rarely has much headache training.

In 2016, the American Headache Society issued its first ever Acute Headache Treatment Guidelines to include emergency care. While not all of these medications are available worldwide or in every emergency room, this list of treatments are worth reviewing with your personal physician as you create your own emergency treatment protocol.

Acute Treatments for Adults with Migraine in a Professional Health Care Facility

Level B: Probably effective
Chlorpromanzine IV
Droperidol IV
Metoclopramide IV
Prochlorperazine IV
Sumatriptan SC
Dexamethasone (to prevent recurrence)
DHE IV, IM, SC
Ketoralac IV, IM
MgSO4 IV (Migraine with aura

Level C: Possibly effective
Valproate IV
Butorphanol IM
Meperidine IM
Methadone IM
Tramadol IV
Dexamethazone IV


Click to View/Download Protocol Form (PDF)

Emergency Migraine Treatment Protocol Form

Name
Date of Birth
Diagnosis
Risk Factors
Allergies
Preventative Medications / Dose / Frequency
Acute Medications / Dose / Frequency
Recommended Emergency Medications
Failed Rescue Medications
Referring Physician Name
Signature
Date
Phone

Migraine Nutrition & Dining Guide

Migraine Nutrition & Dining Guide

Click to View/Download Migraine & Nutrition Dining Guide (PDF)

Introduction

If you approach every buffet or walk down every supermarket aisle thinking it’s a migraine minefield, that’s understandable. Much of what’s written about migraine and food focuses upon trigger avoidance — and the list of triggers seems endless.

Yet researchers tell us there are certain nutrients that are essential for good migraine health. In effect, these nutrients help build up your defenses against migraine over time.

Just like you would water and nourish a plant with important nutrients to make it as healthy as possible, you need to nourish your body for optimal brain health.

“Let thy food be thy medicine, and thy medicine be thy food.”

That’s as true now as when Hippocrates said it around 400 BC. Since then much of our food has evolved over time to what we have today.

What this Nutrition Guide includes:

  1. Three Powerful Nutrients to Fight Migraine
  2. Six Migraine Super Foods
  3. Swapping Food Anxiety for Food Empowerment
  4. Eating at Home: Shopping/Cooking Tips for Migraine Health
  5. Enjoying Restaurants: Tips for Dining Out with Migraine
  6. Recommended Resources on Migraine Nutrition and Food
  7. Food Shopping Lists and Tips

What this Nutrition Guide does not include:

  • Food Triggers to Avoid (See our Trigger Guides and Treatment Directory)
  • Recommended Vitamins and Supplements (See our Treatment Directory)
  • Specific Diets and Recipes (See Recommended Resources in this Guide)

Remember, there are so many small but powerful changes you can make that will add up to lasting success — for your migraine health, and your overall health. This Nutrition Guide will help you create your own plan that allows you to enjoy a healthy, satisfying relationship with food while you nourish your mind and body.

1. Three Powerful Nutrients to Fight Migraine

Every bite you take has the potential to trigger a migraine or help prevent a migraine, or may have no effect at all. We can all eat the nutrient-rich food that helps us build our defenses against migraine attacks.

Researchers have identified a handful of nutrients that can make a demonstrable difference in our migraine frequency and intensity. Discover more about Magnesium, Riboflavin (B2) and Omega-3s, and how to get more of them in your diet.

Magnesium

You need magnesium for your muscles to relax, and stress can drain magnesium from the body [1]. Yet, most of us are not getting enough of this critical mineral from our food.

The Evidence for Migraine and Magnesium

Magnesium appears to play a key role in the pathogenesis of migraine [1].

For that reason, several medical review boards have examined magnesium supplements as a preventative treatment for migraine. The American Academy of Neurology and American Headache Society 2012 report on Complementary and Alternative Treatments considered Magnesium as Probably Effective for migraine prevention. (See our 2017 Medical Treatment Guideline Summary).

Dozens of conditions can be aggravated or caused by magnesium deficiency, many of which are common among people with migraine. They include:

  • Insomnia
  • Irritability
  • Sensitivity to loud noises
  • Anxiety
  • Constipation
  • Headaches
  • Migraines
  • Fibromyalgia
  • Chronic fatigue
  • Obesity
  • Irritable bowel syndrome

Detecting a Magnesium Deficiency

Finding out if you actually have a magnesium deficiency isn’t easy. Tests are not reliable or cheap. Doctors often advise patients to add more magnesium to your diet or start taking supplements to discover if you are deficient. If you feel better, continue.

Fortunately, magnesium is readily available to us in our food supply, although less common in some Western diets.

Yet when was the last time you had a big serving of seaweed, beans, greens, or nuts? If you are like most people, these magnesium-rich foods are not a staple in your diet. That may be one reason why so many people struggle with magnesium deficiency and the many conditions related to it, including migraine.

To compensate for a magnesium deficiency, you need to stop draining your body of magnesium and start eating foods high in magnesium.

Retain Your Body’s Natural Magnesium

Increasing your magnesium intake won’t do much good if your body loses most what you take in. Adopting a few diet and lifestyle changes will ensure you hold onto this powerful mineral. Experts recommend:

  • Limit coffee, colas, salt, sugar, and alcohol, which are diuretics that cause loss of magnesium and fluid through more urination.
  • Learn how to practice active relaxation to overcome the stress that strips your body of magnesium.
  • Check with your doctor if your medication is causing magnesium loss. Many high blood pressure drugs or diuretics cause loss of magnesium.[2]

Eat More Magnesium-Rich Foods

We get most of our minerals from our food, and magnesium is no different. Adding magnesium-rich foods to your diet as often as you can is a simple way to increase your magnesium levels.

Additional foods that are rich in magnesium but may be migraine triggers for some are listed in brackets below. If you know your migraine triggers, you can incorporate these into your diet too.

Foods rich in magnesium include:

  • Proteins: Shrimp and (Beans)
  • Seaweed: Kelp and Dulse
  • Seeds, Nuts and Grains: Wheat Bran, Wheat Germ, Buckwheat, Millet, Rye, Brown Rice, And Barley, (Almonds, Cashews, Brazil Nuts, Filberts, Pecans, Walnuts, Tofu, and Soy Beans)
  • Fruits: Figs, Dates, Kiwi, Apricots, (Avocado, and Bananas)
  • Vegetables: Leafy Greens Like Kale, Spinach, Collard Greens, Parsley, Dandelion Greens, Garlic, Sweet Potatoes, Artichoke, Peas and Okra
  • Dairy: Yogurt and Milk

If you don’t intentionally eat several of these foods, you may be magnesium deficient. Even if you don’t like these foods, there are some really easy ways to get more magnesium by hiding them in foods that you do like. Examples:

  • Instead of almonds, use almond flour, almond milk or almond butter.
  • Instead of dulse (seaweed), use dulse flakes in soups, salads, smoothies or sauces.
  • Keep jars of wheat bran, wheat germ and buckwheat on hand to sprinkle into other dishes.
  • Blend ingredients (including leafy greens) into a smoothie with other fruits you enjoy.

Riboflavin (Vitamin B2)

An inexpensive yet potent vitamin for migraine prevention, Riboflavin has the potential to reduce suffering for many at a low cost. In a Migraine World Summit interview, Dr. Richard Lipton referred to Vitamin B2 as “the great free swing.” Just like a batter’s warm-up routine, it’s free, harmless, and has great potential benefit.

The Evidence for Migraine and Riboflavin

In a 2004 study, patients were given a supplemental dose of riboflavin for 3 to 6 months to measure its effectiveness in preventing migraine attacks. The result: a significant reduction of headache frequency following riboflavin treatment. In addition, the number of abortive anti-migraine tablets was reduced. Consistent with other studies, riboflavin is a safe and well-tolerated alternative in migraine prevention [3].

With several studies reaching a similar conclusion, the American Academy of Neurology published Medical Treatment Guidelines in 2012 indicating that Riboflavin is “probably effective” as a migraine preventative. Other medications in the same category include Atenolol, Amitriptyline and Naproxen, as well as a few other Complementary and Alternative supplements. (See 2017 Medical Treatment Guidelines Summary).

Eat More Riboflavin-Rich Foods

Like other key nutrients, Riboflavin is readily available in our food supply and best absorbed through food.

Additional foods that are rich in riboflavin but may be migraine triggers for some are listed in brackets below. If you know your migraine triggers, you can incorporate these into your diet too.

The Vitamin B2 Rich Foods include:

  • Proteins: Beef liver, lamb, Wild-caught Salmon, Oily fish, Pork, Squid, Oysters, Clams, Mussels
  • Seeds/Nuts & Grains: Sesame Seeds, Chia Seeds, Wheat, (Almonds)
  • Vegetables: Mushrooms, Spinach, Sundried Tomatoes, Beet Greens, Asparagus, Collard Greens, Parsley, Edamame
  • Dairy: Eggs, Milk, Yogurt (Cheese)

Few of us have beef liver, squid and beet greens in our current diet. Even if you don’t like these foods, there are some really easy ways to get more riboflavin by hiding them in foods that you do like. Examples:

  • Instead of almonds, use almond flour, almond milk or almond butter.
  • Keep jars of chia and sesame seeds on hand to sprinkle into other dishes.
  • Blend ingredients (including leafy greens) into a smoothie with other fruits you enjoy.
  • Once a week, make yourself a Vitamin B2 Power Omelet with eggs, milk, (cheese), mushrooms, spinach, sundried tomatoes and parsley.
  • Try making a soup or pasta dish every week with a mix of riboflavin-rich seafood.

Omega-3s

Omega-3 fatty acids are polyunsaturated fats with numerous health benefits, particularly regarding cardiovascular health. Alpha-linolenic acid (ALA) is a type of Omega-3 fat found in plant foods, which cannot be manufactured by the human body.

Two essential fatty acids — EPA and DHA — are primarily found in certain fish. Not only does your body need these fatty acids to function, but also they deliver some big health benefits.

Foods High in Omega-3 Fatty Acids include flaxseed oil, fish oil, chia seeds, walnuts, fish roe (eggs), fatty fish, seafood, soybeans, and spinach.

Omega-3 fatty acids play a crucial role in lessening inflammation. The anti-inflammatory properties of Omega-3 fatty acids can reduce the inflammation in the head that occurs during a migraine [4].

The Evidence for Omega-3 and Migraine

Research shows that increasing Omega-3 and reducing Omega-6 fatty acids reduced headache pain and improved quality-of-life in chronic headache sufferers.

The Omega-3 fatty acids are generally considered good and the omega-6 are considered bad, but it appears that what is more important is the balance between the two types.

The known beneficial effects of fish oil include their effect on the heart, brain, peripheral nerves, mood, inflammation, as well as headaches. [3]

Eat Fewer Foods with Omega-6

The foods with high Omega-6s are like the bad boys of nutrition. We all know we should avoid them, but they taste so good. The key is keeping the ratio of good fat (Omega-3s) to bad fats (Omega-6s) in balance, favoring the 3s.

Therefore, experts recommend limiting your intake of these high Omega-6 foods:

  • Peanut and other nut butters
  • Chips and buttered popcorn
  • Takeout, and packaged foods
  • Fried, battered chicken or fish
  • Margarine and vegetable shortening

Eat More Foods with Omega-3

Sometimes, how you eat certain foods matters a lot. You’ll see that fish is on both Omega-6 and Omega-3 lists. But battered and fried farm-raised Tilapia has a vastly different nutritional value than sautéed wild-caught Salmon, especially if it’s prepared in extra virgin olive oil.

That’s the essence of the Omega-6 vs. Omega-3 balance that matters to your migraine health.

As you’re searching for foods that are high in Omega-3 fatty acids, start with this list:

  • Proteins – Oily fish, preferably wild-caught for the most nutrients, are richest in Omega-3s. Mackerel, tuna, salmons and sardines are all good sources. Aim to eat fish high in DHA and EPA omega-3 fatty acids two to three times a week. (Beans and soybeans are also high in Omega-3).
  • Seeds, Nuts and Grains – Chia Seeds, (Walnuts).
  • Dairy – Eggs, especially those fortified with extra Omega-3.
  • Oils – Extra virgin olive oil, Flaxseed Oil, Fish Oil, Canola Oil and (Walnut Oil)

Even if you don’t like these foods, there are some really easy ways to get more Omega-3s by using Olive Oil to cook foods that you do like, and sprinkling nearly invisible and tasteless chia seeds into your favorite dishes. Adding Omega-3 enhanced eggs in cooking and baking is an easy shortcut to better migraine nutrition.

Many are good to stock in your pantry too. Salmon, tuna and sardines come in cans and pouches. Nuts and seeds can be frozen to extend their life.


2 – Six Migraine Super Foods

Bite for bite, you’ll get more nutrients out of each of these six foods than virtually any others. Be sure to check out Section 7, with 58 more power foods for your shopping list.

Oily Fish

Oily fish are a great source of Omega-3 fatty acids, which play a crucial role in lessening inflammation. The anti-inflammatory properties of Omega-3 fatty acids can reduce the inflammation in the head that occurs during a migraine, so oily fish such as mackerel, tuna and sardines are a good way to reduce migraine symptoms. Other foods that include Omega-3 fatty acids are olives, walnuts and soybeans.

Ginger

It’s a well-known fact that ginger root is good for combating nausea, and it’s commonly recommended for pregnant women who are suffering with morning sickness. [5] The anti-nausea properties in ginger are also effective in calming the stomach sickness caused by migraines. In addition, ginger holds back the synthesis of prostaglandins, lipid compounds that control the body’s response to inflammation (causing pain) and increase certain muscle contractions.

Millet

Millet is a nutritious whole grain that’s full of magnesium, which is essential in reducing the spasms that happen in the head during a migraine attack. [6] You may think that your options are limited if you want to cook with millet, but in fact it has a whole range of uses. It can be made into a porridge-style breakfast, ground to produce flour, and substituted for rice in a number of dishes.

Spinach

Another food that’s high in magnesium, spinach also offers the benefit of high riboflavin (vitamin B2) levels, which helps the body to produce energy. A diet high in riboflavin can decrease the regularity of migraine headaches, as well as making the attacks themselves less severe. [3]

Kale

While it’s nutrient-dense with vitamins K, C, A, folate, calcium, iron and protein, it’s one of the few foods that contain Omega-3s and magnesium. When you add in the fiber that helps digestion, it becomes a migraine super food.

Kale possesses phytonutrients, those miraculous molecules in plants that are often called “antioxidants.” Kale quells inflammation that causes pain, and can even protect brain cells from stress. [7]Cooking kale frees some nutrients like magnesium and decreases others, like heat-sensitive folate. Consuming kale in any form delivers fiber, protein, omega-3s, and a bevy of vitamins and minerals. You can enjoy sautéed kale, kale salads, kale chips, and kale smoothies.

Chia Seeds

An all-round super food, chia seeds are packed full of nutrients and offer a whole heap of health benefits, including being amazing at battling a migraine. A natural source of magnesium, zinc, calcium, and Omega-3 fatty acids (all fantastic aids for easing migraine symptoms), chia seeds also keep blood sugar and hydration even, which is essential for migraine sufferers. “Based on some of their beneficial properties, Chia seeds are the kinds of foods that I’m recommending to help migraine patients” explained Dr. Andrew Charles of the UCLA Goldberg Migraine Program in an interview. [8] He added: “We’re very much open to the idea that natural substances can be helpful or harmful” for migraine patients.

Since chia seeds are also heat-resistant, you can also include them in baked goods without losing any nutritional density.

For a wholesome addition to a meal that’s also packed full of migraine-fighting nutrients, a handful of seeds over salads, or added to soups, stews or porridge is a great choice. In addition to chia seeds, pumpkin seeds, sunflower seeds, flaxseeds and sesame seeds are all fantastic sources of both magnesium and Omega-3 fatty acids.

See the list of 58 More Power Foods on the Shopping List, Section 6


3 – Swapping Food Anxiety for Food Empowerment

Many of us have felt the crush of migraine food anxiety when we eat at a friend’s house, go to a Potluck supper or dine out at a restaurant. If you feel like migraine has sucked the joy out of eating you’re not alone.

Paula Kamen, author of All in My Head, describes the source of her food anxiety: a visit to a headache clinic where she listened to a doctor read off the extensive laundry list of identified food triggers to avoid.

“He painstakingly outlined page after page of prohibited foods, including those that were well-known migraine triggers, such as cheese, caffeine, chocolate, and alcohol. But this list, which went on to fill several pages, also included anything fermented, pickled, or marinated, in every food group, even in food groups that I hadn’t even known about before as existing … After at least a half hour of this, the audience’s mood shifted from polite interest to stunned silence.”

It’s no wonder many people with migraine feel anxiety about eating.

The Key to Food Empowerment

The key to banishing food anxiety and replacing it with food empowerment is, quite simply, knowledge. In this case, it’s about knowing your personal triggers. That makes you feel in control instead of imprisoned by food limitations. It tells you what you CAN eat and just a few things that you CAN’T.

We can’t encourage you enough to invest the time to identify your personal food triggers. Rather than fear every potential trigger listed, which creates food anxiety, invest the time to methodically determine your personal triggers.

Experts remind us that food triggers are not scientifically proven, but self-reported [9]. Furthermore, research by Curelator indicates that most people don’t identify their triggers correctly [10].

How to Identify Your Personal Food Triggers

To identify your personal food triggers, use a headache diary or app, such as Migraine Buddy or Curelator Headache, for 60-90 days. This will help you distinguish the food and drinks that precede your attacks. Next, try to separate your food cravings from actual triggers. A food craving is a common premonitory symptom in the first phase of an attack. Experts suggest triggers are often confused with symptoms [11].

How do you know which is which? Do a simple test for 30 days. If you find that every time you eat chocolate (or your suspected trigger), you have an attack 12-24 hours later, it could be a trigger or a premonitory symptom. To know for sure, ignore your chocolate craving at least three or four times and see if you still get an attack. If you do, chocolate is not a trigger. And you can enjoy it without fear or guilt. Wouldn’t that be worth the effort?

If you know your personal trigger foods it’s going to be a lot easier to dine out and you’ll feel more confident about your food choices.

Food triggers are dramatically different from person to person. There’s no need to avoid everything on a menu that has ever been reported to trigger a migraine. Simply avoid your triggers.


4 – Eating at Home: Shopping/Cooking Tips for Migraine Health

Eating in is absolutely the best way to get the most nutritional value out of your food because you can control the ingredients in your meal and know where it comes from. Part of the food anxiety we experience with migraine comes from all the mystery ingredients in packaged foods and restaurants.

The challenge is, not all of us are capable cooks. And we lead busy lives which makes take-out and fast-food all the more tempting.

The better you are at cooking, the more joy you’ll get from it and the better taste and nutritional value your food will have. Plus, you’ll save a lot of money in the short term (food cost) and the long term (health expenses). Eating-in simply gives you better control of the fuel that goes into your digestive system.

Tips to Enjoy Eating in with Migraine

  • Boost Your Cooking Skills – Cooking shows are now plentiful on television and the web, and offer great inspiration and ideas. Hands-on cooking classes offered at supermarkets, restaurants and cooking schools can be a great date night or social outing- like a meal with dividends. Or hang out with a friend or family member who is an especially great cook and watch each step of their process. Even grocery shopping.
  • Invest in a Few Good Tools – Great knives and cutting boards make chopping vegetables almost therapeutic – it can be a great stress release. A powerful blender, like a Vitamix or NutriBullet, can make smoothies and soups more fun to prepare (and a great way to “hide” nutritious add-ins like kale, yogurt, flax and chia seeds). A pressure cooker or rice cooker can expedite preparation of rice, quinoa, vegetables and meats without losing any nutrients.
  • Do a Pantry Cleanse – You can pay a nutritionist to do this for you, or you can do it yourself. Go through your pantry and dispose of or give away every single item that doesn’t contribute to your health. If the box has mystery ingredients on the package, check to see if it’s MSG, soy or artificial sweeteners, which are all common migraine triggers. Keep a few treats that don’t cause you food anxiety … we all need occasional treats. Just remember the health costs of eating genetically modified food or “Frankenfood.”
  • Buy Fresh, Whole Foods – Shop the outside aisles of the supermarket: the produce section and fresh meat and seafood. You’re looking for food that’s minimally processed with as few strange-sounding additives as possible. Buying fresh, whole foods eliminates that migraine diet conundrum. You can add your own spices, sauces and flavors so you know exactly what you’re consuming. You’ll also avoid the hidden sugars and artificial sweeteners that food manufacturers include in many of our foods.
  • Choose Frozen or Fresh vs. Canned or Boxed – It’s not always possible to buy fresh food, but how do you stock your pantry for everyday cooking and migraine days? First, choose frozen vs. canned. There are three reasons for choosing frozen. First, canned foods contain higher levels of BPA, which manifests itself as estrogen. That’s bad news for women who suffer from hormonal migraines. [12] Second, canned and boxed foods often have MSG as a flavor enhancer, which we already know aggravates migraines. Finally, frozen food is usually flash-frozen shortly after harvest. That makes it taste fresher and better while preserving more nutrients.
  • Double up and Freeze – Make double portions to feed yourself or your family on days when you are stuck on the sofa with a migraine, and freeze them. Keeping bland foods for days when you’re nauseous, like frozen quinoa/rice with veggies, is a good idea, too.
  • Eat Leftovers Quickly – Finally, if tyramines aggravate your headaches, it’s best to avoid leftovers – and toss those more than two days old. Every day leftovers are stored in the refrigerator they increase their levels of tyramines. [13]
  • Watch Your Sugar and Carb Intake – One of the most common yet surprising migraine triggers is known as Reactive Hypoglycemia. [14] It occurs when we eat too many refined carbs (like a big bowl of pasta or white bread toast) or high amounts of sugar (desserts, or hidden sugars in tomato sauce, peanut butter, flavored yogurt, sodas, wine, and juice). Dr. Josh Turknett warns strongly against sugar and refined carbs in his book, The Migraine Miracle.
  • Re-stock with Migraine Super Foods and Power Foods – Take our list of nourishing foods for migraine brains, and build recipes around them that suit your tastes. Or check out the recipes in Joy Bauer’s Food Cures, Josh Turknett’s The Migraine Miracle, or on MigraineAgain.com.

Eating in more often will nearly guarantee you’ll save money, and will probably help you lose weight too. If you’re concerned that you don’t have time to shop for food and prepare it, consider how much time you’ll lose for the migraine attack that a meal eaten out could trigger. Eat out when you need to or really want to.

Finally, don’t let migraine food anxieties steal the joy of eating. For most of us, eating to win our battle with migraine can be simple if you make the choice to eat clean most of the time.


5 – Enjoying Restaurants: Tips for Dining Out with Migraine

Eating at restaurants with migraine can be really tricky. Avoiding MSG, food additives and mystery ingredients not listed on the menu without seeming like a high-maintenance customer is hard.

It can be a bit of a hassle and an expense to dine out when you have dietary restrictions. For many people, it’s worth it now and then to enjoy time with friends and family, and new flavors and experiences.

If you’ve eaten at restaurants in the past, only to experience a migraine attack later, you may be wary of dining out often. That’s understandable. Aside from the physical pain, you may have “paid” for that delicious pizza and beer or Mu Shu Pork with expensive migraine meds, a hospital visit, or missed work. Use your own common sense and experience to weigh the cost/benefit for these types of meals.

Remember there are plenty of restaurants that are quite accommodating to people with food sensitivities of all kinds. With just a few simple guidelines, you CAN dine out with friends and family and avoid a migraine attack.

Tips to Enjoy Dining Out

Generally speaking, most people with migraine can enjoy dining out with a few simple tips.

  • Choose restaurants wisely. Most people select well-reviewed restaurants based on location, cuisine, taste, service and ambience. People with migraine need to filter the list of options with those that serve fresh food made from quality ingredients and those that are accommodating to people with different diets. In each category (fast food, fast casual, cafes and fine dining), these are rarely the cheapest. But the premium you’ll pay will reduce the chance of an expensive emergency room visit or a missed day of work.
  • Enlist support of fellow diners. When people ask: “Where should we go to eat?” remember your trusted restaurants with migraine-safe entrees. You can say, “I have some food allergies. I can join you if we go X restaurant, where I know I can find something safe to eat.” Or be the first to suggest a restaurant, without explanation.

In your search for restaurants where you can relax and enjoy the meal, consider a few guidelines:

  • Avoid cheap restaurants and buffets. Because of the language and cultural barrier, many inexpensive Chinese and Mexican restaurants simply don’t understand when you request no-MSG and no-soy preparations, which are among the most common food triggers. Inexpensive buffets typically use cheaper quality foods that are laden with preservatives and MSG.
  • Scout out quality restaurants. Most quality American, Italian, Seafood restaurants and more expensive Asian and Mexican restaurants will be able to accommodate your needs. Likewise, most chain restaurants now provide detailed nutrition information on their menu items.

Most restaurants offer online menus, which are good to check out in advance and narrow down the options that might interest you. Once you’re at the restaurant, a few helpful tips to select migraine-safe foods and drinks:

  • Request simple preparations. Sauces can hide a variety of ingredients, often MSG, soy and vinegar. MSG-free spices, herbs and salt can add flavor to any dish, plus olive oil. Simpler preparations reduce the risk of trigger exposure.
    • For salads, choose one with the fewest triggers, and customize it. Dress it with olive oil and, if not a trigger, vinegar, and salt and pepper.
    • For entrees, ask for fish, poultry or meat to be grilled with sauce on the side. Pasta with vegetables and fish, poultry or meat plus olive oil and garlic is another good choice for most people.
    • For sides, ask for vegetables to be steamed or sautéed in olive oil. Steamed rice and baked, boiled or roasted potatoes are migraine-friendly choices.
    • For desserts, if you don’t know whether chocolate, nuts and citrus fruits are triggers, fresh berries with whipped cream or biscotti are generally safe options.
    • For drinks, sparkling water with cranberry juice or ginger ale are safe, festive alternatives if you don’t feel like water. Herbal tea with honey is a good alternative if you find the caffeine in coffee or black tea is a trigger for you. 
  • Eat to win. Applying everything you’ve discovered about the best nutrients for those with migraine, look for Omega-3 rich seafood and eggs, magnesium-rich salads and green vegetables, and riboflavin-rich seafood. Many restaurants now feature wild-caught seafood, kale, quinoa, chia seeds and other super foods that’ll help you feel as good as they taste. 

If you’ve experienced a few attacks after restaurant meals, it’s wise to take a few extra precautions when dining out.

  • Don’t guess with your health. A menu is like a print ad, and a server’s verbal description is like a radio ad for a food item. It does not list all the ingredients in a dish. If dining out has triggered an attack for you in the past, take a few more steps to ensure you don’t have a painful surprise coming. 
  • Request a Nutrition Guide, if available. These are generally available in chain restaurants, and will list every single ingredient. Some chains also post them on their websites. Independent restaurants rarely offer this option.

Some people with Chronic Migraine have several triggers and strong food sensitivities. If that’s you, you’ll want to be a bit more vocal about your food sensitivities.

  • Enlist the Server’s Help. When you go to a restaurant, discreetly hand a note to the server and politely say, “I don’t mean to be fussy, but I have serious food allergies. Can you please give this directly to the chef or cook?” Often, servers don’t know quite which ingredients (e.g. onions, MSG, vinegar, soy) are used beyond what’s listed in the menu. Then smile, and tip well.
  • Print your Chef’s note and bring it. Once you know your personal food triggers, as well as any other foods you want or need to avoid, print a dozen dollar-bill sized copies, and carry them in your wallet. At the top, it should say: “Dear Chef, I have a diagnosed medical condition (Migraine). Certain foods and drinks can make me very ill, often for days, sometimes requiring hospital visits and missed work. Please help me choose items on your menu or customize one of your selections to avoid these ingredients.” Then include your list of your known personal food triggers below.
  • Reward restaurants with loyalty. If you’ve found a restaurant that has menu items that work for you, or servers and chefs who are especially accommodating, reward them with return visits.

6 – Recommended Resources on Nutrition and Food

Books

The Migraine Miracle: A Sugar-Free, Gluten-Free, Ancestral Diet to Reduce Inflammation and Relieve Your Headaches for Good by Josh Turknett MD – Dr. Turknett is a neurologist with a personal history of migraines who offers readers a dietary solution that has halted his attacks and continues to work for his patients. He advocates a diet low in wheat, sugar, and processed foods, and high in organic, protein-rich animal products. The book also explores the link between inflammation, diet, and migraines, and contains a 21-day meal plan to help readers change the way they eat.

Joy Bauer’s Food Cures: Eat Right to Get Healthier, Look Younger and Add Years to Your Life by Joy Bauer RD. – Although migraine is just one chapter in this book, it’s one of the best. Joy Bauer’s husband and daughter both have migraine. She believes that many life-threatening diseases can be managed, treated, and sometimes even cured by the foods you eat. Inside you will find easy-to-follow 4-step food prescriptions, customizable and convenient meal plans, and delicious recipes for your favorite meals and snacks. With Joy’s practical, medically sound advice, you will learn how to use food as nature’s ultimate medicine.

Websites

MigraineAgain.com/Eat – Here you’ll find the Best Migraine Diet, a simple three-step plan. There are dozens of free articles on Food, Drinks, Nutrition and Recipes just for people with migraine. Many of the articles on Migraine Again are written by chronic migraine warriors or registered dietitians.

EatRight.org – An excellent free resource from the American Dietetics Association (ADA) for people with a variety of health conditions. If you’re looking for a nutritionist in the US to help you develop a plan, you can find one here.

Apps

Curelator – Much more than an electronic diary, Curelator helps you identify your triggers after 60-90 days of use with impressive accuracy. The app produces an impressive Personal Trigger Map and Protector Map – including food and other protectors that help prevent your attacks when you consume or practice them.

Migraine Buddy – The most popular app on the planet to track every symptom and possible trigger, Migraine Buddy produces report to share with your doctor. Also includes weather and sleep tracking functionality.


7 – Food Shopping List and Tips

  • Shop the Outside of the Store – You’ll find fewer foods with MSG, artificial sweeteners and preservatives that can trigger migraine.
  • Buy Frozen or Fresh – Seafood, Meat, Fruit and Vegetables have more nutrients, less BPA and fewer additives in this form.
  • Choose Nutrients, Add Taste – Start with foods like these that are rich in Magnesium, Riboflavin and Omega-3s. Then flavor them to your taste.

Seafood
Wild-caught Salmon
Mackerel
Tuna
Sardines
Squid
Oysters
Clams
Mussels
Shrimp

Meat
Beef liver
Lamb
Pork

Other Protein
(Beans)
(Soybeans)
(Tofu)

Fruits
Figs
Dates
Kiwi Fruit
Apricots
(Avocado)
(Bananas)

Vegetables & Greens
Spinach
Kale
Collard Greens
Parsley
Dandelion Greens
Garlic
Sweet potatoes
Artichokes
Peas
Okra
Mushrooms
Sundried Tomatoes
Beet Greens
Asparagus
Edamame
Ginger
Kelp
Dulse – seaweed flakes

Oils
Extra virgin olive oil
Flaxseed Oil
Fish Oil
Canola Oil
(Walnut Oil)

Seeds, Nuts and Grains
Millet
Wheat bran
Wheat germ
Buckwheat
Rye
Brown Rice
Barley
Chia Seeds
Sesame Seeds
(Almonds)
(Cashews)
(Brazil nuts)
(Filberts)
(Pecans)
(Walnuts)

Dairy
Omega-3 fortified Eggs
Milk
Yogurt
(Cheese)

Note: Foods in (brackets) are reported migraine triggers for some people. Test each one for yourself. Orange foods are Migraine Super foods.

Sources

  1. Sun-Edelstein, C., & Mauskop, A. (2009, April). Role of magnesium in the pathogenesis and treatment of migraine. Retrieved from https://www.researchgate.net/publication/24187322_Role_of_magnesium_in_the_pathogenesis and treatment of migraine
  1. Glaser, A. (2017, March 25). Easy Fix: Magnesium Deficiency and Migraines. Retrieved from https://migraineagain.com/easy-fix-magnesium-deficiency-migraines/
  1. Ramsden, C. E., Faurot, K. R., Zamora, D., Suchindran, C. M., Macintosh, B. A., Gaylord, S. Mann, J. D. (2013, November). Targeted alteration of dietary n-3 and n-6 fatty acids for the treatment of chronic headaches: a randomized trial. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23886520
  1. Food as Medicine: 7 Best Migraine-Fighting Diet Tips. (2017, January 28). Retrieved from https://migraineagain.com/7-best-anti-migraine-diet-tips/
  1. Lete, I., & Allué, J. (2016). The Effectiveness of Ginger in the Prevention of Nausea and Vomiting during Pregnancy and Chemotherapy. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4818021/
  1. Gröber, U., Schmidt, J., & Kisters, K. (2015, September). Magnesium in Prevention and Therapy. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4586582/
  1. 5 Reasons Why Kale is a Migraine Superfood. (2017, March 13). Retrieved from https://migraineagain.com/5-reasons-kale-migraine-superfood/
  1. 6 Foods That Fight Migraines and Prevent Attacks. (2017, March 05). Retrieved from https://migraineagain.com/6-foods-that-fight-migraines-and-prevent-attacks/
  1. Junge, C. (2011, April 05). Food and migraine: a personal connection. Retrieved from http://www.health.harvard.edu/blog/food-and-migraine-a-personal-connection-201104052222
  1. Curelator, NHF Study Shows Migraine Sufferers Aren’t Good at Determining Own Triggers. (2016, July 22). Retrieved from http://www.headaches.org/2016/07/22/curelator-nhf-study-shows-migraine-sufferers-arent-good-determining-triggers/
  1. Dumas, P. (2017, March 05). Why Some Top Migraine Triggers May Actually be Symptoms. Retrieved from https://migraineagain.com/migraine-trigger-symptom-charles/
  1. Hormonal Migraines: What Else is Messing with Your Estrogen. (2017, January 28). Retrieved from https://migraineagain.com/hormonal-migraines-else-messing-estrogen/
  1. Bauer, J. (n.d.). 9 Common Migraine Triggers: Leftovers. Retrieved from http://www.joybauer.com/photo-gallery/common-trigger-foods/leftovers/

 

2017 VIP Pass Add-ons

Welcome to your 2017 VIP Pass add-on package!

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

The 2017 VIP Access Pass gives you unlimited access via our online portal to 36 Video Presentations, 36 Audio Discussions, and 36 Interview Transcripts. PLUS you also have access to our Private Support Group, a 280+ Treatment Directory, 18 Trigger Guides, Emergency Protocol and Nutrition & Dining Guide.

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

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

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)

Day 1: Real Warriors

Day 2: Causes & Diagnosis

Day 3: Causes & Diagnosis

Day 4: Symptoms

Day 5: Triggers

Day 6: Alternative Treatments

Day 7: Treatments

Day 8: Taking Control

Day 9: MWS Onstage Presentations

Transcripts

Transcripts

Click to View/Download the transcripts (PDF)

Day 1: Real Warriors

Day 2: Causes & Diagnosis

Day 3: Causes & Diagnosis

Day 4: Symptoms

Day 5: Triggers

Day 6: Alternative Treatments

Day 7: Treatments

Day 8: Taking Control

Day 9: MWS Onstage Presentations

2020 VIP Pass Add-ons

Welcome to your 2020 VIP Pass add-on package!

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

The VIP Access Pass gives you unlimited access via our online portal to all 2020 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 290 options, and Guideline Recommended Treatment Report.

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

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

Treatment Guidelines

2020 Migraine Treatment Guidelines Summary

Introduction

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

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

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

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

How to read this report

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

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

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

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

Important notes

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

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

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

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

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


New in 2019 and 2020

NEW Guidelines

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

NEW MEDICAL ACUTE TREATMENTS

Aprepitant (Emend) – nausea relief

Dimenhydrinate (Gravol+) – nausea/vomiting relief

Diphenhydramine (Benadryl+) – antihistamine

Fosaprepitant (Emend) – nausea/vomiting relief

Lasmiditan (Reyvow)**

Rimegepant (Nurtec ODT)**

Ubrogepant (Ubrelvy)**

Neurolief device (Relivion)***

Remote electrical neuromodulation device (Nerivio)**

Allay narrow-band green light lamp**

NEW Acute and Preventive Treatments

Telcagepant

Vazegepant

NEW PREVENTIVE TREATMENTS

Atogepant

Eptizenumab (Vyepti)**

Erenumab (Aimovig)**

Estrogen Patch

Intrauterine Device (IUD)*

Fremanezumab (Ajovy)**

Galcenezumab (Emgality)**

Omega Procedure

Reed Procedure

NEW NONMEDICAL PREVENTIVE TREATMENTS

L-carnitine Dietary Supplement

N1-Headache Smartphone App

THC (Tetrahydrocannabinol)

Trauma-focused Cognitive Behavioral Therapy

Important Notes:

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

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


Preventative treatment of migraine in adults

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

Level A: Established as effective

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

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

Level B: Probably effective

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

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

Level C: Possibly effective

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

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

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

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

Other: treatments that are established as possibly or probably ineffective

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

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


Acute treatment of migraine in adults

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

Level A: Established as effective

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

Level B: Probably effective

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

Level C: Possibly effective

Phenazone*
Butalbital
Lidocaine intranasal

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

Celecoxib
Ketorolac tromethamine nasal spray

Level C Negative

Ketorolac tromethamine nasal spray

*Classification may vary by country


Migraine with Menstruation

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

Level A: Established as effective

Frovatriptan

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

Level B: Probably effective

Naratriptan
Zolmitriptan

Level C: Possibly effective

Estrogen


Children & Adolescents

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

Low Confidence in Evidence

Ibuprofen OS 7.5-10 mg/kg

Acetaminophen / paracetamol

Very Low Confidence in Evidence

Sumatriptan nasal spray 5-10 mg

Sumatriptan oral tablet 25-50 mg

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

Moderate Confidence in Evidence

Sumatriptan nasal spray 5 mg (nausea and vomiting)

Low Confidence in Evidence

Sumatriptan nasal spray 10 mg (vomiting)

Very Low Confidence in Evidence

Sumatriptan nasal spray 10 mg (nausea)

Moderate: Probably no more likely than placebo.

Low: Possibly no more likely than placebo.

Results Summary (2019 AAN):

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

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

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


Emergency Treatment

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

Level B: Probably effective

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

Level C: Possibly effective

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

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

Lidocaine IV
Hydrocortisone IV

Level B Negative: Medication is probably ineffective.

Octreotide SC

Level C Negative: Medication is possibly ineffective.

Chlorpromazine IM
Granisetron IV
Acetaminophen IV


SOURCES:

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

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

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

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

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

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

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

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

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

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