Archives: Pass Add-ons

Non-Medical Migraine Treatments

How to use this reference:

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

Treatments are listed in alphabetical order.

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

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

Medical Treatments

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

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

How to use this reference:

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

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Generic Name (Active Ingredient List)	Brand Names	Drug Class	RX	Format	Treatment Type	Description
Acetaminophen & Codeine	Tylenol 3 or 4, Panadeine	Combination - Opioid	X	Pill, Liquid	Acute	Acetaminophen/paracetamol with codeine is an opioid and analgesic/antipyretic combination. It works in the brain and nervous system to decrease mild to moderately severe pain.
Acetaminophen (Paracetamol)	Little Fevers, Panadol, Tylenol & others	Analgesic (painkiller)		Liquid, Pill, Suppository	Acute	Acetaminophen is also known as paracetamol depending on where you live. A pain reliever and fever reducer, the exact mechanism of action of acetaminophen is unclear. Many common pain conditions including headache, muscle aches, arthritis, backache, toothaches, colds, and fevers are treated with acetaminophen. It relieves pain in mild arthritis but does not affect the underlying inflammation and swelling of the joint.
Acetaminophen, Butalbital & Caffeine	Anolor 300, Dolgic LQ, Esgic, Fioricet, Margesic, Orbivan, Repan, Zebutal & others	Combination - Barbiturate	X	Pill	Acute	Acetaminophen is a pain reliever and fever reducer. Butalbital is a barbiturate, known to relax muscle contractions involved in a tension headache. Caffeine is a stimulant that can relax muscle contractions in blood vessels to improve blood flow. The combination is used to treat tension headaches caused by muscle contractions. Butalbital has a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment. Butalbital is not available in some countries and restricted in others due to its dangerous side effects.
Acetaminophen, Dichloralphenazone & Isometheptene	Duradrin, Midrin	Analgesic (painkiller)	X	Pill	Acute	Acetaminophen, dichloralphenazone, and isometheptene is a combination analgesic, sedative, and sympathomimetic. It works by decreasing pain, providing sedation, and narrowing the blood vessels in the head and brain. It is used to treat migraine, certain other types of headaches (tension, neurovascular), among other conditions.
Acetazolamide	Diamox, Diamox Sequels	Diuretic	X	Pill	Acute & Preventive	Acetazolamide medications are used to treat glaucoma, epilepsy, altitude sickness, periodic paralysis, idiopathic intracranial hypertension, and heart failure. It is sometimes used to treat high-pressure headaches by lowering the production of spinal fluid. Acetazolamide is not well-studied as a preventive treatment for migraine in general, and there is no solid evidence for its effectiveness outside the context of familial hemiplegic migraine.
Acetylsalicylic acid (ASA)	Aspirin, Baby aspirin	Nonsteroidal anti-inflammatory drugs (NSAIDs)		Orally-dissolving tablet, Pill	Acute & Preventive	Regular low-dose aspirin or "baby" aspirin may be one of the most effective ways to help prevent migraine with aura. When tested against topiramate, a common migraine preventive, Italian researchers found that low doses of aspirin daily may be up to six times more effective than topiramate. Up to 1,000 mg of aspirin may also be used in the acute treatment of migraine.
Acetylsalicylic acid (ASA) or Aspirin & Combinations	AsproClear, Bayer Aspirin, Bufferin, Easprin, Ecotrin, Ecpirin, Excedrin, Fasprin & others	Combination – NSAID		Pill, Powder, and others	Acute	Aspirin/ASA is an NSAID that works by reducing substances in the body that cause pain, fever, and inflammation. It is used to treat pain and reduce fever or inflammation. Sometimes aspirin is used to treat or prevent heart attacks, strokes, and chest pain (angina) but it should be used for cardiovascular conditions only under the supervision of a doctor. Some aspirin combination drugs, like Excedrin, also contain acetaminophen and caffeine. Check the label to be sure. Overuse of combination treatments containing caffeine may lead to medication overuse headache.
Acyclovir	Zovirax	Antiviral	X	Pill, Topical ointment	Preventive	Acyclovir is an antiviral drug that is used to treat infections caused by certain types of viruses. It treats shingles caused by herpes zoster and outbreaks of herpes simplex. In people with frequent outbreaks of genital herpes, acyclovir is used to help reduce the number of future episodes. Acyclovir can also be useful in the treatment of fibromyalgia and allodynia, often in conjunction with other medications.
Agomelatine	Valdoxan	Antidepressant	X	Pill	Preventive	Agomelatine is primarily used to treat depression. It acts on brain receptors for melatonin, a hormone that is important for regulating sleep, as well as serotonin receptors. It is the only antidepressant that acts on melatonin receptors.
Air pressure modulation device	Nocira	Neuromodulation	X	Device	Acute	Nocira is an investigational new migraine treatment device intended to deliver a comfortable and non-invasive treatment experience. The device delivers a modulated pattern of gentle puffs of air into the ear, which stimulates pressure-activated sensory neurons to reset the brain's pain response. The pilot study saw 67% of its participants pain-free after 20 minutes of treatment with Nocira. The device operates by way of earpieces controlled through a mobile phone app. Additional clinical trials are planned. Not yet FDA approved as of March 2021.
Almotriptan	Axert, Almogran	Serotonin 5-HT1 agonists or Triptans	X	Pill	Acute	Almotriptan is a second-generation serotonin 5-HT1 receptor agonist, also known as a triptan. An agonist mimics the effects of the neurotransmitter found naturally in the brain. It works by narrowing the blood vessels around the brain, blocking pain signals and the release of substances that cause other migraine symptoms. A person with migraine is thought to be hypersensitive to widened blood vessels exerting pressure on the brain.
Alprazolam	Niravam, Xanax	Benzodiazepines	X	Pill	Preventive	Alprazolam 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.
Amitriptyline	Elavil, Endep	Antidepressant	X	Pill	Preventive	Amitriptyline is a tricyclic antidepressant. It affects brain chemicals that may become unbalanced. Amitriptyline is used to treat symptoms of depression.
Amphetamine	Adzenys XR-ODT, Dyanavel XR, Evekeo	Stimulant	X	Pill	Preventive	Amphetamine is a stimulant used to treat attention-deficit hyperactivity disorder (ADHD), narcolepsy, and obesity. Stimulants increase the level of dopamine, a neurotransmitter associated with pleasure, movement, and attention. Use of this medication should be closely monitored, as it carries a high risk for addiction. In the context of migraine, amphetamine can contribute to medication overuse headache (MOH).
Angiotensin-converting enzyme (ACE) inhibitors	Prinivil, Qbrelis, Zestril, Epanded, Vasotec, Altace	Hypertension	x	Pill	Preventive	Angiotensin-converting enzyme (ACE) inhibitors are commonly prescribed to treat high blood pressure, heart problems, and other conditions by helping to relax veins and arteries. A 2019 study concluded that ACE inhibitors could be used as a preventive treatment for migraine in persons with high blood pressure or high risk of side effects, but the evidence did not support use of it as a preventive otherwise.
Aprepitant	Emend	Neurokinin-1 receptor antagonist (antiemetic)	X	Pill	Acute	Used to prevent chemotherapy-induced or postoperative nausea and vomiting, and for CVS (Cyclic Vomiting Syndrome, a migraine variant). Also used to control nausea and vomiting related to intravenous DHE (dihydroergotamine).
Asenapine	Saphris	Other - schizophrenic & bipolar	X	Pill	Preventive	Asenapine treats schizophrenia. It is used alone or along with lithium or valproate to treat acute manic or mixed episodes associated with bipolar disorder or manic-depression. Asenapine is an atypical antipsychotic. Exactly how it works is not known. It may work by blocking certain substances in the brain.
Aspirin & Codeine	Aspalgin, Disprin Forte	Analgesic (painkiller)	X	Pill	Acute	Aspirin with codeine is an analgesic combination. It works to relieve pain by dulling pain perception in the brain and blocking certain chemicals in the body that cause pain, swelling, and inflammation. It helps relieve mild to severe pain. Codeine is an opioid and opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment.
Aspirin, Butalbital & Caffeine	Fiorinal, Fortabs, Farbital, Fiormor, Fiortal, Idenal, Isollyl, Lanorinal & others	Combination - Barbiturate	X	Pill	Acute	Aspirin is a pain reliever, anti-inflammatory, and fever reducer. Butalbital is part of a group of drugs called barbiturates, which have high risk for addiction and medication overuse headache (MOH). They are known to relax muscle contractions involved in tension headache. Caffeine is a stimulant that can relax muscle contractions in blood vessels to improve blood flow. The combination of aspirin, butalbital, and caffeine is used to treat tension headaches caused by muscle contractions.
Aspirin, Caffeine & Orphenadrine	Norgesic	Combination - NSAID	X	Pill	Acute	Orphenadrine, aspirin, and caffeine is a muscle relaxant and stimulant combination. It works by decreasing pain and inflammation, which helps muscles to relax. This combination relieves mild to moderate pain from certain muscle problems.
Atenolol	Tenormin	Beta blocker	X	Pill	Preventive	Atenolol is part of a group of drugs called beta blockers. Beta blockers affect the heart and the circulation of blood flow through arteries and veins. Atenolol is used to treat angina (chest pain) and hypertension. It may also be used to treat or prevent heart attack.
Atogepant	Qulipta	Small molecule CGRP receptor antagonist (Gepant)	X	Pill	Preventive	Atogepant is an oral CGRP receptor antagonist used for the preventive treatment of episodic migraine. Atogepant is chemically distinct from ubrogepant, an orally-administered CGRP receptor antagonist for the acute treatment of migraine. Atogepant has a longer half-life, making it suitable for preventive treatment. It was approved by the FDA in September 2021.
Baclofen	Lioresal, Gablofen	Muscle Relaxant	X	Pill	Acute	Baclofen 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/Barbitone	Medinal, Veronal	Barbiturate	X	Cachets, Pill	Preventive	As barbital is a controlled substance, other substances have largely replaced barbital-based medications. When barbitone was first introduced, it was considered a great improvement over the existing hypnotics. It was used as a sleeping aid (hypnotic) from 1903 until the mid-1950s. Barbiturates have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment.
Bariatric surgery	-	-	X	Procedure	Preventive	Bariatic surgery, including gastric bypass, is a weight-loss surgical procedure. Weight reduction, by means of bariatric surgery, for obese individuals may contribute to a reduction in the frequency, severity, and duration of migraine attacks. The beneficial impact of weight loss on migraine has been noted to a comparable degree for both bariatric surgery and weight lost through lifestyle modification. Obesity is associated with an increased risk of progression from episodic to chronic migraine.
Budesonide	Entocort, Pulmicort, Rhinocort Aqua	Steroid	X	Nasal Spray, Pill	Preventive	Budesonide is a steroid that reduces inflammation in the body. Budesonide is primarily used to treat mild to moderate Crohn's disease.
Buprenorphine	Buprenex, Temgesic	Opioid	X	Injection, Pill	Acute	Buprenorphine is an opioid analgesic. It works on the brain and nervous system to decrease pain. It can help relieve moderate to severe pain. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment.
Butalbital	-	Barbiturate	X	-	Acute	Butalbital has been discontinued as a single agent and is not recommended as a single agent or in combination drugs, due to high risk for addiction and medication overuse headache (MOH). It is known to relax muscle contractions involved in a tension headache. Butalbital is often combined with other medications, such as acetaminophen, aspirin, and codeine for the treatment of headache.
Candesartan	Blopress, Atacand, Amias, Ratacand	Hypertension	X	Pill	Preventive	Candesartan is an angiotensin II receptor blocker (ARB). It works by relaxing blood vessels. This helps to lower blood pressure. Candesartan is used to treat high blood pressure alone or with other medicines. It is used in certain patients to treat heart failure. It may also be used for other conditions as determined by your doctor.
Cannabidiol oil (CBD)	Hundreds of OTC brands	Phytocannabidiol		Topicals, Edibles, Oils, Sublingual, & Vapors	Acute & Preventive	CBD is the nonpsychoactive part of the cannabis, or marijuana, plant. CBD oil is made by extracting CBD from the cannabis plant then diluting it with a carrier oil. It has quickly become popular in the health and wellness community, with several research-backed studies suggesting it may be helpful in alleviating such conditions as anxiety, depression, and chronic pain, including migraine. It comes in many formats including edibles such as gummies and baked goods, topical creams and gels, among others. Epidiolex is the first FDA-approved prescription for highly purified CBD oil which is used in some forms of epilespy.
Carbamazepine	Carbatrol, Epitol, Equetro, TEGretol, TEGretol XR	Anticonvulsant	X	Pill	Preventive	Carbamazepine is an anticonvulsant. It works by decreasing nerve impulses that cause seizures and pain. Carbamazepine is used to treat seizures and nerve pain such as trigeminal neuralgia and diabetic neuropathy. It is also used to treat bipolar disorder.
Carvedilol	Coreg	Beta blocker	X	Pill	Preventive	Carvedilol is a beta blocker. Beta blockers affect the heart and blood circulation. Carvedilol is used to treat heart failure and hypertension. It is also used after a heart attack that has compromised your heart’s ability to function effectively.
Celecoxib	Bextra, Celebrex, Elyxyb, Vioxx	Nonsteroidal anti-inflammatory drugs (NSAIDs)	X	Liquid, Pill	Acute & Preventive	Celecoxib is an NSAID. It works by reducing hormones that cause inflammation and pain in the body. Celecoxib is used to treat pain or inflammation caused by many conditions such as arthritis, ankylosing spondylitis, and menstrual pain. Celecoxib is also used in the treatment of hereditary polyps in the colon. Vioxx and Bextra are no longer available due to increased risk of heart attack and stroke. It is sometimes recommended before exercise to prevent a migraine attack. Celebrex is the only brand available in the U.S. Vioxx and Bextra are no longer available due to increased risk of heart attack and stroke. Elyxcyb is an oral liquid format.
Celecoxib	Celebrex, Vioxx, Bextra	COX inhibitor	X	Pill	Acute & Preventive	A subclass of NSAIDs that work by reducing the production of prostaglandins, the chemicals that promote inflammation, pain, and fever. The enzymes that produce prostaglandins are called cyclooxygenase (COX). There are two types: COX-1 and COX-2. Unlike older NSAIDs that block both inhibitors, the newer COX-2 inhibitors only block the COX-2 enzyme. Sometimes recommended before exercise to prevent a migraine attack. Celebrex is the only brand available in the U.S. Vioxx and Bextra are no longer available due to increased risk of heart attack and stroke.
Cetirizine	Zyrtec	Antihistamine		Pill	Acute	Cetirizine is an antihistamine that reduces the natural chemical histamine in the body. Histamine can produce symptoms of sneezing, itching, watery eyes, and runny nose. Cetirizine is used to treat cold or allergy symptoms such as sneezing, itching, watery eyes, or runny nose. It is also used to treat itching and swelling caused by hives.
Chlorpromazine	Largactil, Thorazine	Other - schizophrenic & bipolar	X	Injection, Pill, Suppository	Preventive	Chlorpromazine is a phenothiazine. The exact way chlorpromazine works is not known. It is used to treat certain mental or mood disorders (e.g. schizophrenia), the manic phase of manic-depressive disorder, anxiety and restlessness before surgery, the blood disease porphyria, severe behavioral and conduct disorders in children, nausea and vomiting, and severe hiccups. It is also used with other medicines to treat symptoms associated with tetanus.
Citalopram	Cipramil, Celexa	Antidepressant	X	Pill	Preventive	Citalopram is a selective serotonin reuptake inhibitor (SSRI). This medication works by helping to restore the balance of serotonin in the brain. Citalopram is used to treat depression. It may improve your energy level and feelings of well-being. Leading neurologist Dr. Andrew Charles has flagged SSRI medications as having the potential to make migraine worse. If you take an SSRI and have migraine, consider discussing with your doctor whether an alternative medication might be right for you.
Clonazepam	Klonopin	Benzodiazepines	X	Pills Tablets	Acute	Clonazepam belongs to a group of drugs called benzodiazepines and is known as an anticonvulsant drug. It is used as a treatment to prevent and control seizures and also for panic attacks, insomnia, and anxiety disorders. Clonazepam works by calming down the brain and nerves.
Clonidine	Catapres, Dixarit, Kapvay	Hypertension	X	Pill	Preventive	Clonidine lowers blood pressure by decreasing the levels of certain chemicals in your blood. This allows your blood vessels to relax and your heart to beat more slowly and easily. Clonidine is used to treat hypertension. The Kapvay brand of clonidine is used to treat attention deficit hyperactivity disorder (ADHD).
Codeine	Migraleve	Opioid	X	Pill, Suppository	Acute	Codeine is used to treat mild to moderately severe pain. Codeine or 3-methylmorphine (a naturally occurring methylated morphine) is an opiate used for its analgesic, antitussive, antidiarrheal, antihypertensive, anxiolytic, antidepressant, sedative, and hypnotic properties. It is also used to suppress premature labor contractions, myocardial infarction, and for many other uses. It is often sold as a salt in the form of either codeine sulfate or codeine phosphate in the United States and Australia. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment.
Combination therapy	-	-	X	Various	Preventive	Combination therapy uses more than one method of treatment for a condition. An example of combination therapy for migraine prevention is using both Botox and a CGRP monoclonal antibody. An example of combination therapy for a migraine attack is using both a neuromodulation device and a triptan.
CPAP machine	RESmart, ResMed, Philips, Fisher & Paykel	Ventilator	X	Device	Preventive	Continuous 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.
Cyclobenzaprine	Amrix, Fexmid, Flexeril	Muscle relaxant	X	Pill	Acute	Cyclobenzaprine is a muscle relaxant. It works by blocking nerve impulses or pain sensations that are sent to your brain. It is used together with rest and physical therapy to treat skeletal muscle conditions such as pain or injury.
Cyproheptadine	Periactin	Antihistamine	X	Pill	Preventive	Cyproheptadine is an antihistamine. It works by blocking the action of histamine to reduce allergy symptoms. Cyproheptadine is used to treat symptoms of allergic reactions caused by seasonal allergies, food, blood, or plasma. It is also used to treat mild, uncomplicated hives.
Desvenlafaxine	Khedezla, Pristiq	Antidepressant	X	Pill	Preventive	Desvenlafaxine is in the class of antidepressant drugs called selective serotonin and norepinephrine reuptake inhibitors (SNRI). SNRIs block or delay the reuptake of the neurotransmitters, serotonin and norepinephrine by the presynaptic nerves. This increases the levels of these two neurotransmitters in the synapse and tends to elevate mood. Serotonin-norepinephrine reuptake inhibitors (SNRIs) are used to treat depression, anxiety disorder, panic disorder and other mood disorders.
Diazepam	Valium	Other - psychoactive benzodiazepine	X	Injection, Pill, Suppository	Acute	Diazepam 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.
Diclofenac	Cambia, Cataflam, Voltaren-XR, Zipsor, Zorvolex, Voltaren	Nonsteroidal anti-inflammatory drugs (NSAIDs)		Injection, Gel, Pill Suppository	Acute	Diclofenac is an NSAID. It is used to treat mild to moderate pain, or signs and symptoms of osteoarthritis or rheumatoid arthritis. The Cataflam brand of this medicine is also used to treat menstrual cramps. Diclofenac oral powder (Cambia) is used to treat migraine attacks acutely.
Dihydroergotamine mesylate (DHE)	Dihydergot, DHE 45, Migranal, Trudhesa	Ergot alkaloid - derivative	X	Injection, Nasal spray	Acute	Dihydroergotamine (DHE) is used to treat acute migraine with or without aura, and cluster headaches. DHE is an ergot derivative. It works by constricting blood vessels in the brain, which can help to relieve migraine. Trudhesa, a DHE nasal spray targeting the upper nasal space, was approved by the FDA in September 2021; it is thought that the nasal spray allows the medication to work faster and more effectively.
Diltiazem	Cardizem, Cartia XT, Dilacor XR, Dilt-CD, Diltzac, Flunarizine, Matzim LA, Tiazac & others	Calcium channel blockers	X	Pill	Preventive	Diltiazem is part of a group of drugs called calcium channel blockers. These work by relaxing the muscles of your heart and blood vessels. Diltiazem is used to treat hypertension, angina (chest pain), and certain heart rhythm disorders.
Dimenhydrinate	Gravol, Dramamine & others	Antihistamine, antiemetic		Injection, Liquid, Pill, Suppository	Acute	Used to prevent and treat nausea, vomiting, and dizziness due to motion sickness. Gravol is used to control vomiting associated with migraine but it has largely been replaced by Zofran (ondansetron).
Diphenhydramine	Benadryl, Nytol, Simply Sleep & others	Antihistamine		Pill	Acute	Used to control high levels of histamine. May speed relief of migraine when taken with migraine medications.
Divalproex sodium	Depakote, Depakote ER, Depakote Sprinkles	Anticonvulsant	X	Pill	Preventive	Divalproex sodium affects chemicals in the body that may be involved in causing seizures. It is used to treat various types of seizure disorders. It is sometimes used together with other seizure medications. Divalproex sodium is also used to treat manic episodes related to bipolar disorder and to prevent migraine headaches.
Domperidone	Molax, Motilium, Motinorm Costi, Nomit	Antiemetic	X	Injection, Pill, Suppository	Acute	Antiemetics help relieve the nausea associated with migraine attacks. Domperidone helps increase the transit of food through the stomach which helps facilitate its antinausea properties.
Dosulepin/Dothiepin	Prothiaden, Dothep, Thaden, Dopress	Antidepressant	X	Pill	Preventive	Dosulepin is a tricyclic antidepressant. This class of antidepressants is named after its chemical structure, which contains three rings of atoms. Today they have largely been replaced in clinical use by newer classes of antidepressants.
Doxylamine	Restavit, Dozile	Antihistamine		Pill	Acute	Doxylamine is an antihistamine. It works by depressing the central nervous system to produce drowsiness. Doxylamine is used to treat occasional sleeplessness and reduce difficulty falling asleep.
Doxylamine, Paracetamol & Codeine	Mersyndol	Antihistamine		Pill	Acute	Mersyndol is an analgesic intended for short-term use to relieve moderate pain and fever. Paracetamol and codeine are both active ingredients designed to help reduce pain. See Codeine & Paracetamol. Doxylamine is a type of antihistamine that can cause drowisness and/or have a calming effect.
Duloxetine	Cymbalta	Antidepressant	X	Pill	Preventive	Duloxetine is a selective serotonin and norepinephrine reuptake inhibitor (SNRI). SNRIs block or delay the reuptake of the neurotransmitters, serotonin and norepinephrine, by the presynaptic nerves. This increases the levels of these two neurotransmitters in the synapse and tends to elevate mood. SNRIs are used to treat depression, anxiety disorder, panic disorder, and other mood disorders. Duloxetine can also be useful in the treatment of fibromyalgia and allodynia.
Ear insufflation therapy	-	Neuromodulation	X	Procedure	Acute	Ear insufflation therapy is the administration of small bursts of air or ozone gas to the ear drum via a tool called a pneumatic otoscope. Researchers believe these controlled puffs of air stimulate pressure-activated nerve receptors found in the ears, resetting the pain centers in the brain. This in-office procedure is not currently FDA approved but rather a new and developing concept being investigated.
Eletriptan	Relpax	Serotonin 5-HT1 agonists or Triptans	X	Pill	Acute	Eletriptan is a second-generation triptan drug intended for the treatment of migraine. It is used as an abortive treatment to help block a migraine attack that is already in progress.
Eptinezumab	Vyepti	CGRP monoclonal antibody	X	IV Infusion	Preventive	Eptinezumab is a preventive CGRP monoclonal antibody approved by the FDA in February 2020. CGRP monoclonal antibodies attach to the calcitonin gene-related peptide (CGRP) and inactivate it. Eptinezumab is given as an IV infusion four times a year.
Erenumab	Aimovig	CGRP monoclonal antibody	X	Injection	Preventive	Erenumab is a preventive CGRP monoclonal antibody approved by the FDA in May 2018. This CGRP monoclonal antibody attaches to CGRP receptors to inhibit its function. Erenumab is self administered monthly. An FDA warning was added for erenumab about high blood pressure after the first dose. If you are on erenumab or start it, you should monitor your blood pressure.
Ergotamine tartrate	Cafergot, Ergomar, Migril	Ergot alkaloid - derivative	X	Pill, Suppository	Acute	Ergotamine is an ergot derivative. It works by narrowing blood vessels in the brain, which can help to relieve migraine. Some brands, like Cafergot, also contain caffeine.
Escitalopram	Lexapro	Antidepressant	X	Pill	Preventive	Escitalopram is a selective serotonin reuptake inhibitor (SSRI). It works by restoring the balance of serotonin which helps to improve certain mood problems. It is used to treat depression or generalized anxiety disorder. Leading neurologist Dr. Andrew Charles has flagged SSRI medications as having the potential to make migraine worse. If you take an SSRI and have migraine, consider discussing with your Doctor whether an alternative medication might be right for you.
Estrogen patch	Alora, Estraderm, EstroGel, Vivelle & others	Estradiol hormone	X	Transdermal patch	Preventive	An estrogen patch used for 7 to 10 days during the tail end of the menstrual cycle before a menstrual period may blunt the cyclic fall in estrogen and prevent a menstrual migraine.
Eszopiclone	Lunesta	Hypnotic	X	Pills Tablets	Acute	Eszopiclone is a sedative, also called a hynoptic. It affects chemicals in one's brain that may be unbalanced in people with insomnia. Eszopiclone causes relaxation to help one fall asleep and stay asleep.
Eye Drops – Dry Eyes	Artificial Tears, Cyclosporine, Restasis	Immunosuppressant	X	Eye drops	Preventive	Because dry-eye symptoms are prevalent in people with migraine, doctors may prescribe artificial tears. Nonprescription eye drops contain preservatives, while prescription formulas like Cyclosporine or Restasis do not. Both decrease inflammation that can cause dry eyes and discomfort for people with migraine.
Eye drops – Glaucoma	Levobunolol, Timolol	Beta blocker	X	Eye drops	Acute & Preventive	Beta 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.
Famciclovir	Famvir	Antiviral	X	Pill	Preventive	Famciclovir is an antiviral drug that is used to treat infections caused by certain types of viruses. It treats shingles caused by herpes zoster and outbreaks of herpes simplex. In people with frequent outbreaks of genital herpes, famciclovir is used to help reduce the number of future episodes. It can also be useful in the treatment of fibromyalgia and allodynia, often in conjunction with other medications.
Fludrocortisone	Florinef Acetate	Steroid	X	Pill	Preventive	Fludrocortisone is a corticosteroid. It works by causing the kidneys to retain sodium and acting as a replacement for cortisone when the body does not produce enough. It is used to treat adrenocortical insufficiency in Addison’s disease and for treating salt-losing adrenogenital syndrome.
Flunarizine	Sibelium	Calcium channel blockers	X	Pill	Preventive	Flunarizine is part of a group of drugs called calcium channel blockers. These work by relaxing the muscles of your heart and blood vessels. Flunarizine reduces calcium entry into neurons making them less “excitable.”
Fluoxetine	Lovan, Prozac, Sarafem	Antidepressant	X	Pill	Preventive	Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) antidepressant used to treat major depressive disorder, bulimia nervosa, obsessive-compulsive disorder, panic disorder, and premenstrual dysphoric disorder (PMDD). Leading neurologist Dr. Andrew Charles has flagged SSRI medications as having the potential to make migraine worse. If you take an SSRI and have migraine, consider discussing with your Doctor whether an alternative medication might be right for you.
Fluvoxamine	Luvox	Antidepressant	X	Pill	Preventive	Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI). It works by restoring the balance of serotonin, a natural substance in the brain, which helps to decrease obsessive or compulsive behavior. It is used to treat obsessive-compulsive disorder (OCD) and other conditions. Leading neurologist Dr. Andrew Charles has flagged SSRI medications as having the potential to make migraine worse. If you take an SSRI and have migraine, consider discussing with your doctor whether an alternative medication might be right for you.
Fosaprepitant	Emend for Injection	Neurokinin 1 receptor antagonist (antiemetic)	X	Injection	Acute	Used to prevent chemotherapy-induced or postoperative nausea and vomiting and for CVS (Cyclic Vomiting Syndrome, a migraine variant). Also used to control nausea and vomiting related to intravenous DHE (dihydroergotamine).
Fremanezumab	Ajovy	CGRP monoclonal antibody	X	Injection	Preventive	Fremanezumab is a preventive monoclonal antibody approved by the FDA in September 2018 for the prevention of migraine. This CGRP monoclonal antibody attaches to CGRP and inactivates it. Ajovy is self administered monthly or quarterly, as your physician advises.
Frovatriptan	Frova, Migard	Serotonin 5-HT1 agonists or Triptans	X	Pill	Acute	Frovatriptan is a triptan. It works by narrowing the blood vessels in the brain, which helps to relieve migraine. It is used to treat acute migraine with or without aura in adults. It should not be used as a migraine preventive.
Gabapentin	Gralise, Horizant, Neurontin, Gabarone	Anticonvulsant	X	Pill	Preventive	Gabapentin is an anticonvulsant medication. It affects chemicals and nerves in the body that are involved in the cause of seizures and some types of pain. Gabapentin is used in adults to treat nerve pain caused by herpes virus or shingles. The Horizant brand is also used to treat restless legs syndrome (RLS). The Neurontin brand is also used to treat seizures in adults and children who are at least 3 years old.
Galcanezumab	Emgality	CGRP monoclonal antibody	X	Injection	Preventive	Galcanezumab is a CGRP monoclonal antibody approved by the FDA in September 2018 for prevention of migraine, and for treatment of episodic cluster headache in June 2019. This CGRP monoclonal antibody attaches to CGRP and inactivates it. Emgality is self administered monthly for migraine. For cluster, it is self administered initially at a loading dose at the start of a cluster period and then monthly until the end of the cluster period.
Greater occipital nerve (GON) block	Decadron, Dexamethasone Intensol, Dexasone, Solurex, Baycadron / Xylocaine, XTLido & others	Other - steroid & anesthetic	X	Injection	Preventive	This treatment injects a steroid and lidocaine into the greater occipital nerve (GON) to block pain messages to the brain from the GON. The occipital nerves are two pairs of nerves originating in the upper cervical vertebrae. The GON is located beneath the scalp in the back of the head. This region of the brain deals with vision including color recognition, spatial awareness, and word recognition. Most people who have migraine and headache also have tenderness in the suboccipital region of the skull. In cases where migraine is resistant to medication, or treatment is hindered by adverse effects, a GON block may be explored.
Hormone Therapy	-	Other - hormones	X	Pill	Preventive	Hormone replacement therapy (HRT) refers to any form of hormone therapy where the patient receives hormones, either to supplement a lack of naturally occurring hormones, or to substitute other hormones for naturally occurring hormones. HRT is typically prescribed for those experiencing either natural or surgically induced menopause. The main types of hormones involved are estrogens, progesterone or progestins, and sometimes testosterone. For pre-menopausal use, contraceptive pills containing hormones may be used to skip periods (and can avert menstrual migraine).
Hydrocodone	Hysingla ER, Zohydro ER	Opioid	X	Nasal Spray, Pill, Suppository	Acute	Hydrocodone is an opioid pain medication. Zohydro ER and Hysingla ER are extended-release forms of hydrocodone that are used for around-the-clock treatment of severe pain. Extended-release hydrocodone is not for use on an as-needed basis for pain. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment.
Hydromorphone	Dilaudid-HP, Jurnista	Opioid	X	Pill	Acute	Hydromorphone is an opioid analgesic. It works in the brain and nervous system to reduce pain. It is used to treat moderate to severe pain in opioid-tolerant patients who require larger than usual doses to provide adequate pain relief. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment.
Hydroxyzine	Atarax, Alamon, Equipose, Vistaril IM, Hyzine, Rezine, Vistaril IM, Vistazine & others	Antihistamine	X	Injection, Pill	Acute	Hydroxyzine reduces activity in the central nervous system. It also acts as an antihistamine that reduces natural chemical histamine in the body. Histamine can produce symptoms of sneezing and runny nose, or hives on the skin. Hydroxyzine is used as a sedative to treat anxiety and tension. It is also used with other medications for anesthesia. Hydroxyzine may also be used to control nausea and vomiting, and to treat allergic skin reactions such as hives or contact dermatitis.
Ibuprofen	Advil, Genpril, IBU, Midol, Motrin, Nuprin, Nurofen & others	Nonsteroidal anti-inflammatory drugs (NSAIDs)		Injection, Pill, Suppository, Topical	Acute	Ibuprofen is an NSAID that works by reducing hormones that cause inflammation and pain in the body. Ibuprofen is used to reduce fever and treat pain or inflammation caused by many conditions such as headache, toothache, back pain, arthritis, menstrual cramps, or minor injury.
Ibuprofen & Codeine	ProVen Plus, Rafen Plus, Panafen Plus, Nurofen Plus	Nonsteroidal anti-inflammatory drugs (NSAIDs)		Pill	Acute	Ibuprofen, an NSAID, combined with codeine, an opioid, is used to reduce pain and inflammation. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment. See ibuprofen and codeine for their separate descriptions.
Indomethacin	Indocin, Indocid	Nonsteroidal anti-inflammatory drugs (NSAIDs)	X	Injection, Pill, Suppository, Topical	Acute	Indomethacin is used to treat patent ductus arteriosus (PDA) in certain premature infants. It is thought to work by blocking the action of a certain chemical in the body called prostaglandin.
Intrauterine Device (IUD)	Kyleena, Liletta, Mirena, ParaGard, Skyla	Other - hormones	X	Device	Preventive	An IUD is a T-shaped device that is inserted into the uterus as a birth control method. There are five types, four of which are hormonal (Liletta, Kyleena, Mirena, and Skyla) and one that is made of copper and is hormone free (ParaGard). For some women with menstrual migraine, continuous hormone treatment may be helpful in preventing attacks linked to falling estrogen levels.
Irbesartan	Abisart, Avapro	Hypertension	X	Pill	Preventive	Irbesartan is an angiotensin II receptor blocker (ARB), which relaxes blood vessels. This helps to lower blood pressure. It is also used in certain patients to treat kidney problems caused by diabetes.
Isometheptene mucate	Duradrin, Midrin	Other		Pill	Acute	Isometheptene works by causing the blood vessels in the brain to narrow. By decreasing the width of blood vessels, isometheptene helps relieve the pain from migraine attacks. It is often used in combination with other active ingredients. The British National Formulary states that, as more effective preparations are now available, this is no longer widely used.
Ketamine	Ketalar	Anesthetic	X	Injection, IV	Acute	Ketamine 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.
Ketoprofen	Actron, Orudis, Oruvail	Nonsteroidal anti-inflammatory drugs (NSAIDs)	X	Injection, Pill, Topical	Acute	Ketoprofen is an NSAID. Exactly how it works is not known. It may block certain substances in the body that are linked to inflammation. NSAIDs treat the symptoms of pain and inflammation. They do not treat the disease that causes those symptoms. Ketoprofen is used to treat rheumatoid arthritis or osteoarthritis, menstrual cramps and pain, and other conditions as determined by your doctor.
Ketorolac	Toradol	Nonsteroidal anti-inflammatory drugs (NSAIDs)	X	Injection, IV, Pill	Acute	Ketorolac is an NSAID indicated for short-term management of moderate to severe pain. Concerns about the high incidence of side effects has led to restriction in its dosage and maximum duration of use. In the U.K., treatment should be initiated only in a hospital. Maximum duration of treatment should not exceed five days for tablets, or two days for continuous daily dosing with intravenous or intramuscular formulations. May be used intravenously in hospital or emergency settings. Ketorolac is used in the short-term treatment of moderately severe pain (usually after surgery), alone or in combination with other medicines.
Lasmiditan	Reyvow	5-HT1F receptor agonist (Ditan)	X	Pill	Acute	Like triptans, ditans work on serotonin receptors, but they work on the receptors that are not found on the blood vessels. Ditans are a potential acute therapy option for people with migraine who have heart conditions, as they avoid the blood vessels while working on similar mechanisms as triptans. Lasmiditan has been shown to work when migraine pain has progressed to moderate or severe.
Levetiracetam	Keppra	Anticonvulsant	X	Pill	Preventive	Levetiracetam is an anticonvulsant. Exactly how it works is not known, but it may work by slowing abnormal nerve impulses in the brain. Levetiracetam is used to treat partial-onset, myoclonic, or other types of seizures in patients with epilepsy. It may be used in combination with other medicines.
Lidocaine	Burn-O-Jel, LMX4, LMX5	Analgesic (painkiller)	x	Topical	Acute	Lidocaine is commonly used for numbing an area of the body to reduce pain or discomfort. Some topical lidocaine prescriptions can also be used to relieve nerve pain — these come in forms of gel or skin patches that can be worn on the neck, shoulders and forehead for migraine. Over-the-counter creams are also available to help relieve joint and muscle pain.
Lithium	Eskalith, Lithobid	Antimanic agent	X	Pill, Solution	Preventive	Lithium can be used to prevent hypnic headache, a type of headache that occurs exclusively during sleep and awakens the patient. Taken at bedtime, lithium has been shown to be effective in preventing a hypnic headache attack from occurring. Lithium is also indicated for use as a mood stabilizer to treat manic episodes associated with bipolar disorder. Lithium should be used with caution in cases of kidney or thyroid disease, dehydration, or in conjunction with diuretics.
Loratadine	Alavert, Alavert Allergy, Claritin, lear-Atadine, Clear-Atadine Children's, Dimetapp ND,Tavist ND, Wal-itin & others	Antihistamine		Pill	Acute	Loratadine 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.
Lorazepam	Ativan	Benzodiazepines	X	Pills, Tablets, injection	Acute	Lorazepam belongs to a group of drugs called benzodiazepines and is used to treat the symptoms of anxiety disorders. It is thought lorazepam works by enhancing the activity of certain neurotransmitters in the brain.
Marijuana/Medical cannabis	-	-	X	Edibles, Pill+E236, Tea, Oils	Acute	The 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.
Meclizine	Antivert, Bonine, Dramamine Less Drowsy	Antiemetics		Pills	Acute & Preventive	Meclizine is an antiemetic with less associated drowsiness than some other antiemetics. It is used to help prevent motion sickness and treat dizziness (vertigo), both of which can be symptoms of migraine.
Mefenamic acid	Ponstan, Ponstel	Nonsteroidal anti-inflammatory drugs (NSAIDs)		Pill	Acute	Mefenamic acid is an NSAID. Exactly how it works is not known. It may block certain substances in the body that are linked to inflammation. NSAIDs treat the symptoms of pain and inflammation. Mefenamic acid is used for menstrual pain. It may be used for short term (no more than 7 days) treatment of mild to moderate pain.
Meloxicam	Mobic, Movalis	Nonsteroidal anti-inflammatory drugs (NSAIDs)	X	Pill	Acute	Meloxicam is an NSAID that works by reducing hormones that cause inflammation and pain in the body. Meloxicam is used to treat pain or inflammation caused by osteoarthritis or rheumatoid arthritis in adults and children who are at least 2 years old.
Memantine	Abixa, Akatinol, Axura, Ebixa, Memox, Namenda	Other - central nervous system agent	X	Pill	Preventive	Memantine 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.
Meperidine	Demerol	Opioid	X	Injection, Pill	Acute	Meperidine is an opioid analgesic. It works in the brain and nervous system to decrease pain. Meperidine is used in the short-term treatment of moderate to severe pain. It may also be used before or during surgery (e.g. to support anesthesia), for pain relief during labor and delivery, or for other conditions as determined by your doctor. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment.
Metaxalone	Skelaxin	Muscle relaxant	X	Pill	Acute	Metaxalone is a muscle relaxant used to relax muscles and relieve pain caused by strains, sprains, and other musculoskeletal conditions. Its exact mechanism of action is not known, but it may be due to general central nervous system depression.
Methazolamide	GlaucTabs, Neptazane	Diuretic	X	Pill	Acute & Preventive	These medications are used to treat glaucoma, epilepsy, altitude sickness, periodic paralysis, idiopathic intracranial hypertension, and heart failure. Sometimes used to treat high-pressure headaches by lowering the production of spinal fluid.
Methocarbamol & Acetaminophen	Robaxin, Robaxacet	Muscle relaxant		Injection, Pill	Acute	Methocarbamol is a central muscle relaxant used to treat skeletal muscle spasms. It is used in conjunction with acetaminophen. See acetaminophen for a separate description of this medication.
Methyl salicylate	Menthoderm, Thera-Gesic Plus, Salonpas Pain Patch	Other - topical rubefacient		Topical	Acute	Methyl salicylate, or menthol cream, is a topical analgesic. It works by temporarily relieving minor pain. Topical rubefacients cause irritation and reddening of the skin, due to increased blood flow. They are used in the treatment of pain in various musculoskeletal conditions and in the temporary relief of minor aches and pains caused by arthritis, simple backache, strains, sprains, and bruises.
Methysergide	Deseril, Sansert	Anti-serotonergic (Anti 5-HT)	X	Pill	Preventive	The exact way that methysergide works is unknown. It is believed to be involved in narrowing the veins and arteries that supply blood to your head. Serotonin 5-HT is a chemical occurring in the body, and is thought to play a key role in migraine. These drugs block 5-HT2 receptors to stop the effects of 5-HT. Methysergide is a semi-synthetic ergot alkaloid. It should only be administered under hospital supervision because of potential side effects including retroperitoneal fibrosis and fibrosis of heart values and pleura.
Metoclopramide	Maxolon, Metozolv ODT, Pramin, Reglan	Antiemetic	X	Injection, Pill	Acute	Metoclopramide increases muscle contractions in the upper digestive tract which speeds up the rate at which the stomach empties into the intestines. It is used short term to treat heartburn caused by gastroesophageal reflux when other medications have not relieved symptoms. Metoclopramide is also used to treat slow gastric emptying in people with diabetes (also called diabetic gastroparesis) which can cause nausea, vomiting, heartburn, loss of appetite, and a feeling of fullness after meals.
Metoclopramide & Paracetamol	Anagrain, Metomax, Paramax	Combination - Analgesic & antiemetic		Pill	Acute	The combination of metoclopramide and paracetamol is used to treat the symptoms of migraine, both to relieve headache (the paracetamol) and to treat associated nausea and vomiting (the antiemetic). In addition to its direct antiemetic effect, metoclopramide also stimulates gastric emptying (prokinetic), which is often delayed during migraine attacks, and accelerates the absorption of paracetamol.
Metoprolol	Dutoprol, Betaloc, Lopressor	Beta blocker	X	Pill	Preventive	Metoprolol is a beta blocker that affects the heart and circulation. Metoprolol is used to treat angina (chest pain) and hypertension. It is also used to treat or prevent heart attack.
Mini-prevention	-	-	X	Various	Preventive & Acute	Mini-prevention involves keeping a diary or journal to track days of migraine attacks to identify the days at risk in advance and then treat in anticipation of those days. Treating in anticipation of risk involves starting treatment a day before the attack onset (or the morning of) and then continuing treatment twice daily for five to seven days. A person would continue this regimen regardless of whether an attack is occurring because the likelihood of an attack in that time period is high. Mini-prevention is especially helpful for the treatment of menstrually related migraine.
Mirtazapine	Remeron	Antidepressant	X	Pill	Preventive	Mirtazapine is an antidepressant. It affects chemicals in the brain that may become unbalanced and cause depression. Mirtazapine is used to treat major depressive disorder.
Mometasone	Elocon, Nasonex	Steroid		Nasal Spray, Topical	Acute	Mometasone is a corticosteroid that works by reducing inflammatory reactions and modifying immune reactions in the body. The topical format is used for treating and preventing allergic nasal symptoms including congestion, sneezing, itching, and runny nose. It is also used for treatment of growths in the nose (nasal polyps). As a spray, it reduces inflammatory reactions in the nasal airway in response to allergens and irritants in the air. It is used to treat itching, redness, and swelling in many skin conditions.
Morphine	AVINza, Kadian, MS Contin	Opioid	X	Inhalation, Injection, Pill, Suppository	Acute	Morphine is an opioid pain medication. Morphine is used to treat moderate to severe pain. Short-acting formulations are taken as needed for pain. The extended-release form of this medicine is for around-the-clock treatment of pain and is not for use on an as-needed basis for pain. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment.
Moxonidine	Physiotens	Hypertension	X	Pill	Preventive	Moxonidine 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.
Nadolol	Corgard	Beta blocker	X	Pill	Preventive	Nadolol is a beta blocker. It works by slowing down the heart and decreasing the amount of blood it pumps out. This helps to decrease blood pressure, helps the heart pump more efficiently, and reduces the workload on the heart. Nadolol is used in the long-term management of angina (chest pain). It is also used alone or with other medicines to treat high blood pressure.
Naproxen	Aleve, Anaprox, Midol Extended Relief, Naprelan 375, Naprosyn, Synflex & others	Nonsteroidal anti-inflammatory drugs (NSAIDs)		Pill	Acute	Naproxen is an NSAID that works by reducing hormones that cause inflammation and pain in the body. Naproxen is used to treat pain or inflammation caused by conditions such as arthritis, ankylosing spondylitis, tendinitis, bursitis, gout, or menstrual cramps. Naproxen is the preferred NSAID for long-term use in people with a high risk of cardiovascular complications, due to its relatively low risk of causing such complications.
Naratriptan	Amerge, Naramig	Serotonin 5-HT1 agonists or Triptans	X	Pill	Acute	Naratriptan 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.
Nimodipine	Nimotop	Calcium channel blockers	X	Injection, Pill	Preventive	Nimodipine is a calcium channel-blocking agent. Exactly how nimodipine works is unknown. It is used to help reduce problems from a lack of oxygen caused by bleeding from a blood vessel in the brain.
Nitrazepam	Alodorm, Insoma, Mogadon, Nitrosun, Ormodon, Paxadorm, Somnite & others	Hypnotic	X	Pill	Acute	Nitrazepam is a hypnotic drug of the benzodiazepine class, indicated for the short-term relief of severe, disabling anxiety and insomnia. It also has sedative and motor-impairing properties, as well as amnestic, anticonvulsant, and skeletal muscle relaxant effects.
Nonsteroidal anti-inflammatory drugs (NSAIDs)	Advil, Bayer Aspirin, Aleve, Celebrex, Miniprin, Motrin, Ponstel, Voltaren & others	Nonsteroidal anti-inflammatory drugs (NSAIDs)		Pill	Acute & Preventive	Nonsteroidal anti-inflammatory drugs (NSAIDs) are a group of medicines that reduce inflammation and relieve pain and fever. There are many different kinds of NSAIDs which can be grouped according to their preference for COX-1 and COX-2 enxymes. NSAIDs are used to treat mild-to-moderate pain from a wide range of conditions including headaches, migraine attacks, arthritis, toothache and fevers.
Nortriptyline	Allegron, Pamelor	Antidepressant	X	Pill	Preventive	Nortriptyline belongs to a group of medicines called tricyclic antidepressants (TCAs). It is used to treat depression and some other conditions. It affects chemicals in the brain that may become unbalanced.
Omega Procedure (see also Reed Procedure®)	-	Neuromodulation	X	Surgically implanted neuromodulation	Preventive	The Omega Procedure is a trademarked surgical procedure for patients diagnosed with chronic migraine that involves implanting an occipital-nerve stimulator beneath the skin while the patient is under general anesthesia. It requires an initial minor surgery for a trial period, and a second surgery for permanent implantation as well as a battery-pack change every 10 years. Removal or repair requires surgery. The Omega Procedure and the Reed Procedure® are the same surgical procedure; the difference is solely in their registered names. From a practical standpoint, the difference comes in the relative experience of the physicians involved. Not FDA approved.
OnabotulinumtoxinA	Botox	Muscle relaxant	X	Injection	Preventive	OnabotulinumtoxinA (Botox), also called botulinum toxin type A, is made from the bacteria that causes botulism. Botulinum toxin blocks nerve activity in the muscles, causing a temporary reduction in muscle activity. Botox can be used to prevent chronic migraine in adults but should not be used to treat tension headache. It is an in-office procedure where multiple injections are inserted into the muscles of the forehead, head and neck. Treatment is repeated every 12 weeks if successful; however, there are maximum dose limits to be aware of. Botox is also used for other conditions and for cosmetic purposes.
Ondansetron	Zofran, Zofran ODT, Zuplenz	Antiemetic	X	Injection, Pill	Acute	Ondansetron blocks the actions of chemicals in the body that can trigger nausea and vomiting. It is used to prevent nausea and vomiting that may be caused by surgery or by medicine to treat cancer (chemotherapy or radiation).
Other neuromodulation devices	Relivion MG	Neuromodulation	X	Device	Acute	Relivion is a smartphone-controlled, cloud-connected, multichannel neuromodulation device. It offers precise, personalized care by delivering stimulation to six branches of the occipital and trigeminal nerves via three adaptive output channels. This creates a cumulative effect by releasing neurotransmitters in the brain stem and modulating brain networks associated with control of pain and mood. Approved as an OTC in Europe in July 2019. Cleared by FDA in March 2021 and is available with a prescription in the United States.
Oxycodone	Endone, Oxecta, OxyContin, Oxyfast, Roxicodone	Opioid	X	Injection, Pill, Suppository	Acute	Oxycodone is an opioid pain medication used to treat moderate to severe pain. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment.
Oxygen	-	Inhalant/Device	X	Cannula/Mask	Acute & Preventive	It has been shown that oxygen causes a marked decrease in cerebral blood flow concurrent with a reduced degree of pain in cluster headache. There are two high-flow oxygen delivery methods for migraines: normobaric and hyperbaric, with normobaric more effective for migraine.
Oxymetazoline nasal	Allerest, Afrin, Mucinex, Nostrilla, Sinex	Decongestant		Nasal Spray	Acute	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.
Pantoprazole	Protonix, Protonix IV, Somac	Proton-pump inhibitors	X	Injection, Pill	Acute	Pantoprazole is a proton-pump inhibitor that decreases the amount of acid produced in the stomach. It is used to treat erosive esophagitis and other conditions involving excess stomach acid, such as Zollinger-Ellison syndrome. Pantoprazole is not for immediate relief of heartburn symptoms. Leading neurologist Dr. Andrew Charles has flagged proton-pump inhibitors as having the potential to make migraine worse. If you use one and have migraine, consider discussing with your doctor whether an alternative medication might be right for you.
Paracetamol & Codeine	Paracodol	Opioid	X	Pill	Acute	Paracetamol combined with codeine phosphate is used for the relief of moderate to severe pain when milder painkillers are not effective. Paracetamol is an analgesic and also an antipyretic, which helps reduce your body temperature if you have a fever. Codeine phosphate is also an analgesic and acts by blocking pain and emotional response to pain. See codeine for more detail. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment.
Paracetamol & Ibuprofen	Maxigesic	Combination - Analgesic & NSAID		Pill	Acute	For the temporary relief of mild to moderate pain associated with migraine, headache, backache, menstrual pain, dental pain, rheumatic and muscular pain, pain of non-serious arthritis, cold and flu symptoms, sore throat and fever. This combination is especially suitable for pain which requires stronger analgesia than ibuprofen or paracetamol alone.
Paracetamol (Acetaminophen)	Little Fevers, Panadol, Tylenol & others	Analgesic (painkiller)		Liquid, Pill, Suppository	Acute	Paracetamol is also known as Acetaminophen depending on where you live. A pain reliever and fever reducer, the exact mechanism of action of paracetamol is unclear. Many common pain conditions including headache, muscle aches, arthritis, backache, toothaches, colds, and fevers are treated with paracetamol. It relieves pain in mild arthritis but does not affect the underlying inflammation and swelling of the joint.
PFO valve closure	-	-	X	Procedure	Preventive	Multiple studies suggest that migraine with aura is more prevalent in subjects with patent foramen ovale (PFO), an open passage between the chambers of the heart. Several studies suggest that PFO closure, a surgical procedure, may be an effective treatment for migraine. However, the grade of evidence from these studies is low.
Phenylephrine Hydrochloride & Ibuprofen	Sudafed PE	Combination - Decongestant & NSAID		Pill	Acute	Contains ibuprofen and phenylephrine hydrochloride, which are effective in relieving the symptoms of influenza and cold, including fever, headache, painful sinuses, sore throat, and muscle and joint pain. Moreover, it helps relieve a runny or stuffy nose and nasal sinuses.
Phenylephrine Hydrochloride & Paracetamol	Dimetapp PE Sinus Pain, Lemsip Cold & Flu, Panadol Cold & Flu, Sudafed	Combination - Decongestant & Analgesic		Pill	Acute	This combination medication contains a decongestant & analgesic (paracetamol) and can help ease symptoms such as blocked or runny nose, sore throat, and body aches and headaches.
Pizotifen	Sandomigran	Anti-serotonergic (Anti 5-HT)	X	Pill	Preventive	Pizotifen acts on serotonin 5-HT, a chemical that is thought to play a key role in migraine. It is part of a class of drugs that block 5-HT2 receptors to inhibit the effects of 5-HT. Pizotifen also has antihistamine properties and is related to the tricyclic group of antidepressants.
Potassium	Various	Vitamin/Supplement	X	IV Infusiton, Pill, Liquid	Acute & Preventive	A mineral and electrolyte that assists in several body functions, including blood pressure, water balance, muscle contractions, digestion, heart rhythm and pH balance. It is sometimes taken in supplement form to balance electrolytes which are often low due to migraine and nausea.
Prednisone	Rayos, Sterapred	Steroid	X	Injection, Nasal Spray, Pill, Suppository,	Acute	Prednisone is a corticosteroid that prevents the release of substances in the body that cause inflammation. It is used as an anti-inflammatory or an immunosuppressant medication. Prednisone treats many different conditions such as allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, and breathing disorders.
Pregabalin	Lyrica	Anticonvulsant	X	Pill	Preventive	Pregabalin is an anticonvulsant and neuropathic pain agent. Exactly how pregabalin works is not known. It is thought to bind to certain areas in the brain that help reduce seizures, nerve pain, and anxiety. Pregabalin is used to treat fibromyalgia or nerve pain caused by certain conditions (e.g., shingles, diabetic nerve problems, spinal cord injury). It is also used in combination with other medicines to treat certain types of seizures. Pregabalin can also be useful in the treatment of allodynia.
Prochlorperazine	Compazine, Stemzine, Buccastem, Stemetil, Phenotil	Antiemetic & Antipsychotic	X	Injection, Pill, Suppository	Acute	Prochlorperazine is a phenothiazine. It is not known exactly how it works. It is a highly potent typical antipsychotic, 10–20× more potent than chlorpromazine. It is used to help control severe nausea and vomiting, and to treat schizophrenia. It is also used to treat migraine. Intravenous administration can be used to treat status migrainosus.
Promethazine	Phernergan, Phenadoz, Promethegan	Antihistamine & antiemetic	X	Injection, Pill, Suppository	Acute	Promethazine 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.
Propranolol	Hemangeol, Inderal LA, Inderal XL, InnoPran XL, Inderal	Beta blocker	X	Injection, Pill, Suppository	Preventive	Propranolol is a beta blocker. Beta blockers affect the heart and blood circulation. Propranolol is used to treat tremors, angina (chest pain), hypertension, heart rhythm disorders, and other heart or circulatory conditions. It is also used to treat or prevent heart attack and to reduce the severity and frequency of migraine.
Pseudoephedrine	Contac Cold, Elixsure Decongestant, Entex, Genaphed, Sudafed, Suphedrin, Unifed & others	Decongestant		Pill	Acute	Pseudoephedrine 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.
Quetiapine	Seroquel	Anti-psychotic	X	Pill	Preventive	Quetiapine is an atypical antipsychotic. Exactly how it works is not known. It is thought to affect certain substances in the brain. It is used to treat schizophrenia or bipolar disorder.
Radiofrequency ablation	-	-	X	Procedure	Preventive	Radiofrequency ablation or neurotomy is an in-office procedure that uses heat generated by radio waves to target specific nerves and temporarily turn off their ability to send pain signals. Due to the proximity to other nerves in the face, a high degree of technical precision is necessary to perform the procedure. Radiofrequency ablation is generally considered for the treatment of chronic headaches that have failed to respond to other treatments or procedures.
Reed Procedure® (see also Omega Procedure)	-	Neuromodulation	X	Surgically implanted neuromodulation	Preventive	The Reed Procedure® is a surgical procedure for patients diagnosed with chronic migraine that involves implanting an occipital nerve stimulator beneath the skin while the patient is under general anesthesia. It requires an initial minor surgery for a trial period and a second surgery for permanent implantation as well as a battery pack change every 10 years. Removal or repair requires surgery. The Omega Procedure and the Reed Procedure® are the same surgical procedure; the difference is solely in their registered names. From a practical standpoint, the difference comes in the relative experience of the physicians involved. Not FDA approved.
Remote wearable neuromodulation (REN) device	Nerivio	Neuromodulation	X	Device	Acute	Nerivio is a wireless non-invasive remote electrical stimulation wearable device applied to the upper arm at the onset of migraine headache or aura. Nerivio induces an inherent pain inhibition brain mechanism, resulting in clinically significant pain relief. Nerivio is controlled by a smartphone app, which includes a treatment diary. It was FDA cleared for use in adults in October 2020 and for adolescents in January 2021.
Rimegepant	Nurtec ODT	Small molecule CGRP receptor antagonist (Gepant)	X	Orally-dissolving tablet	Acute & Preventive	Rimegepant is a gepant that treats acute migraine with or without aura by blocking CGRP receptors. CGRP is a brain chemical that causes vasodilation, inflammation, and pain at sites along the trigeminovascular pathway. Early studies show promise in the lack of association of gepants with medication overuse headache. It was FDA approved for acute treatment in February 2020 and for the preventive treatment of episodic migraine in June 2021.
Rizatriptan	Maxalt	Serotonin 5-HT1 agonists or Triptans	X	Pill, Sublingual	Acute	Rizatriptan is a triptan that works by narrowing dilated blood vessels in the brain, relieving migraine. It is used to treat migraine with or without aura. It should not be used to prevent migraine or to treat cluster headache.
Sertraline	Zoloft	Antidepressant	X	Pill	Preventive	Sertraline is an selective serotonin reuptake inhibitors (SSRIs) antidepressant. It is used to treat depression, obsessive-compulsive disorder, panic disorder, anxiety disorders, post-traumatic stress disorder (PTSD), and premenstrual dysphoric disorder (PMDD). Leading neurologist Dr. Andrew Charles has flagged SSRI medications as having the potential to make migraine worse. If you take an SSRI and have migraine, consider discussing with your medical practitioner whether an alternative medication might work for you.
Sodium valproate	Epilim	Anticonvulsant	X	Injection, Pill	Preventive	Valproate is an anticonvulsant that works by increasing a certain chemical in the brain. The injectable form of sodium valproate is used to control epileptic seizures in patients who are unable to take the oral form. It is also used for the treatment of migraine and bipolar disorder.
Sphenopalatine ganglion (SPG) device	Sphenocath, Allevio, & Tx360	Neuromodulation	X	Device	Preventive	The Sphenopalatine Ganglion (SPG) is a group of nerve cells that is linked to the trigeminal nerve, the main nerve involved in headache. Application of local anesthetics (or numbing medications) to block or partially block the SPG, can be helpful in reducing head and facial pain. Three devices have been approved for performing SPG blocks. A doctor inserts a very thin plastic tube into the nose to insert numbing medication in and around the SPG.
Sumatriptan	Imigran, Imitrex, Treximet, Zembrace Symtouch, Onzetra XSail, Sumavel DosePro	Serotonin 5-HT1 agonists or Triptans	X	Needle-less injection, Nasal Spray, Pill	Acute	Sumatriptan is a triptan that works by narrowing blood vessels in the brain, which helps to relieve migraine and cluster headache. Sumatriptan is used to treat migraine with or without aura. It is one of the most common treatments with numerous high quality studies demonstrating its efficacy for the treatment of acute migraine. It is also used to treat cluster headache. The Treximet brand is a combination of sumatriptan and naproxen sodium, both of which are available as generics.
Supraorbital TNS unit or External Trigeminal Nerve Stimulation (eTNS)	Cefaly	Neuromodulation	X	Device	Acute & Preventive	A battery-powered electrical stimulator that's applied to the forehead. The device activates a low-level electrical current intended to stimulate the upper branches of the trigeminal nerve, which transmits some of the pain associated with migraine. The Cefaly I is a headband; Cefaly II is a smaller rechargeable unit with adjustable intensity.
Telcagepant	-	Gepant/small molecule CGRP receptor antagonist		-	Acute & Preventive	Early CGRP treatment withdrawn from market by its manufacturer, Merck in 2009. A previous safety study showed patients taking it experienced elevated liver enzymes.
Timolol	Blocadren, Betimol, Betrim, Istalol, Timoptic	Beta blocker	X	Eye drops, Pill	Preventive	Timolol is part of a group of drugs called beta blockers. It is used to treat hypertension. Timolol eye drops are used to treat increased pressure in the eye (ocular hypertension) and open-angle glaucoma. It may also be used for other conditions as determined by your doctor.
Tizanidine	Zanaflex	Muscle relaxant	X	Injection, Nasal Spray, Pill	Acute	Tizanidine is a short-acting muscle relaxant. It works by blocking nerve impulses or pain sensations that are sent to your brain. Tizanidine is used to treat spasticity by temporarily relaxing muscle tone.
Topiramate	Topamax	Anticonvulsant	X	Pill	Preventive	Topiramate is an anticonvulsant that is also helpful to prevent migraine. It works by affecting several chemicals in the brain that help to reduce seizure activity and prevent migraine from occurring. It may be used alone or with other medications.
Tramadol	ConZip, Rybix ODT, Ryzolt, Ultram	Opioid	X	Injection, Pill, Suppository	Acute	Tramadol is a centrally-acting, oral opioid-like analgesic and is approved for the treatment of moderate to moderately severe pain in adults. The extended-release form of tramadol is for around-the-clock treatment of pain and not for use on an as-needed basis for pain.
Tramadol & Paracetamol (Acetominophen)	Tramacet, Ultracet	Opioid-like & Analgesic (painkiller)	X	Injection, Pill	Acute	This formulation combines individual ingredients for a stronger effect. See individual active ingredients for mode of action.
Transcranial Magnetic Stimulation (TMS) device	sTMS mini	Neuromodulation	X	Device	Acute & Preventive	TMS uses magnets to emit a single pulse of electricity. This pulse has been shown to treat cortical spreading depression (CSD), which is the physical change in the brain during aura and migraine. Research shows that daily use of TMS for 3 months or longer can lead to a reduction in acute medication use. eNeura’s sTMS mini is a TMS device available via prescription.
Transcutaneous electrical nerve stimulation (TENS) device	Cefaly, Icy Hot Smart Relief, Omron, truMedic	Neuromodulation	X	Device	Acute	TENS units are predominately used for nerve-related pain conditions, which may be acute or chronic. TENS machines work by sending stimulating pulses across the surface of the skin and along the nerve strands. The stimulating pulses help prevent pain signals from reaching the brain. TENS devices also help stimulate your body to produce higher levels of endorphins, its natural painkillers.
Ubrogepant	Ubrelvy	Small molecule CGRP receptor antagonist (Gepant)	X	Pill	Acute	Ubrogepant is a gepant designed to treat migraine with or without aura as well as the symptoms of light sensitivity, sound sensitivity, or nausea. Ubrogepant targets CGRP receptors, blocking the CGRP from attaching. CGRP is a brain chemical that causes vasodilation, inflammation and pain at sites along the trigeminovascular pathway. Early studies show promise in the lack of association of gepants with medication overuse headache. It was FDA approved for acute treatment in December 2019.
Vagus Nerve Stimulation (VNS) device	gammaCore	Neuromodulation	X	Device	Acute & Preventive	The vagus nerve runs from the brain stem through the chest and abdomen on each side of the body. Vagus nerve stimulation appears to inhibit cortical spreading depression as well as calm the brain’s excitability. A VNS device stimulates the production of inhibitory neurotransmitters in the brain, including GABA, serotonin, and norepinephrine, which affect migraine and cluster headache. gammaCore is a handheld VNS device that stimulates the nerves noninvasively when placed above the vagus nerve in the neck. It is FDA cleared in the United States for adjunctive use for the preventive treatment of cluster headache in adults; acute treatment of pain associated with episodic cluster headache in adults; acute and preventive treatment of migraine in adolescents (age 12+ years) and adults; and treatment of paroxysmal hemicrania and hemicrania continua in adults.
Valproic Acid	Depakene, Valproate Sodium, Depacon, Stavzor	Anticonvulsant	X	IV, Liquid, Pill	Preventive	Valproic acid is used to treat various types of seizure disorders, sometimes together with other seizure medications. Valproic acid is also used to treat manic episodes from bipolar disorder and to prevent migraine.
Venlafaxine	Effexor	Antidepressant	X	Pill	Preventive	Venlafaxine is an antidepressant in a group of drugs called selective serotonin and norepinephrine reuptake inhibitors (SNRIs). Venlafaxine affects chemicals in the brain that may become unbalanced and cause depression. Venlafaxine is used to treat major depressive disorder, anxiety, and panic disorder.
Verapamil	Calan, Isoptin	Calcium channel blockers	X	Injection, Pill	Preventive	Verapamil is a calcium channel blocker. It works by relaxing the muscles of your heart and blood vessels. Verapamil is used to treat hypertension, angina (chest pain), and certain heart rhythm disorders.
Zaleplon	Sonata	Hypnotic	X	Pills	Acute	Zaleplon is a sedative, also called a hynoptic. It affects chemicals in one's brain that may be unbalanced in people with insomnia. Zaleplon causes relaxation to help one fall asleep and stay asleep.
Zavegepant (formerly Vazegepant)	-	Small molecule CGRP receptor antagonist (Gepant)	X	Nasal Spray, Oral (in testing)	Acute	Zavegepant (formerly vazegepant) is a gepant currently in clinical trials. Trial participants treated with nasal zavegepant had rapid onset of pain relief at 15 minutes and returned to normal function as early as 30 minutes. The 10 mg and 20 mg zavegepant doses showed therapeutic benefits on both pain relief and return to normal function at 2 hours. Zavegepant is the first and only intranasal CGRP receptor antagonist in late-stage development. In September 2020, zavegepant received the go-ahead from FDA for clinical trials on oral formulations. Not yet FDA appoved as of March 2021.
Zolmitriptan	Zomig	Serotonin 5-HT1 agonists or Triptans	X	Nasal Spray, Pill	Acute	Zolmitriptan is a triptan that works by narrowing blood vessels in the brain, which helps to relieve migraine. It is used to treat migraine with or without aura in adults. It is not intended to prevent migraine attacks.
Zolpidem	Ambien, Edluar, Intermezzo, Stilnox, Zonadin, Sanval, Zolpimist Hypnogen	Hypnotic	X	Pill, Suppository	Acute	Zolpidem is a sedative, also called a hypnotic. It affects chemicals in your brain that may become unbalanced and cause sleep problems or insomnia. The immediate-release forms of zolpidem are Ambien, Intermezzo, Edluar, and Zolpimist. The extended-release form of zolpidem is Ambien CR. Ambien, Edluar, and Zolpimist are used to help you fall asleep when you first go to bed. Intermezzo is used to help you fall back asleep if you wake up in the middle of the night.
Zonisamide	Zonegran	Anticonvulsant	X	Pill	Preventive	Zonisamide 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

Introduction

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

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

Methodology

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

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

Organization

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

1) Medical; and
2) Nonmedical.

1) Medical Treatments

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

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

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

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

2) Nonmedical Treatments

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

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

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

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

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

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

How to Use this Treatment Directory

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

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

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

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

Tips

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

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

Warning

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

Disclaimers

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

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

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

TREATMENT MAP

 

 

2022 Migraine Treatment Guidelines Summary

Introduction

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

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

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

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

How to read this report

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

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

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

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

Important notes

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

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

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

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

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Preventive Treatment of Migraine in Adults

Level A: Established as effective

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

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

Notes on behavioral and device therapies:

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

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

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

eTNS
nVNS
REN
sTMS

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

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

Level B: Probably effective

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

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

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Acute Treatment of Migraine in Adults

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

Level A: Established as effective

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

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

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

Level B: Probably effective

Migraine-specific
Dihydroergotamine (other forms)
Ergotamine

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

Nonspecific antiemetics
Chlorpromazine
Droperidol
Metoclopramide
Prochlorperazine
Promethazine

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Migraine with Menstruation

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

Level A: Established as effective

Frovatriptan

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

Level B: Probably effective

Naratriptan
Zolmitriptan

Level C: Possibly effective

Estrogen

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Children & Adolescents

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

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

Low confidence in evidence

Ibuprofen OS 7.5-10 mg/kg
Acetaminophen / paracetamol

Very low confidence in evidence

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

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

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

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

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

Moderate: Probably no more likely than placebo.

Low: Possibly no more likely than placebo.

Results Summary (2019 AAN)

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

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

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

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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

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SOURCES:

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

Interview Summaries

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)

TITLE	EXPERT
DAY 1
New Research on the Real Migraine Patient Experience	Rebecca Wells, MD, MPH
Expert Tips to Manage Persistent Migraine Pain	Jessica Ailani, MD
Migraine Long Haulers: Lasting Effects	Matthew Robbins, MD
The Latest New Treatments for Migraine	Deborah Friedman, MD, MPH, FAAN
DAY 2
Persistent Chronic Migraine Symptoms Between Attacks	Christine Lay, MD, FAHS
10 Steps to Migraine Management Your Doctor Should be Taking	Messoud Ashina, MD
True Resilience: How a Paralympian Wins With Migraine	Allysa Seely
When Nothing Works: Treatment-Resistant Chronic Migraine	Amaal Starling, MD
DAY 3
Complementary and Integrative Treatments for Migraine	Elizabeth Leroux, MD, FRCPC
Autoimmune Disease and Migraine: A Closer Look	Peter McAllister, MD
Inflammation Control as Migraine Control	Gretchen Tietjen, MD
Ehlers-Danlos, Connective Tissue Disorders & Migraine	Vince Martin, MD
DAY 4
Physical Therapy Modalities for Headache & Pain	Ali Ladak, PT, DPT, PhD
Drug-Free Devices for Modulating Migraine	Deena Kuruvilla, MD, FAHS
Understanding The Genetics of Headache	Lyn Griffiths, PhD
Techniques for Managing Vestibular Migraine	Michael T. Teixido, MD
DAY 5
Long-Term Effects of New Migraine Medications	Robert Cowan, MD
Strategies to Boost Brain Health	Krystal L. Culler, DBH, MA
New Daily Persistent Headache: Causes, Symptoms & Treatment	David Dodick, MD
Food and Diets: A Nutritionist’s Take On How They Affect Migraine	Margaret Slavin, PhD, RDN
DAY 6
Chronic Cluster Headache	Christopher Gottschalk, MD, FAHS
Learning How to Sleep Better with Migraine	Alex Dimitriu, MD
How We Got to Now: A History of Migraine	Katherine Foxhall
Navigating COVID with Migraine in Europe	Patricia Pozo Rosich, MD, PhD
DAY 7
Osmophobia: Scent-Induced Migraine	Frederick Godley, MD
Chronic Disease on Social Media: Helpful or Harmful?	Cynthia E. Armand, MD
Best Practices for Treating Children With Migraine	Scott W. Powers, PhD, ABPP, FAHS
Women’s Health Inequities and Migraine	Monica P. Mallampalli, PhD
DAY 8
Staying Hopeful: Treatment Burnout in Chronic Disease	Dawn Buse, PhD
How Women’s Hormones Affect Migraine	Jelena Pavlovic, MD, PhD
The Latest Cannabis Research for Migraine	Nathaniel M. Schuster, MD
The Latest Developments in Migraine Research	Richard Lipton, MD

Welcome to your 2022 VIP Pass add-on package!

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

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

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

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

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VIP & Boxed Set Timings:

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

Boxed Set Deliveries:

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

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

Current 2022 Delivery Timeline:

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

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

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

Thank you,
Migraine World Summit Editorial Team

Interview Summaries

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

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

Click to View/Download the summaries (PDF)

To download a compilation of all summaries, click here.

TITLE	EXPERT
DAY 1
Why Doesn’t Migraine Have a Cure Yet?	Tissa Wijeratne, MD, FRACP, FAAN
Unlocking the Mystery of Migraine Pathogenesis	Peter Goadsby, MD
Latest Strategies for Chronic Migraine Control	Carrie Dougherty, MD, FAHS
Finding Resilience With Migraine, Its Comorbidities, and COVID	Noah Rosen, MD, FAHS
DAY 2
Discovering New Treatments Worth Trying	David Dodick, MD
Racial Inequities In Migraine Treatment	Sheila L. Thorne
What Causes Migraine and Its Symptoms	Catherine Stark, MD
Moving Through the Pain: Exercise and Migraine	Richard Lipton, MD
DAY 3
Preventing Attacks Before They Happen	Jan Lewis Brandes, MD
How Weight Affects Migraine Disease	Dale Bond, PhD
Light Sensitivity and Therapy for Migraine	Deborah Friedman, MD, MPH
How to Manage Weather Triggers	Jan Hoffmann MD, PhD
Is the Gut-Brain Connection at the Heart of Oral Migraine Treatment Failure?	Nada Hindiyeh, MD
DAY 4
How An Integrative Approach Can Help Migraine	Deena Kuruvilla, MD, FAHS
Headache and Migraine in Later Life	Matthew Robbins, MD
Recovering From Trauma and Concussion	Morris Levin, MD
Yoga For Migraine: Does It Help?	Adriane Dellorco
DAY 5
Migraine Diets and Food Triggers	Vince Martin, MD
Medications that Make Migraine Worse	Stewart J. Tepper, MD, FAHS
Finding Work That Works Despite Migraine	Melanie Whetzel, MA, CBIS
Difficult Diagnoses: Rare Headache Types	Shuu-Jiun Wang, MD
DAY 6
Shortening Attacks With Early Migraine Intervention	Andrew Charles, MD
Sex Headaches: Serious or Just Awkward?	Katherine Hamilton, MD
Autoimmune Disease and Migraine: What’s the Link?	Peter McAllister, MD
Managing Migraine With Little to No Insurance	David Watson, MD, FAAN
DAY 7
Juggling Multiple Conditions With Migraine	Rebecca C. Burch, MD, FAHS
Understanding Treatment Failure and Options	Simona Sacco, MD
Fighting Migraine With Food and Nutrition	Belinda Savage-Edwards, MD, FAAN, AQH
When Migraine Starts or Stays in Your Neck	Sait Ashina, MD
DAY 8
How Your Gut and Sleep Affect Migraine	Stasha Gominak, MD
COVID in the Real World	Lindsay Videnieks, JD
Understanding Vestibular Migraine	Shin Beh, MD
Overcoming Monthly Menstrual Migraine	Christine Lay, MD, FAHS

Welcome to your 2021 VIP Pass add-on package!

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

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

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

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

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VIP & Boxed Set Timings:

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

Boxed Set Deliveries:

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

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

Delivery Timeline:

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

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

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

Thank you,
Migraine World Summit Editorial Team.

Trigger Guides

These 17 Trigger Guides can help you identify and better manage your migraine triggers.

Click to View/Download the guides (PDF)

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• • • ALCOHOL GUIDE
    • CAFFEINE GUIDE
    • DEHYDRATION GUIDE
    • EXERCISE GUIDE
    • HEAD-RELATED GUIDE
    • HORMONES GUIDE
    • HUNGER GUIDE
    • ILLNESS TRIGGER GUIDE
    • JAW GUIDE
    • MEDICATION TRIGGER GUIDE
    • NECK GUIDE
    • NOISE GUIDE
    • ODOR GUIDE
    • SLEEP GUIDE
    • STRESS GUIDE
    • VISION GUIDE
    • WEATHER GUIDE

2021 Migraine Treatment Guidelines Summary

Introduction

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

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

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

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

How to read this report

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

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

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

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

Important notes

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

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

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

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

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

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NOTABLE NEW TREATMENTS

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

New since the last guidelines release

NEW MEDICAL ACUTE TREATMENTS

Lasmiditan (Reyvow)**

Rimegepant (Nurtec ODT)**

Ubrogepant (Ubrelvy)**

Neurolief device (Relivion)***

Remote wearable neuromodulation device (Nerivio)**

Zavegepant (in testing as an acute treatment)

NEW ACUTE AND PREVENTIVE TREATMENTS

Telcagepant

Vazegepant

NEW PREVENTIVE TREATMENTS

Atogepant (in testing as a preventive treatment)

Eptizenumab (Vyepti)**

Erenumab (Aimovig)**

Fremanezumab (Ajovy)**

Galcenezumab (Emgality)**

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

NEW NONMEDICAL PREVENTIVE TREATMENTS

Green-light lamp (Allay lamp)**

Important Notes:

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

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

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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

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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

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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

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Children & Adolescents

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

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

Low Confidence in Evidence

Ibuprofen OS 7.5-10 mg/kg

Acetaminophen / paracetamol

Very Low Confidence in Evidence

Sumatriptan nasal spray 5-10 mg

Sumatriptan oral tablet 25-50 mg

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

Moderate Confidence in Evidence

Sumatriptan nasal spray 5 mg (nausea and vomiting)

Low Confidence in Evidence

Sumatriptan nasal spray 10 mg (vomiting)

Very Low Confidence in Evidence

Sumatriptan nasal spray 10 mg (nausea)

Moderate: Probably no more likely than placebo.

Low: Possibly no more likely than placebo.

Results Summary (2019 AAN):

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

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

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

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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

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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

Quick Start Guide

Introduction

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

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

Methodology

That’s why we’ve crowd-sourced more than 300 medicinal and nonmedicinal treatments that those with migraine have self-reported they are using. Several are new in the 2021 edition of the Migraine World Summit Treatment Directory.

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

Organization

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

1) Medical; and
2) Nonmedical.

1) Medical Treatments

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

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

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 coming soon).

Major classes of off-label preventive drugs you’ll find here:

• Anticonvulsants – Originally designed to prevent seizures, these include topiramate and valproic 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.
• Injectables – These include the new class of CGRP monoclonal antibodies and other injectable treatments such as Botox or nerve blocks.
• 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) Nonmedical Treatments

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

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

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

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

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

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

How to Use this Treatment Directory

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

To discover new options. When you think you’ve tried everything, scrolling through this list may narrow down some new choices 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, a non-medicinal alternative, may be worth considering. You might even discover treatments that are just as effective with fewer side effects or that are 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 Control-F or Command-F) will help you find it quickly.

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

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

Tips

If you find yourself taking more Acute medications 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 better plan, including a different mix of Prevention + Acute treatments.

Change just one thing at a time. That way, you’ll be able to isolate the one variable you have changed to know if it is working.

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

Disclaimers

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

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

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

TREATMENT MAP

 

 

Medicinal 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)
• Rx: If a prescription is required to purchase a medication, it will be marked with ‘X’.
• Format: This refers to the different formats available for a treatment i.e. tablets, capsules, injection, intranasal, topical, etc.
• Preventive 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. Preventive 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 Names	Drug Class	RX	Format	Acute or Preventive Treatment	Description
Acetaminophen or Paracetamol	Little Fevers, Panadol, Tylenol and many others	Analgesic (painkiller)		Tablets, capsules, liquid, suppository	Acute	Acetaminophen is also known as paracetamol, and your location will determine whether you refer to this treatment as one or the other. A pain reliever and a fever reducer, the exact mechanism of action of acetaminophen/paracetamol is unclear. Many conditions including headache, muscle aches, arthritis, backache, toothaches, colds, and fevers, are treated with acetaminophen (paracetamol). It relieves pain in mild arthritis but does not affect the underlying inflammation and swelling of the joint.
Acetaminophen, Butalbital, Caffeine	Alagesic, Anolor 300, Dolgic LQ, Dolgic Plus, Esgic, Fioricet, Geone, Margesic, Medigesic, Orbivan, Repan, Zebutal	Combination - Barbiturate	X	Tablets	Acute	Acetaminophen is a pain reliever and fever reducer. Butalbital is part of a group of drugs called barbiturates. They are known to relax muscle contractions involved in a tension headache. Caffeine is a central nervous system stimulant that can relax muscle contractions in blood vessels to improve blood flow. The combination of acetaminophen, butalbital, and caffeine is used to treat tension headaches caused by muscle contractions. Butalbital has a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment. Butalbital is not available in some countries and restricted in others due to its dangerous side effects.
Acetaminophen, Codeine	Tylenol 3 or 4, Panadeine	Combination - Narcotic	X	Tablets, Liquid	Acute	Acetaminophen/paracetamol with codeine is a narcotic and analgesic/antipyretic combination. It works in the brain and nervous system to decrease mild to moderately severe pain.
Acetaminophen, Dichloralphenazone & Isometheptene	Duradrin, Midrin	Analgesic (painkiller)	X	Capsules	Acute	Acetaminophen, dichloralphenazone, and isometheptene is a combination analgesic, sedative, and sympathomimetic. It works by decreasing pain, providing sedation, and narrowing the blood vessels in the head and brain. It is used to treat migraine, certain types of headaches (tension, neurovascular), and other conditions as determined by your doctor.
Acetazolamide	Diamox	Carbonic anhydrase inhibitor	X	Tablets, Capsules	Acute and preventive (depends on what it's treating, but for migraine, only preventive)	Acetazolamide is used to prevent and treat the symptoms of altitude sickness. It can also be used to reduce edema, treat glaucoma, control epileptic seizures, and, in some cases, prevent hemiplegic migraine. Acetazolamide is not well-studied as a preventive treatment for migraine in general, and there is no solid evidence for its effectiveness outside the context of familial hemiplegic migraine.
Acetazolamide, methazolamide	Diamox Sequels, Neptazane	Diuretic	X	Tablets	Acute/Preventive	Medications used to treat glaucoma, epilepsy, altitude sickness, periodic paralysis, idiopathic intracranial hypertension, and heart failure. Sometimes used to treat high-pressure headaches by lowering the production of spinal fluid.
Acetylsalicylic Acid (ASA)	Aspirin, Baby Aspirin	Nonsteroidal anti-inflammatory drugs (NSAIDs)		Tablets, dissolvable tablets	Acute/Preventive	Regular low-dose aspirin or "baby" aspirin may be one of the most effective ways to help prevent migraine with aura. When tested against topiramate, a common migraine preventive, Italian researchers found that low doses of aspirin daily may be up to six times more effective than topiramate. Up to 1,000 mg of aspirin may also be used in the acute treatment of migraine.
Acetylsalicylic Acid (ASA) & Combinations	AsproClear, Arthritis Pain, Ascriptin Enteric, Aspir 81, Aspir-Low, Bayer Aspirin, Bayer ChildrenÕs Aspirin, Bufferin, Easprin, Ecotrin, Ecpirin, Excedrin, Fasprin, Halfprin, Miniprin, St. Joseph Aspirin	Combinations Ð Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)		Tablets, powder, and others	Acute	Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that works by reducing substances in the body that cause pain, fever, and inflammation. It is used to treat pain and reduce fever or inflammation. Sometimes aspirin is used to treat or prevent heart attacks, strokes, and chest pain (angina) but it should be used for cardiovascular conditions only under the supervision of a doctor. Some aspirin combination drugs, like Excedrin, also contain acetaminophen/paracetamol and caffeine. Check the label to be sure. Overuse of combination treatments containing caffeine may lead to rebound headaches.
Acyclovir	Zovirax	Antiviral	X	Tablets, capsules, topical ointment	Preventive	Acyclovir is an antiviral drug that is used to treat infections caused by certain types of viruses. It treats shingles caused by herpes zoster and outbreaks of herpes simplex. In people with frequent outbreaks of genital herpes, acyclovir is used to help reduce the number of future episodes. Acyclovir can also be useful in the treatment of fibromyalgia and allodynia, often in conjunction with other medications.
Agomelatine	Valdoxan	Antidepressant	X	Tablets	Preventive	Agomelatine is primarily used to treat depression. It acts on brain receptors for melatonin, a hormone that is important for regulating sleep, as well as serotonin receptors. It is the only antidepressant that acts on melatonin receptors.
Air pressure modulation device	Nocira	Neuromodulation	X	Device	Acute	Nocira is an investigational new migraine treatment device intended to deliver a comfortable and non-invasive treatment experience. The device delivers a modulated pattern of gentle puffs of air into the ear, which stimulates pressure-activated sensory neurons to reset the brain's pain response. The pilot study saw 67% of its participants pain-free after 20 minutes of treatment with Nocira. The device operates by way of earpieces controlled through a mobile phone app. Additional clinical trials are planned. Not yet FDA approved as of March 2021.
Almotriptan	Axert, Almogran	Serotonin 5-HT1 agonists or triptans	X	Tablets	Acute	Almotriptan is a second-generation serotonin 5-HT1 receptor agonist, also known as a triptan. An agonist mimics the effects of the neurotransmitter found naturally in the brain. It works by narrowing the blood vessels around the brain, blocking pain signals and the release of substances that cause other migraine symptoms. A person with a migraine attack is thought to be hypersensitive to widened blood vessels exerting pressure on the brain.
Alprazolam	Niravam, Xanax	Benzodiazepines	X	Tablets	Preventive	Alprazolam belongs to a group of drugs called benzodiazepines. It works by slowing down the movement of brain chemicals 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.
Amitriptyline	Elavil, Endep	Antidepressant	X	Tablets	Preventive	Amitriptyline is a tricyclic antidepressant. It affects chemicals in the brain that may become unbalanced. Amitriptyline is used to treat symptoms of depression.
Amphetamine	Adzenys XR-ODT, Dyanavel XR, Evekeo	Stimulant	X	Tablets	Preventive	Amphetamine is a stimulant used to treat attention-deficit hyperactivity disorder (ADHD), narcolepsy, and obesity. Stimulants increase the level of dopamine, a neurotransmitter associated with pleasure, movement, and attention. Use of this medication should be closely monitored, as it carries a high risk for addiction. In the context of migraine, amphetamine can contribute to medication overuse headache (MOH).
Angiotensin-converting enzyme (ACE) inhibitors	Prinivil, Qbrelis, Zestril, Epanded, Vasotec, Altace	Hypertension	X	Tablets	Preventive	Angiotensin-converting enzyme (ACE) inhibitors are commonly prescribed to treat high blood pressure, heart problems, and other conditions by helping to relax veins and arteries. It has been thought that ACE inhibitors could be used as a preventive treatment for migraine because it can narrow the blood vessles in the brain. A 2019 study concluded that ACE inhibitors could be used a preventive treatment for migraine in persons with high blood pressure or high risk of side effects, but the evidence did not support use of it as a preventive otherwise.
Aprepitant	Emend	Neurokinin 1 receptor antagonist (antinausea)	X	Capsule	Acute	Used to prevent chemotherapy-induced or postoperative nausea and vomiting, and for CVS (Cyclic Vomiting Syndrome, a migraine variant). Also used to control nausea and vomiting related to intravenous DHE (dihydroergotamine).
Asenapine	Saphris	Other - schizophrenic & bipolar	X	Tablets	Preventive	Asenapine treats schizophrenia. It is used alone or along with lithium or valproate to treat acute manic or mixed episodes associated with bipolar disorder or manic-depression. Asenapine is an atypical antipsychotic. Exactly how it works is not known. It may work by blocking certain substances in the brain.
Aspirin, Butalbital, Caffeine	Fiorinal, Fortabs, Laniroif, Farbital, Fiormor, Fiortal, Idenal, Isollyl, Lanorinal	Combination - Barbiturate	X	Tablets, Capsules	Acute	Aspirin is a pain reliever, anti-inflammatory, and fever reducer. Butalbital is part of a group of drugs called barbiturates, which have high risk for addiction and medication overuse headache (MOH). They are known to relax muscle contractions involved in a tension headache. Caffeine is a central nervous system stimulant that can relax muscle contractions in blood vessels to improve blood flow. The combination of aspirin, butalbital, and caffeine is used to treat tension headaches caused by muscle contractions.
Aspirin, Caffeine, Orphenadrine	Norgesic	NSAID Ð combination	X	Tablets	Acute	Orphenadrine, aspirin, and caffeine is a muscle relaxant and stimulant combination. It works by decreasing pain and inflammation, which helps muscles to relax. This combination relieves mild to moderate pain from certain muscle problems.
Aspirin, Codeine	Aspalgin, Disprin Forte	Analgesic (painkiller)	X	Tablets, capsules	Acute	Aspirin 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.
Atenolol	Tenormin	Beta blockers	X	Tablets	Preventive	Atenolol is part of a group of drugs called beta blockers. Beta blockers affect the heart and the circulation of blood flow through arteries and veins. Atenolol is used to treat angina (chest pain) and hypertension (high blood pressure). It may also be used to treat or prevent heart attack.
Atogepant		Small molecule CGRP receptor antagonist (Gepant)	X	In testing for oral	Preventive	Atogepant is an oral CGRP receptor antagonist in development for the prevention of migraine. Atogepant is chemically distinct from ubrogepant, an orally-administered CGRP receptor antagonist for the acute treatment of migraine. Atogepant has a longer half-life, making it suitable for preventive treatment. Not FDA approved as of March 2021.
Baclofen	Lioresal, Gablofen	Muscle Relaxant	X	Tablets	Acute	Baclofen 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/Barbitone	Veronal, Medinal	Barbiturate	X	Capsule, cachets	Preventive	As barbital is a controlled substance, other substances have largely replaced barbital-based medications. When barbitone was first introduced, it was considered a great improvement over the existing hypnotics. It was used as a sleeping aid (hypnotic) from 1903 until the mid-1950s. Barbiturates have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment.
Bariatric surgery	N/A	-	X	Surgical Procedure	Preventive	Obesity is associated with an increased risk of progression from episodic to chronic migraine. For obese individuals, weight reduction by means of bariatric surgery may contribute to a reduction in the frequency, severity, and duration of migraine attacks. The beneficial impact of weight loss on migraine has been noted to a comparable degree for both bariatric surgery and weight lost through lifestyle modification.
Budesonide	Entocort, Pulmicort, Rhinocort Aqua	Steroid	X	Capsule, intranasal	Preventive	Budesonide is a steroid that reduces inflammation in the body. Budesonide is primarily used to treat mild to moderate Crohn's disease.
Buprenorphine	Buprenex, Temgesic	Narcotic	X	Injection, tablets	Acute	Buprenorphine is a narcotic analgesic. It works on the brain and nervous system to decrease pain. It can help relieve moderate to severe pain.
Butalbital (Discontinued)	N/A	Barbiturate	X	N/A	Acute	Butalbital is known to relax muscle contractions involved in a tension headache. Butalbital is often combined with other medications, such as acetaminophen, aspirin, and codeine for the treatment of headache. It has been discontinued as a single agent, and is not recommended due to high risk for addiction and medication overuse headache (MOH).
Candesartan	Blopress, Atacand, Amias, Ratacand	Hypertension	X	Tablets	Preventive	Candesartan is an angiotensin II receptor blocker (ARB). It works by relaxing blood vessels. This helps to lower blood pressure. Candesartan is used to treat high blood pressure alone or with other medicines. It is used in certain patients to treat heart failure. It may also be used for other conditions as determined by your doctor.
Cannabidiol oil (CBD)	Hundreds of OTC brands; Epidiolex is the first FDA-approved prescription for highly purified CBD oil.	Phytocannabidiol		Tinctures, oils, gummies and other edible forms, creams, gels, sublingual sprays, vapors, transdermal patches	Acute/Preventive	The nonpsychoactive part of the cannabis, or marijuana plant. CBD oil is made by extracting CBD from the cannabis plant, then diluting it with a carrier oil. It has quickly become popular in the health and wellness community, with several research-backed studies suggesting it may be helpful in alleviating such conditions as anxiety, depression, and chronic pain, including migraine.
Carbamazepine	Carbatrol, Epitol, Equetro, TEGretol, TEGretol XR	Anticonvulsant	X	Tablets	Preventive	Carbamazepine is an anticonvulsant. It works by decreasing nerve impulses that cause seizures and pain. Carbamazepine is used to treat seizures and nerve pain such as trigeminal neuralgia and diabetic neuropathy. It is also used to treat bipolar disorder.
Carvedilol	Coreg	Beta blocker	X	Tablets	Preventive	Carvedilol 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 heartÕs ability to function effectively.
Celecoxib	Celebrex, Vioxx and Bextra	COX inhibitor	X	Tablets	Acute/Preventative	A subclass of NSAIDs that work by reducing the production of prostaglandins, the chemicals that promote inflammation, pain, and fever. The enzymes that produce prostaglandins are called cyclooxygenase (COX). There are two types: COX-1 and COX-2. Only COX-1 produces prostaglandins that protect the stomach and intestinal lining. Unlike older NSAIDs that block both inhibitors, the newer COX-2 inhibitors only block the COX-2 enzyme. Sometimes recommended before exercise to prevent a migraine attack. Celebrex is the only brand available in the U.S. Vioxx and Bextra are no longer available due to increased risk of heart attack and stroke.
Cetirizine	Zyrtec	Antihistamine		Tablets	Acute	Cetirizine is an antihistamine that reduces the natural chemical histamine in the body. Histamine can produce symptoms of sneezing, itching, watery eyes, and runny nose. Cetirizine is used to treat cold or allergy symptoms such as sneezing, itching, watery eyes, or runny nose. It is also used to treat itching and swelling caused by hives.
Chlorpromazine	Largactil, Thorazine	Other - schizophrenic & bipolar	X	Capsule, tablets, injection, suppository	Preventive	Chlorpromazine is a phenothiazine. The exact way chlorpromazine works is not known. It is used to treat certain mental or mood disorders (e.g. schizophrenia), the manic phase of manic-depressive disorder, anxiety and restlessness before surgery, the blood disease porphyria, severe behavioral and conduct disorders in children, nausea and vomiting, and severe hiccups. It is also used with other medicines to treat symptoms associated with tetanus.
Citalopram	Cipramil, Celexa	Antidepressant	X	Tablets	Preventive	Citalopram is a selective serotonin reuptake inhibitor (SSRI). This medication works by helping to restore the balance of a certain natural substance (serotonin) in the brain. Citalopram is used to treat depression. It may improve your energy level and feelings of well-being. Leading neurologist Andrew Charles has flagged SSRI medications as having the potential to make migraine worse. If you take an SSRI and have migraine, consider discussing with your medical practitioner whether an alternative medication might be right for you.
Clonidine	Catapres, Dixarit, Kapvay	Hypertension	X	Tablets	Preventive	Clonidine 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).
Codeine	Migraleve	Opioid	X	Capsule, tablets, rectal suppository	Acute	Codeine is used to treat mild to moderately severe pain. Codeine or 3-methylmorphine (a naturally occurring methylated morphine) is an opiate used for its analgesic, antitussive, antidiarrheal, antihypertensive, anxiolytic, antidepressant, sedative, and hypnotic properties. It is also used to suppress premature labor contractions, myocardial infarction, and has many other potential and indicated uses. It is often sold as a salt in the form of either codeine sulfate or codeine phosphate in the United States and Australia. Codeine hydrochloride is more common worldwide than codeine sulfate or phosphate, and citrate, hydroiodide, hydrobromide, tartrate, as well as other salts are also used. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment.
CPAP Machine	RESmart, ResMed, Philips, Fisher & Paykel	Ventilator	X	Device	Preventive	Continuous 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.
Cyclobenzaprine	Amrix, Fexmid, Flexeril	Muscle relaxant	X	Tablets	Acute	Cyclobenzaprine is a muscle relaxant. It works by blocking nerve impulses or pain sensations that are sent to your brain. It is used together with rest and physical therapy to treat skeletal muscle conditions such as pain or injury.
Cyproheptadine	Periactin	Antihistamine	X	Tablets	Preventive	Cyproheptadine is an antihistamine. It works by blocking the action of histamine to reduce allergy symptoms. Cyproheptadine is used to treat symptoms of allergic reactions caused by seasonal allergies, food, blood, or plasma. It is also used to treat mild, uncomplicated hives.
Desvenlafaxine	Khedezla, Pristiq	Antidepressant	X	Tablets	Preventive	Desvenlafaxine 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.
Diazepam	Valium	Other - psychoactive benzodiazepine	X	Tablets, injection, suppository	Acute	Diazepam 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.
Diclofenac	Cambia, Cataflam, Voltaren-XR, Zipsor, Zorvolex, Voltaren	Nonsteroidal anti-inflammatory drugs (NSAIDs)		Tablets, injection, gel, suppository	Acute	Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID). It is used to treat mild to moderate pain, or signs and symptoms of osteoarthritis or rheumatoid arthritis. The Cataflam brand of this medicine is also used to treat menstrual cramps. Diclofenac oral powder (Cambia) is used to treat migraine. Cambia will only treat a migraine attack that has already begun.
Dihydroergotamine mesylate (DHE)	Dihydergot, DHE 45, Migranal, INP104 (Trudhesa)	Ergot alkaloid - derivative	X	Injection, Nasal Spray	Acute	Dihydroergotamine is used to treat acute migraine with or without aura, and cluster headaches. Dihydroergotamine is an ergot derivative. It works by constricting blood vessels in the brain, which can help to relieve migraine. Unlike most acute treatments, it is thought that DHE does not contribute to medication overuse headache or worsening headache from increased use of the drug.
Diltiazem	Cardizem, Cartia XT, Dilacor XR, Dilt-CD, Dilt-XR, Diltia XT, Diltiazem Hydrochloride CD, Diltiazem, Diltzac, Flunarizine, Taztia XT, Tiazac, Cardizem Monovial, Matzim LA	Calcium channel blockers	X	Tablets	Preventive	Diltiazem is part of a group of drugs called calcium channel blockers. These work by relaxing the muscles of your heart and blood vessels. Diltiazem is used to treat hypertension (high blood pressure), angina (chest pain), and certain heart rhythm disorders.
Dimenhydrinate	Gravol, Dramamine and many others	Antihistamine, antiemetic		Tablet, Capsule, Injection, Suppository, or Liquid	Acute	Used to prevent and treat nausea, vomiting, and dizziness due to motion sickness. Gravol is used to control vomiting associated with migraine, but it has largely been replaced by Zofran (ondansetron).
Diphenhydramine	Benadryl, Nytol, Simply Sleep and others	Antihistamine		Pill or Capsule	Acute	Used to control high levels of histamine. May speed relief of migraine when taken with migraine medications.
Divalproex sodium	Depakote, Depakote ER, Depakote Sprinkles	Anticonvulsant	X	Tablets	Preventive	Divalproex sodium affects chemicals in the body that may be involved in causing seizures. It is used to treat various types of seizure disorders. It is sometimes used together with other seizure medications. Divalproex sodium is also used to treat manic episodes related to bipolar disorder (manic depression) and to prevent migraine headaches.
Domperidone	Molax, Motilium, Motinorm Costi, Nomit	Anti-emetic (anti-nausea)	X	Tablets, injection, suppository	Acute	Anti-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/Dothiepin	Prothiaden, Dothep, Thaden, Dopress	Antidepressant	X	Tablets	Preventive	Dosulepin is a tricyclic antidepressant. This class of antidepressants is named after its chemical structure, which contains three rings of atoms. Today they have largely been replaced in clinical use by newer classes of antidepressants.
Doxylamine	Restavit, Dozile	Antihistamine		Tablets	Acute	Doxylamine is an antihistamine. It works by depressing the central nervous system to produce drowsiness. Doxylamine is used to treat occasional sleeplessness and reduce difficulty falling asleep.
Doxylamine, Paracetamol, Codeine	Mersyndol	Antihistamine		Tablets	Acute	Helps produce drowsiness along with two active painkiller ingredients. See Codeine & Paracetamol.
Duloxetine	Cymbalta	Antidepressant	X	Tablets	Preventive	Duloxetine is a selective serotonin and norepinephrine reuptake inhibitor (SNRI). SNRIs block or delay the reuptake of the neurotransmitters, serotonin, and norepinephrine, by the presynaptic nerves. This increases the levels of these two neurotransmitters in the synapse and tends to elevate mood. SNRIs are used to treat depression, anxiety disorder, panic disorder and other mood disorders. Duloxetine can also be useful in the treatment of fibromyalgia and allodynia.
Ear insufflation therapy	N/A	Neuromodulation	X	In-Office Procedure	Acute	Ear insufflation therapy is the administration of small bursts of air or ozone gas to the ear drum via a tool called a pneumatic otoscope. Researchers believe these controlled puffs of air stimulate pressure-activated nerve receptors found in the ears, resetting the pain centers in the brain. This procedure is not currently FDA approved.
Eletriptan	Relpax	Serotonin 5-HT1 agonists or triptans	X	Tablets	Acute	Eletriptan is a second-generation triptan drug intended for the treatment of migraine. It is used as an abortive treatment to help block a migraine attack that is already in progress.
Eptinezumab	Vyepti	CGRP monoclonal antibody	X	Intravenously	Preventive	Eptinezumab is a preventive CGRP monoclonal antibody approved by the FDA in February 2020. CGRP monoclonal antibodies attach to the calcitonin gene-related peptide (CGRP) and inactivate it. Eptinezumab is given as an IV infusion four times a year.
Erenumab	Aimovig	CGRP monoclonal antibody	X	Injection	Preventive	Erenumab is a preventive CGRP monoclonal antibody approved by the FDA in May 2018. This CGRP monoclonal antibody attaches to CGRP receptors to inhibit its function. Erenumab is self administered monthly. An FDA warning was added for erenumab about high blood pressure after the first dose. If you are on erenumab or start it, you should monitor your blood pressure.
Ergotamine tartrate	Cafergot, Ergomar, Migril	Ergot alkaloid - derivative	X	Tablets, suppository	Acute	Ergotamine is an ergot derivative. It works by narrowing blood vessels in the brain, which can help to relieve migraine. Some brands, like Cafergot, also contain caffeine.
Escitalopram	Lexapro	Antidepressant	X	Tablets	Preventive	Escitalopram 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. Leading neurologist Andrew Charles has flagged SSRI medications as having the potential to make migraine worse. If you take an SSRI and have migraine, consider discussing with your medical practitioner whether an alternative medication might be right for you.
Estrogen patch	Alora, Estraderm, EstroGel, Vivelle and others	Estradiol hormone	X	Transdermal patch	Preventive	An estrogen patch used for 7 to 10 days during the tail end of the menstrual cycle before a menstrual period may blunt the cyclic fall in estrogen and prevent a menstrual migraine.
Eye Drops Ð Dry Eyes	Artificial Tears, Cyclosporine, Restasis	Immunosuppressant	*	Eye Drops	Preventive	Because dry-eye symptoms are prevalent in people with migraine, doctors may prescribe artificial tears. Nonprescription eye drops contain preservatives, while prescription formulas like Cyclosporine/Restasis do not. Both decrease inflammation that can cause dry eyes and discomfort for people with migraine.
Eye Drops Ð Glaucoma	Timolol, Levobunolol	Beta blockers	X	Eye Drops	Acute/Preventive	Beta 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.
Famciclovir	Famvir	Antiviral	X	Tablets	Preventive	Famciclovir is an antiviral drug that is used to treat infections caused by certain types of viruses. It treats shingles caused by herpes zoster and outbreaks of herpes simplex. In people with frequent outbreaks of genital herpes, famciclovir is used to help reduce the number of future episodes. It can also be useful in the treatment of fibromyalgia and allodynia, often in conjunction with other medications.
Fludrocortisone	Florinef Acetate	Other - corticosteroid	X	Tablets	Preventive	Fludrocortisone 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's disease and for treating salt-losing adrenogenital syndrome.
Flunarizine	Sibelium	Calcium channel blockers	X	Tablets, Capsules	Preventive	Flunarizine is part of a group of drugs called calcium channel blockers. These work by relaxing the muscles of your heart and blood vessels. Flunarizine reduces calcium entry into neurons making them less Òexcitable.Ó
Fluoxetine	Lovan, Prozac, Sarafem	Antidepressant	X	Capsules	Preventive	Fluoxetine is a selective serotonin reuptake inhibitors (SSRI) antidepressant. It is used to treat major depressive disorder, bulimia nervosa (an eating disorder), obsessive-compulsive disorder, panic disorder, and premenstrual dysphoric disorder (PMDD). Leading neurologist Andrew Charles has flagged SSRI medications as having the potential to make migraine worse. If you take an SSRI and have migraine, consider discussing with your medical practitioner whether an alternative medication might be right for you.
Fluvoxamine	Luvox	Antidepressant	X	Tablets	Preventive	Fluvoxamine 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.
Fosaprepitant	Emend for Injection	Neurokinin 1 receptor antagonist (antinausea)	X	Intravenously	Acute	Used to prevent chemotherapy-induced or postoperative nausea and vomiting and for CVS (Cyclic Vomiting Syndrome, a migraine variant). Also used to control nausea and vomiting related to intravenous DHE (dihydroergotamine).
Fremanezumab	Ajovy	CGRP monoclonal antibody	X	Injection	Preventive	Fremanezumab is a preventive monoclonal antibody approved by the FDA in September 2018 for the prevention of migraine. This CGRP monoclonal antibody attaches to CGRP and inactivates it. Ajovy is self administered monthly or quarterly, as your physician advises.
Frovatriptan	Frova, Migard	Serotonin 5-HT1 agonists (Triptans)	X	Tablets	Acute	Frovatriptan is a triptan. It works by narrowing the blood vessels in the brain, which helps to relieve migraine. It is used to treat acute migraine with or without aura in adults. It should not be used as a migraine preventive.
Gabapentin	Gralise, Horizant, Neurontin, Gabarone	Anticonvulsant	X	Tablets, capsules	Preventive	Gabapentin is an anticonvulsant medication. It affects chemicals and nerves in the body that are involved in the cause of seizures and some types of pain. Gabapentin is used in adults to treat nerve pain caused by herpes virus or shingles. The Horizant brand is also used to treat restless legs syndrome (RLS). The Neurontin brand is also used to treat seizures in adults and children who are at least 3 years old.
Galcanezumab	Emgality	CGRP monoclonal antibody	X	Injection	Preventive	Galcanezumab is a CGRP monoclonal antibody approved by the FDA in September 2018 for prevention of migraine, and for treatment of episodic cluster headache in June 2019. This CGRP monoclonal antibody attaches to CGRP and inactivates it. Emgality is self administered monthly for migraine. For cluster, it is self administered initially at a loading dose at the start of a cluster period and then monthly until the end of the cluster period.
Greater Occipital Nerve (GON) Block		Other - steroid & anesthetic	X	Injection	Preventive	This treatment injects a steroid and lidocaine into the greater occipital nerve (GON) to block pain messages to the brain from the GON. The occipital nerves are two pairs of nerves originating in the upper cervical vertebrae. The GON is located beneath the scalp in the back of the head. This region of the brain deals with vision including color recognition, spatial awareness, and word recognition. Most people who have regular migraine and headache also have tenderness in the suboccipital region of the skull. In cases where migraine is resistant to medication, or treatment is hindered by adverse effects, a GON block may be explored.
Hormone Replacement Therapy/Contraceptive pills	-	Other - hormones	X	Tablets	Preventive	Hormone replacement therapy (HRT) refers to any form of hormone therapy where the patient receives hormones, either to supplement a lack of naturally occurring hormones, or to substitute other hormones for naturally occurring hormones. HRT is typically prescribed for those experiencing either natural or surgically induced menopause. The main types of hormones involved are estrogens, progesterone or progestins, and sometimes testosterone. ItÕs often referred to as treatment rather than therapy. For pre-menopausal use, contraceptive pills containing hormones may be used to skip periods (and can avert menstrual migraine).
Hydrocodone	Hysingla ER, Zohydro ER	Opioid	X	Tablets, suppository, intranasal	Acute	Hydrocodone is an opioid pain medication. Zohydro ER and Hysingla ER are extended-release forms of hydrocodone that are used for around-the-clock treatment of severe pain. Extended-release hydrocodone is not for use on an as-needed basis for pain. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment.
Hydromorphone	Dilaudid-HP, Jurnista	Opioid	X	Tablets	Acute	Hydromorphone is an opioid analgesic. It works in the brain and nervous system to reduce pain. It is used to treat moderate to severe pain in opioid-tolerant patients who require larger than usual doses to provide adequate pain relief. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment.
Hydroxyzine	Atarax, Alamon, Aterax, Durrax, Equipose, Masmoran Vistaril, Vistaril IM, Hyzine, Vistaject-50, Rezine, Tran-Q, Orgatrax, Quiess, Tranquizine, Vistacon, Vistacot, Vistazine	Antihistamine	X	Tablets, capsules, injection	Acute	Hydroxyzine reduces activity in the central nervous system. It also acts as an antihistamine that reduces natural chemical histamine in the body. Histamine can produce symptoms of sneezing and runny nose, or hives on the skin. Hydroxyzine is used as a sedative to treat anxiety and tension. It is also used together with other medications for anesthesia. 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.
Ibuprofen	Advil, Genpril, IBU, Midol, Motrin, Nuprin, Nurofen	Nonsteroidal anti-inflammatory drugs (NSAIDs)		Tablets, suppository, injection, topical	Acute	Ibuprofen 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, Codeine	ProVen Plus, Rafen Plus, Panafen Plus, Nurofen Plus	Nonsteroidal anti-inflammatory drugs (NSAIDs)		Tablets	Acute	In 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.
Indomethacin	Indocin, Indocid	Nonsteroidal anti-inflammatory drugs (NSAIDs)	X	Capsules suppository, injection, topical	Acute	Indomethacin 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.
Irbesartan	Abisart, Avapro	Hypertension	X	Tablets	Preventive	Irbesartan is an angiotensin II receptor blocker (ARB), which relaxes blood vessels. This helps to lower blood pressure. It is also used in certain patients to treat kidney problems caused by diabetes.
Isometheptene mucate	Midrin, Duradrin	Other		Capsules	Acute	Isometheptene works by causing the blood vessels in the brain to narrow. By decreasing the width of blood vessels, isometheptene helps relieve the pain from migraine attacks. It is often used in combination with other active ingredients. The British National Formulary states that as more effective preparations are now available, this is no longer widely used.
IUD	Liletta, Kyleena, Mirena, Skyla, ParaGard	Other - hormones	X	Device	Acute/Preventive	The IUD is a T-shaped device that is inserted into the uterus as a birth control method. There are five types, four of which are hormonal (Liletta, Kyleena, Mirena, and Skyla) and one that is made of copper and is hormone free (ParaGard). For some women with menstrual migraine, continuous hormone treatment may be helpful in preventing attacks linked to falling estrogen levels.
Ketamine	Ketalar	Anesthetic	X	Injection, IV	Acute	Ketamine 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.
Ketoprofen	Actron, Orudis, Oruvail	Nonsteroidal anti-inflammatory drugs (NSAIDs)	X	Capsules, injection, topical	Acute	Ketoprofen is an NSAID. Exactly how it works is not known. It may block certain substances in the body that are linked to inflammation. NSAIDs treat the symptoms of pain and inflammation. They do not treat the disease that causes those symptoms. Ketoprofen is used to treat rheumatoid arthritis or osteoarthritis. It is also used to treat menstrual cramps and pain. It may also be used for other conditions as determined by your doctor.
Ketorolac	Toradol	Nonsteroidal anti-inflammatory drugs (NSAIDs)	X	Tablets, injection, IV	Acute	Ketorolac is an NSAID indicated for short-term management of moderate to severe pain. Concerns about the high incidence of reported side effects has led to restriction in its dosage and maximum duration of use. In the U.K., treatment should be initiated only in a hospital. Maximum duration of treatment should not exceed five days for tablets (per package insert), or two days for continuous daily dosing with intravenous or intramuscular formulations. May be used intravenously in hospital or emergency settings. Ketorolac is used in the short-term (up to five days) treatment of moderately severe pain (usually after surgery), alone or in combination with other medicines.
Lamotrigin	Lamictal	Anticonvulsant	X	Tablets	Preventive	Lamotrigine 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.
Lasmiditan	Emgality	5-HT1F receptor agonist (Ditan)	X	Tablets	Acute	Like triptans, ditans work on serotonin receptors, but they work on the receptors that are not found on the blood vessels. Ditans are a potential acute therapy option for people with migraine who have heart conditions, as they avoid the blood vessels while working on similar mechanisms as triptans. Lasmiditan has been shown to work when migraine pain has progressed to moderate or severe.
Levetiracetam	Keppra	Anticonvulsant	X	Tablets	Preventive	Levetiracetam is an anticonvulsant. Exactly how it works is not known, but it may work by slowing abnormal nerve impulses in the brain. Levetiracetam is used to treat partial-onset, myoclonic, or other types of seizures in patients with epilepsy. It may be used in combination with other medicines.
Lidocaine	Burn-O-Jel, LMX4, LMX5	Analgesic (painkiller)	X	Topical	Acute	Lidocaine is most commonly used for numbing an area of the body to help reduce pain or discomfort. Some topical lidocaine prescriptions can also be used to relieve nerve pain — these come in forms of gel or skin patches that can be worn on the neck, shoulders and forehead for migraine. Over-the-counter lidocaine creams are also availabe to help relieve joint and muscle pain.
Lithium	Eskalith, Lithobid	Antimanic agent	X	Tablets, Capsules, Solution	Preventive	Lithium can be used to prevent hypnic headache, a type of headache that occurs exclusively during sleep and awakens the patient. Taken at bedtime, lithium has been shown to be effective in preventing a hypnic headache attack from occurring. Lithium is also indicated for use as a mood stabilizer to treat manic episodes associated with bipolar disorder. Lithium should be used with caution in cases of kidney or thyroid disease, dehydration, or in conjunction with diuretics.
Loratadine	Alavert, Alavert Allergy, Claritin, lear-Atadine, Clear-Atadine Children's, Dimetapp ND, Loratadine Reditab, Tavist ND, Wal-itin	Antihistamine		Tablets	Acute	Loratadine 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/Medical Cannabis	-	Other	X	Tea, edibles, capsules, oils	Acute	The 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 acid	Ponstan, Ponstel	Nonsteroidal anti-inflammatory drugs (NSAIDs)		Capsules	Acute	Mefenamic acid is an NSAID. Exactly how it works is not known. It may block certain substances in the body that are linked to inflammation. NSAIDs treat the symptoms of pain and inflammation. Mefenamic acid is used for menstrual pain. It may be used for short term (not more than 7 days) treatment of mild to moderate pain.
Meloxicam	Mobic, Movalis	Nonsteroidal anti-inflammatory drugs (NSAIDs)	X	Tablets	Acute	Meloxicam (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.
Memantine	Abixa, Akatinol, Axura, Ebixa, Memox, Namenda	Other - central nervous system agent	X	Tablets	Preventive	Memantine 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.
Meperidine	Demerol	Opioid	X	Tablets, injection	Acute	Meperidine is an opioid analgesic. It works in the brain and nervous system to decrease pain. Meperidine is used in the short-term treatment of moderate to severe pain. It may also be used before or during surgery (e.g. to support anesthesia), for pain relief during labor and delivery, or for other conditions as determined by your doctor. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment.
Metaxalone	Skelaxin	Muscle relaxant	X	Tablets, capsules	Acute	Metaxalone (brand name Skelaxin) is a muscle relaxant used to relax muscles and relieve pain caused by strains, sprains, and other musculoskeletal conditions. Its exact mechanism of action is not known, but it may be due to general central nervous system depression.
Methocarbamol, Acetaminophen	Robaxin, Robaxacet	Muscle relaxant		Tablets, injection	Acute	Methocarbamol is a central muscle relaxant used to treat skeletal muscle spasms. It is used in conjunction with acetaminophen. See acetaminophen for a separate description of this medication.
Methyl Salicylate	Menthoderm, Thera-Gesic Plus, Salonpas Pain Patch	Other - topical rubefacient		Topical	Acute	Methyl 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 in the temporary relief of minor aches and pains caused by arthritis, simple backache, strains, sprains, and bruises.
Methysergide	Deseril, Sansert	Anti-serotonergic (Anti 5-HT)	X	Tablets	Preventive	The exact way that methysergide works is unknown. It is believed to be involved in narrowing the veins and arteries that supply blood to your head. Serotonin (5-HT) is a chemical occurring in the body, and is thought to play a key role in migraine. These drugs block 5-HT2 receptors to stop the effects of 5-HT. Methysergide is a semi-synthetic ergot alkaloid. It should only be administered under hospital supervision because of the potential side effects (retroperitoneal fibrosis and fibrosis of heart values and pleura).
Metoclopramide	Maxolon, Metozolv ODT, Pramin, Reglan	Anti-emetic (anti-nausea)	X	Tablets, injection	Acute	Metoclopramide 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 gastroparesis), which can cause nausea, vomiting, heartburn, loss of appetite, and a feeling of fullness after meals.
Metoclopramide, Paracetamol	Anagrain, Metomax, Paramax	Other - combination analgesic & anti-emetic (anti-nausea)		Tablets	Acute	The combination of metoclopramide and paracetamol is used to treat the symptoms of migraine, both to relieve headache (the Paracetamol) and to treat associated nausea and vomiting (the 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.
Metoprolol	Dutoprol, Betaloc, Lopressor	Beta blocker	X	Tablets	Preventive	Metoprolol 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.
Mirtazapine	Remeron	Antidepressant	X	Tablets	Preventive	Mirtazapine is an antidepressant. It affects chemicals in the brain that may become unbalanced and cause depression. Mirtazapine is used to treat major depressive disorder.
Mometasone	Elocon, Nasonex	Steroid		Topical, intranasal	Acute	Mometasone is a 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). As a spray, it reduces inflammatory reactions in the nasal airway in response to allergens and irritants in the air. It is used to treat itching, redness, and swelling in many skin conditions.
Morphine	AVINza, Kadian, MS Contin	Opioid	X	Tablets, injection, suppository, inhalation	Acute	Morphine is an opioid pain medication. Morphine is used to treat moderate to severe pain. Short-acting formulations are taken as needed for pain. The extended-release form of this medicine is for around-the-clock treatment of pain. This form of morphine is not for use on an as-needed basis for pain. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment.
Moxonidine	Physiotens	Hypertension	X	Tablets	Preventive	Monoxidine 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.
Nadolol	Corgard	Beta blocker	X	Tablets	Preventive	Nadolol is a beta blocker. It works by slowing down the heart and decreasing the amount of blood it pumps out. This helps to decrease blood pressure, helps the heart pump more efficiently, and reduces the workload on the heart. Nadolol is used in the long-term management of angina (chest pain). It is also used alone or with other medicines to treat high blood pressure.
Naproxen	Aleve, Anaprox, Anaprox-DS, EC-Naprosyn, Leader Naproxen Sodium, Midol Extended Relief, Naprelan 375, Naprosyn, Synflex	Nonsteroidal anti-inflammatory drugs (NSAIDs)		Tablets	Acute	Naproxen 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. Naproxen 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.
Naratriptan	Amerge, Naramig	Serotonin 5-HT1 agonists or triptans	X	Tablets	Acute	Naratriptan 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.
Neurolief device	Relivion	Neuromodulation		Device	Acute	Relivion is a smartphone-controlled, cloud-connected, multichannel neuromodulation device. It offers precise, personalized care by delivering stimulation to six branches of the occipital and trigeminal nerves via three adaptive output channels. This creates a cumulative effect by releasing neurotransmitters in the brain stem and modulating brain networks associated with control of pain and mood. Approved as an OTC in Europe in July 2019. Cleared by FDA in March 2021, expected to be available late summer 2021.
Nimodipine	Nimotop	Calcium channel blockers	X	Capsules, injection	Preventive	Nimodipine is a calcium channel-blocking agent. Exactly how nimodipine works is unknown. It is used to help reduce problems from a lack of oxygen caused by bleeding from a blood vessel in the brain.
Nitrazepam	Alodorm, Arem, Insoma, Insomin, Mogadon, Nitrados, Nitrazadon, Nitrosun, Ormodon, Paxadorm, Remnos, Somnite	Hypnotic	X	Tablets	Acute	Nitrazepam 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.
Nortriptyline	Allegron, Pamelor	Antidepressant	X	Capsule	Preventive	Nortriptyline belongs to a group of medicines called tricyclic antidepressants (TCAs). It is used to treat depression and some other conditions. It affects chemicals in the brain that may become unbalanced.
Omega Procedure (see also Reed Procedure		Neuromodulation	X	Surgically implanted neuromodulation	Preventive	The Omega Procedure is a trademarked surgical procedure for patients diagnosed with chronic migraine (15 or more attacks per month) that entails implanting an occipital-nerve stimulator beneath the skin while the patient is under general anesthesia. It requires an initial minor surgery for a trial period, a second surgery for permanent implantation, and a battery-pack change every 10 years. Removal or repair requires surgery, as well. The Omega Procedure and the Reed Procedure® are the exact same surgical procedure; the difference is solely in their registered names. From a practical standpoint, the difference comes in the relative experience of the physicians involved.
OnabotulinumtoxinA	Botox	Muscle relaxant	X	Injection	Preventive	OnabotulinumtoxinA (Botox), also called botulinum toxin type A, is made from the bacteria that causes botulism. Botulinum toxin blocks nerve activity in the muscles, causing a temporary reduction in muscle activity. Botox can be used to prevent chronic migraine in adults who have migraine 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 doctorÕs office, multiple Botox injections are inserted into the muscles of the forehead, head 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.
Ondansetron	Zofran, Zofran ODT, Zuplenz	Anti-emetic (anti-nausea)	X	Tablets, injection	Acute	Ondansetron 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).
Oxycodone	Endone, Oxecta, OxyContin, Oxyfast, Roxicodone	Opioid	X	Tablets, injection, suppository	Acute	This 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 the analgesic group of medicines. It is also an antipyretic, which helps reduce your body temperature if you have a fever. Codeine phosphate is also an analgesic, and acts by blocking pain and emotional response to pain. See codeine for more detail. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment.
Oxygen	--	Inhalant/Device	X	Cannula/Mask	Acute/Preventive	It has been shown that oxygen causes a marked decrease in cerebral blood flow concurrent with a reduced degree of pain in cluster headache. There are two high-flow oxygen delivery methods for migraines: normobaric and hyperbaric, with normobaric more effective for migraine.
Oxymetazoline nasal	Allerest, Afrin, Mucinex, Nostrilla, Sinex	Decongestant		Intranasal Spray	Acute	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.
Pantoprazole	Protonix, Protonix IV, Somac	Proton-pump inhibitors	X	Tablets, injection	Acute	Pantoprazole is a proton-pump inhibitor that decreases the amount of acid produced in the stomach. It 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. Leading neurologist Andrew Charles has flagged proton-pump inhibitors as having the potential to make migraine worse. If you use a proton-pump inhibitor and have migraine, consider discussing with your medical practitioner whether an alternative medication might be right for you.
Paracetamol, Codeine	Paracodol	Narcotic	X	Tablets	Acute	This 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 the analgesic group of medicines. It is also an antipyretic, which helps reduce your body temperature if you have a fever. Codeine phosphate is also an analgesic, and acts by blocking pain and emotional response to pain. See codeine for more detail.
Paracetamol, Ibuprofen	Maxigesic	Combination - Analgesic & NSAID		Tablets	Acute	For 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.
PFO Valve Closure	N/A	Procedure	X	--	Preventive	Multiple studies suggest that migraine with aura is more prevalent in subjects with patent foramen ovale (PFO), an open passage between the chambers of the heart. Several studies suggest that PFO closure, a surgical procedure, may be an effective treatment for migraine. However, the grade of evidence from these studies is low.
Phenylephrine hydrochloride, Ibuprofen	Sudafed PE	Combination - Decongestant & NSAID		Tablets	Acute	Contains ibuprofen and phenylephrine hydrochloride, which are effective in relieving the symptoms of influenza and cold, including fever, headache, painful sinuses, sore throat, and muscle and joint pain. Moreover, it helps relieve a runny or stuffy nose and nasal sinuses.
Phenylephrine Hydrochloride, Paracetamol	Dimetapp PE Sinus Pain, Lemsip Cold & Flu, Panadol Cold & Flu, Sudafed	Combination - Decongestant & Analgesic		Tablets	Acute	This combination medication contains a decongestant & analgesic (paracetamol), and can help ease symptoms such as blocked or runny nose, sore throat, and body aches and headaches.
Pizotifen	Sandomigran	Anti-serotonergic (Anti 5-HT)	X	Tablets	Preventive	Pizotifen acts on serotonin (5-HT), a chemical that is thought to play a key role in migraine. It is part of a class of drugs that block 5-HT2 receptors to inhibit the effects of 5-HT. Pizotifen also has antihistamine properties and is related to the tricyclic group of antidepressants.
Potassium	Various	Vitamin/supplement	X	Tablets, liquid format, I.V. infusion	Acute/Preventive	A mineral and electrolyte that assists in several body functions, including blood pressure, water balance, muscle contractions, digestion, heart rhythm and pH balance. It is sometimes taken in supplement form to balance electrolytes which are often low due to migraine and nausea.
Prednisone	Rayos, Sterapred	Steroid	X	Tablets, injection, suppository, nasal	Acute	Prednisone 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, and breathing disorders.
Pregabalin	Lyrica	Anticonvulsant	X	Capsules	Preventive	Pregabalin is an anticonvulsant and neuropathic pain agent. Exactly how pregabalin works is not known. It is thought to bind to certain areas in the brain that help reduce seizures, nerve pain, and anxiety. Pregabalin is used to treat fibromyalgia or nerve pain caused by certain conditions (e.g., shingles, diabetic nerve problems, spinal cord injury). It is also used in combination with other medicines to treat certain types of seizures. Pregabalin can also be useful in the treatment of allodynia.
Prochlorperazine	Compazine, Stemzine, Buccastem, Stemetil, Phenotil	Anti-emetic (anti-nausea) & Antipsychotic	X	Tablets, injection, suppository	Acute	Prochlorperazine is a phenothiazine. It is not known exactly how it works. It is a highly potent typical antipsychotic, 10Ð20_ more potent than chlorpromazine. It is used to help control severe nausea and vomiting, and to treat schizophrenia. It is also used to treat migraine. Intravenous administration can be used to treat status migrainosus.
Promethazine	Phenergan, Promethegan, Romergan, Fargan, Farganesse, Fenazin, Prothiazine, Avomine, Atosil, Receptozine, Lergigan, Pipolphen, Sominex	Antihistamine & Anti-emetic (anti-nausea)	X	Tablets, injection, suppository	Acute	Promethazine 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.
Propranolol	Hemangeol, Inderal LA, Inderal XL, InnoPran XL, Inderal	Beta blocker	X	Tablets, injection, suppository	Preventive	Propranolol 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.
Pseudoephedrine	Contac Cold, Drixoral Decongestant Non-Drowsy, Elixsure Decongestant, Entex, Genaphed, Kid Kare Drops, Nasofed, Seudotabs, Silfedrine, Sudafed, Sudodrin, SudoGest, Suphedrin, Triaminic Softchews Allergy Congestion, Unifed	Decongestant		Tablets, capsules	Acute	Pseudoephedrine 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.
Quetiapine	Seroquel	Antipsychotic	X	Tablets	Preventive	Quetiapine is an atypical antipsychotic. Exactly how it works is not known. It is thought to affect certain substances in the brain. It is used to treat schizophrenia or bipolar disorder.
Radiofrequency ablation	N/A	N/A	X	In-Office Procedure	Preventive	Radiofrequency ablation or neurotomy uses heat generated by radio waves to target specific nerves and temporarily turn off their ability to send pain signals. Due to the proximity to other nerves in the face, a high degree of technical precision is necessary to perform the procedure. Radiofrequency ablation is generally considered for the treatment of chronic headaches that have failed to respond to other treatments or procedures.
Reed Procedure (see also Omega Procedure)		Neuromodulation	X	Surgically implanted neuromodulation	Preventive	The Reed Procedure® is a surgical procedure for patients diagnosed with chronic migraine (15 or more attacks per month) that entails implanting an occipital nerve stimulator beneath the skin while the patient is under general anesthesia. It requires an initial minor surgery for a trial period, a second surgery for permanent implantation, and a battery pack change every 10 years. Removal or repair requires surgery as well. The Omega Procedure and the Reed Procedure® are the exact same surgical procedure; the difference is solely in their registered names. From a practical standpoint, the difference comes in the relative experience of the physicians involved.
Remote wearable neuromodulation (REN) device	Nerivio	Neuromodulation	X	Device	Acute	Nerivio is a wireless non-invasive remote electrical stimulation wearable device applied to the upper arm at the onset of migraine headache or aura. Nerivio induces an inherent pain inhibition brain mechanism, resulting in clinically significant pain relief. Nerivio is controlled by a smartphone app, which includes a treatment diary. Nerivio was approved for use in adults in October 2020 and for adolescents in January 2021.
Rimegepant	Nurtec ODT	Small molecule CGRP receptor antagonist (Gepant)	X	Orally-dissolving Tablets	Acute	Rimegepant is a gepant that treats acute migraine with or without aura by blocking CGRP receptors. CGRP is a brain chemical that causes vasodilation, inflammation, and pain at sites along the trigeminovascular pathway. Early studies show promise in the lack of association of gepants with medication overuse headache. It was FDA approved for acute treatment in February 2020 and as of March 2021 is being reviewed by the FDA for approval as a preventive treatment.
Rizatriptan	Maxalt	Serotonin 5-HT1 agonists or triptans	X	Tablets, sublingual	Acute	Rizatriptan is a serotonin 5-HT1 receptor agonist or "triptan.Ó It works by narrowing dilated blood vessels in the brain, relieving migraine. It is used to treat migraine with or without aura. It should not be used to prevent migraines or to treat cluster headache.
Sertraline	Zoloft	Antidepressant	X	Tablets	Preventive	Sertraline is an antidepressant in a group of drugs called selective serotonin reuptake inhibitors (SSRIs). It is used to treat depression, obsessive-compulsive disorder, panic disorder, anxiety disorders, post-traumatic stress disorder (PTSD), and premenstrual dysphoric disorder (PMDD). Leading neurologist Andrew Charles has flagged SSRI medications as having the potential to make migraine worse. If you take an SSRI and have migraine, consider discussing with your medical practitioner whether an alternative medication might work for you.
Sodium Valproate	Epilim	Anticonvulsant	X	Tablets, capsules, injection	Preventive	Valproate is an anticonvulsant that works by increasing a certain chemical in the brain. The injectable form of sodium valproate is used to control epileptic seizures in patients who are unable to take the oral form. It is also used for the treatment of migraine and bipolar disorder.
Sphenopalatine Ganglion (SPG) Device	Sphenocath, Allevio, & Tx360Ê	Neuromodulation	X	Device	Preventive	The Sphenopalatine Ganglion (SPG) is a group of nerve cells that is linked to the trigeminal nerve, the main nerve involved in headache. Application of local anesthetics (or numbing medications) to block or partially block the SPG, can be helpful in reducing head and facial pain. Three devices have been approved for performing SPG blocks. A doctor inserts a very thin plastic tube into the nose to insert numbing medication in and around the SPG.
Sumatriptan	Imigran, Imitrex, Treximet, Zembrace Symtouch, Onzetra XSail, Sumavel DosePro,	Serotonin 5-HT1 agonists or triptans	X	Tablets, injection, Needle-less injection, nasal spray	Acute	Sumatriptan is a serotonin 5-HT1 receptor agonist (triptan). It works by narrowing blood vessels in the brain, which helps to relieve migraine and cluster headache. Sumatriptan is used to treat migraine with or without aura. It is one of the most common treatments with numerous high quality studies demonstrating itÕs scientific efficacy for the treatment of acute migraine. It is also used to treat cluster headache. The Treximet brand is a combination of sumatriptan and naproxen sodium, both of which are available as generics.
Telcagepant		Gepant/ small molecule CGRP receptor antagonist		N/A	Acute/Preventive	Early CGRP treatment withdrawn from market by its manufacturer, Merck in 2009. A previous safety study showed patients taking it experienced elevated liver enzymes.
THC (Tetrahydrocannabinol)		Natural compound in the cannabis plant (marijuana)		Oils, Edibles, Tinctures, Capsules, or by consuming marijuana	Acute/Preventive	THC and marijuana are controlled substances in the U.S., prohibited by federal law. THC is a psychoactive compound of marijuana used by some for acute or preventive migraine relief.
Timolol	Blocadren, Betimol, Betrim, Istalol, Timoptic	Beta blocker	X	Tablets, eye drops	Preventive	Timolol is part of a group of drugs called beta blockers. It is used to treat hypertension (high blood pressure). Timolol eye drops are used to treat increased pressure in the eye (ocular hypertension) and open-angle glaucoma. It may also be used for other conditions as determined by your doctor.
Tizanidine	Zanaflex	Muscle relaxant	X	Tablets, injection, intranasal	Acute	Tizanidine is a short-acting muscle relaxant. It works by blocking nerve impulses or pain sensations that are sent to your brain. Tizanidine is used to treat spasticity by temporarily relaxing muscle tone.
Topiramate	Topamax	Anticonvulsant	X	Tablets	Preventive	Topiramate is an anticonvulsant that is also helpful to prevent migraine. It works by affecting several chemicals in the brain that help to reduce seizure activity and prevent migraine from occurring. It may be used alone or with other medications.
Tramadol	ConZip, Rybix ODT, Ryzolt, Ultram	Opioid	X	Tablets, injection, suppository	Acute	Tramadol is a centrally-acting, oral opioid-like analgesic and is approved for the treatment of moderate to moderately severe pain in adults. The extended-release form of tramadol is for around-the-clock treatment of pain and not for use on an as-needed basis for pain.
Tramadol, Paracetamol/Acetaminophen	Tramacet, Ultracet	Narcotic-like & Analgesic (painkiller)	X	Tablets, injection	Acute	This formulation combines individual ingredients for a stronger effect. See individual active ingredients for mode of action.
Transcranial Magnetic Stimulation (TMS) device	sTMS mini	Neuromodulation	X	Device	Acute	TMS 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. eNeuraÕs sTMS mini is a TMS device available via prescription.
Transcutaneous electrical nerve stimulation (TENS) device	Cefaly	Neuromodulation	X	Device	Preventive/Acute	TENS units are predominately used for nerve-related pain conditions, which may be acute or chronic. TENS machines work by sending stimulating pulses across the surface of the skin and along the nerve strands. The stimulating pulses help prevent pain signals from reaching the brain. TENS devices also help stimulate your body to produce higher levels of endorphins, its natural painkillers. The Cefaly I is a battery-powered headband. Cefaly II isa smaller rechargeable unit with adjustable intensity.
Ubrogepant	Ubrelvy	Small molecule CGRP receptor antagonist (Gepant)	X	Tablets	Acute	Ubrogepant is a gepant designed to treat migraine with or without aura as well as the symptoms of light sensitivity, sound sensitivity, or nausea. Ubrogepant targets CGRP receptors, blocking the CGRP from attaching. CGRP is a brain chemical that causes vasodilation, inflammation and pain at sites along the trigeminovascular pathway. Early studies show promise in the lack of association of gepants with medication overuse headache. It was FDA approved for acute treatment in December 2019.
Vagus-Nerve Stimulation (VNS) device	Gammacore	Neuromodulation	X	Device	Acute	The vagus nerve runs from the brain stem through the chest and abdomen on each side of the body. Vagus nerve stimulation appears to inhibit cortical spreading depression as well as calm the brain’s excitability. A VNS device stimulates the production of inhibitory neurotransmitters in the brain, including GABA, serotonin, and norepinephrine, which affect migraine and cluster headache. gammaCore is a handheld VNS device that stimulates the nerves noninvasively when placed above the vagus nerve in the neck.
Valproic acid, zonisamide, lidocaine, amiloride	Valproic, Lidocaine, Ranolazine, Phenytoin, Disopyramide, Midamor	Sodium channel blockers	X	Tablets, injection	Acute/Preventive	Anti-arrhythmic compounds that bind to and block sodium influx through cell membranes. Some are also used as local anesthetics and anticonvulsants. Sometimes used to treat chronic migraine. Primarily prescribed for high blood pressure, heart failure, or edema. There have been some reports that it is used to treat patients with migraine with aura, but further studies are needed.
Zavegepant (formerly Vazegepant)		Small molecule CGRP receptor antagonist (Gepant)	X	In testing as an intranasal and oral		Zavegepant (formerly vazegepant) is a gepant currently in clinical trials. Trial participants treated with nasal zavegepant had rapid onset of pain relief at 15 minutes and returned to normal function as early as 30 minutes. The 10 mg and 20 mg zavegepant doses showed therapeutic benefits on both pain relief and return to normal function at 2 hours. Zavegepant is the first and only intranasal CGRP receptor antagonist in late-stage development. In September 2020, zavegepant received the go-ahead from FDA for clinical trials on oral formulations. Not yet FDA appoved as of March 2021.
Venlafaxine	Effexor	Antidepressant	X	Tablets, capsules	Preventive	Venlafaxine 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.
Verapamil	Isoptin, Calan	Calcium channel blockers	X	Tablets, injection	Preventive	Verapamil 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.
Zolmitriptan	Zomig	Serotonin 5-HT1 agonists or triptans	X	Tablets, nasal spray	Acute	Zolmitriptan is a serotonin 5-HT1 receptor agonist or "triptan." It works by narrowing blood vessels in the brain, which helps to relieve migraine. It is used to treat migraine with or without aura in adults. It is not intended to prevent migraines.
Zolpidem	Ambien, Edluar, Intermezzo, Stilnox, Zonadin, Sanval, Zolpimist Hypnogen	Hypnotic	X	Tablets, suppository	Acute	Zolpidem is a sedative, also called a hypnotic. It affects chemicals in your brain that may become unbalanced and cause sleep problems or insomnia. The immediate-release forms of zolpidem are Ambien, Intermezzo, Edluar, and Zolpimist. The extended-release form of zolpidem is Ambien CR. Ambien, Edluar, and Zolpimist are used to help you fall asleep when you first go to bed. Intermezzo is used to help you fall back asleep if you wake up in the middle of the night.
Zonisamide	Zonegran	Anticonvulsant	X	Capsules	Preventive	Zonisamide 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.