Archives: Pass Add-ons

Migraine Nutrition & Dining Guide

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

Introduction

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

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

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

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

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

What this Nutrition Guide includes:

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

What this Nutrition Guide does not include:

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

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

1. Three Powerful Nutrients to Fight Migraine

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

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

Magnesium

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

The Evidence for Migraine and Magnesium

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

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

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

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

Detecting a Magnesium Deficiency

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

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

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

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

Retain Your Body’s Natural Magnesium

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

• Limit coffee, colas, salt, sugar, and alcohol, which are diuretics that cause loss of magnesium and fluid through more urination.

• Learn how to practice active relaxation to overcome the stress that strips your body of magnesium.
• Check with your doctor if your medication is causing magnesium loss. Many high blood pressure drugs or diuretics cause loss of magnesium.[2]

Eat More Magnesium-Rich Foods

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

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

Foods rich in magnesium include:

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

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

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

Riboflavin (Vitamin B2)

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

The Evidence for Migraine and Riboflavin

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

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

Eat More Riboflavin-Rich Foods

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

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

The Vitamin B2 Rich Foods include:

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

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

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

Omega-3s

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

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

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

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

The Evidence for Omega-3 and Migraine

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

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

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

Eat Fewer Foods with Omega-6

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

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

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

Eat More Foods with Omega-3

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

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

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

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

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

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

---

2 – Six Migraine Super Foods

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

Oily Fish

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

Ginger

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

Millet

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

Spinach

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

Kale

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

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

Chia Seeds

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

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

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

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

---

3 – Swapping Food Anxiety for Food Empowerment

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

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

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

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

The Key to Food Empowerment

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

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

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

How to Identify Your Personal Food Triggers

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

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

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

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

---

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

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

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

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

Tips to Enjoy Eating in with Migraine

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

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

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

---

5 – Enjoying Restaurants: Tips for Dining Out with Migraine

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

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

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

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

Tips to Enjoy Dining Out

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

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

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

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

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

• Request simple preparations. Sauces can hide a variety of ingredients, often MSG, soy and vinegar. MSG-free spices, herbs and salt can add flavor to any dish, plus olive oil. Simpler preparations reduce the risk of trigger exposure.
  • For salads, choose one with the fewest triggers, and customize it. Dress it with olive oil and, if not a trigger, vinegar, and salt and pepper.
  • For entrees, ask for fish, poultry or meat to be grilled with sauce on the side. Pasta with vegetables and fish, poultry or meat plus olive oil and garlic is another good choice for most people.
  • For sides, ask for vegetables to be steamed or sautéed in olive oil. Steamed rice and baked, boiled or roasted potatoes are migraine-friendly choices.
  • For desserts, if you don’t know whether chocolate, nuts and citrus fruits are triggers, fresh berries with whipped cream or biscotti are generally safe options.
  • For drinks, sparkling water with cranberry juice or ginger ale are safe, festive alternatives if you don’t feel like water. Herbal tea with honey is a good alternative if you find the caffeine in coffee or black tea is a trigger for you. 

• Eat to win. Applying everything you’ve discovered about the best nutrients for those with migraine, look for Omega-3 rich seafood and eggs, magnesium-rich salads and green vegetables, and riboflavin-rich seafood. Many restaurants now feature wild-caught seafood, kale, quinoa, chia seeds and other super foods that’ll help you feel as good as they taste. 

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

• Don’t guess with your health. A menu is like a print ad, and a server’s verbal description is like a radio ad for a food item. It does not list all the ingredients in a dish. If dining out has triggered an attack for you in the past, take a few more steps to ensure you don’t have a painful surprise coming. 

• Request a Nutrition Guide, if available. These are generally available in chain restaurants, and will list every single ingredient. Some chains also post them on their websites. Independent restaurants rarely offer this option.

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

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

---

6 – Recommended Resources on Nutrition and Food

Books

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

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

Websites

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

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

Apps

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

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

---

7 – Food Shopping List and Tips

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

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

Meat
Beef liver
Lamb
Pork

Other Protein
(Beans)
(Soybeans)
(Tofu)

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

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

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

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

Dairy
Omega-3 fortified Eggs
Milk
Yogurt
(Cheese)

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

Sources

1. Sun-Edelstein, C., & Mauskop, A. (2009, April). Role of magnesium in the pathogenesis and treatment of migraine. Retrieved from https://www.researchgate.net/publication/24187322_Role_of_magnesium_in_the_pathogenesis and treatment of migraine

2. Glaser, A. (2017, March 25). Easy Fix: Magnesium Deficiency and Migraines. Retrieved from https://migraineagain.com/easy-fix-magnesium-deficiency-migraines/

3. Ramsden, C. E., Faurot, K. R., Zamora, D., Suchindran, C. M., Macintosh, B. A., Gaylord, S. Mann, J. D. (2013, November). Targeted alteration of dietary n-3 and n-6 fatty acids for the treatment of chronic headaches: a randomized trial. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23886520

4. Food as Medicine: 7 Best Migraine-Fighting Diet Tips. (2017, January 28). Retrieved from https://migraineagain.com/7-best-anti-migraine-diet-tips/

5. Lete, I., & Allué, J. (2016). The Effectiveness of Ginger in the Prevention of Nausea and Vomiting during Pregnancy and Chemotherapy. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4818021/

6. Gröber, U., Schmidt, J., & Kisters, K. (2015, September). Magnesium in Prevention and Therapy. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4586582/

7. 5 Reasons Why Kale is a Migraine Superfood. (2017, March 13). Retrieved from https://migraineagain.com/5-reasons-kale-migraine-superfood/

8. 6 Foods That Fight Migraines and Prevent Attacks. (2017, March 05). Retrieved from https://migraineagain.com/6-foods-that-fight-migraines-and-prevent-attacks/

9. Junge, C. (2011, April 05). Food and migraine: a personal connection. Retrieved from http://www.health.harvard.edu/blog/food-and-migraine-a-personal-connection-201104052222

10. Curelator, NHF Study Shows Migraine Sufferers Aren’t Good at Determining Own Triggers. (2016, July 22). Retrieved from http://www.headaches.org/2016/07/22/curelator-nhf-study-shows-migraine-sufferers-arent-good-determining-triggers/

11. Dumas, P. (2017, March 05). Why Some Top Migraine Triggers May Actually be Symptoms. Retrieved from https://migraineagain.com/migraine-trigger-symptom-charles/

12. Hormonal Migraines: What Else is Messing with Your Estrogen. (2017, January 28). Retrieved from https://migraineagain.com/hormonal-migraines-else-messing-estrogen/

13. Bauer, J. (n.d.). 9 Common Migraine Triggers: Leftovers. Retrieved from http://www.joybauer.com/photo-gallery/common-trigger-foods/leftovers/

 

Welcome to your 2017 VIP Pass add-on package!

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

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

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

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

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

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

Click to View/Download the summaries (PDF)

Day 1: Real Warriors

• • • Triumph Over a Private Pain – Amanda Beard
    • Hiding in the Spotlight: Celebrities with Migraine – Andrew Levy, PhD
    • Fighting for Cluster Relief – Bob Wold
    • Patient Panel: Thriving Despite Migraine – Jon Summer, Alicia Torborg, Shirley Kessel

Day 2: Causes & Diagnosis

• • • Why Most Doctors Get the Diagnosis Wrong – Robert Cowan, MD
    • Migraine Genetics, MTHFR and Concussion – Lyn Griffiths, PhD
    • Link Between Unresolved Trauma and Migraine – Gretchen Tietjen, MD
    • How Concussion and Head Injuries Lead to Migraine – Mia Minen, MD, MPH

Day 3: Causes & Diagnosis

• • • Common Traps of Chronic Migraine – Deborah Friedman, MD, MPH
    • How Pain Works in the Migraine Brain – Patricia Pozo Rosich, MD, PhD
    • Hormonal Migraine Seasons in a Woman’s Life – Jessica Ailani, MD: Hormonal Migraine Seasons in a Woman’s Life
    • Status Migraine: When Pain Doesn’t Stop – Christina Treppendahl, FNP-BC, AQH, MHD

Day 4: Symptoms

• • • Disabling Nausea and Cyclical Vomiting – Amy Gelfand, MD
    • Understanding Migraine-Related Mood Disorders – Steven M. Baskin, MD
    • Pain, Memory and Migraine – Jack D. Schim, MD
    • Autoimmune Diseases and Facial Pain – Hossein Ansari, MD

Day 5: Triggers

• • • Weather, Food, and More: The Truth About Triggers – Vince Martin, MD
    • How Fasting, Weight and Dehydration Affect Your Brain – Elizabeth Leroux, MD, FRCPC
    • Pros and Cons of Blocking CGRP – Antoinette Maassen van den Brink, PhD
    • The Science of Light Sensitivity and How to Manage It – Rami Burstein, PhD

Day 6: Alternative Treatments

• • • Supplements and Natural Alternatives – Alexander Mauskop, MD
    • CBD Oil for Migraine – Stephen Silberstein, MD
    • Mindfulness-Based Stress Reduction – Rebecca Wells, MD, MPH
    • Food and Nutrition For Migraine – Cynthia E. Armand, MD

Day 7: Treatments

• • • The Latest New Treatment Innovations – Peter Goadsby, MD
    • Are Migraine Surgeries Worth It? – William Young, MD
    • Real-World Use of CGRP Medications – Brian Grosberg, MD
    • Multi-Disciplined Approach to Migraine Management – Tina Poole, MD

Day 8: Taking Control

• • • Migraine and Psychological Comorbidities – Paul Martin, PhD
    • Cognition and Aging Well with Migraine – Shivang Joshi, MD, MPH, RPh
    • Navigating Insurance and Access Issues – Katie Golden
    • Migraine at Work: Issues and Progress – Elena Ruiz de la Torre

Day 9: MWS Onstage Presentations

• • • Are You Really Just Fine? – William Young, MD
    • Why 2020 Is the Time to Feel Better – Dawn Buse, PhD
    • How Can You Stand Up Against Migraine? – Amaal Starling, MD
    • Migraine Is No Joke For This Comedian – Whitney Cummings

Transcripts

Click to View/Download the transcripts (PDF)

Day 1: Real Warriors

• • • Triumph Over a Private Pain – Amanda Beard
    • Hiding in the Spotlight: Celebrities with Migraine – Andrew Levy, PhD
    • Fighting for Cluster Relief – Bob Wold
    • Patient Panel: Thriving Despite Migraine – Jon Summer, Alicia Torborg, Shirley Kessel

Day 2: Causes & Diagnosis

• • • Why Most Doctors Get the Diagnosis Wrong – Robert Cowan, MD
    • Migraine Genetics, MTHFR and Concussion – Lyn Griffiths, PhD
    • Link Between Unresolved Trauma and Migraine – Gretchen Tietjen, MD
    • How Concussion and Head Injuries Lead to Migraine – Mia Minen, MD, MPH

Day 3: Causes & Diagnosis

• • • Common Traps of Chronic Migraine – Deborah Friedman, MD, MPH
    • How Pain Works in the Migraine Brain – Patricia Pozo Rosich, MD, PhD
    • Hormonal Migraine Seasons in a Woman’s Life – Jessica Ailani, MD: Hormonal Migraine Seasons in a Woman’s Life
    • Status Migraine: When Pain Doesn’t Stop – Christina Treppendahl, FNP-BC, AQH, MHD

Day 4: Symptoms

• • • Disabling Nausea and Cyclical Vomiting – Amy Gelfand, MD
    • Understanding Migraine-Related Mood Disorders – Steven M. Baskin, MD
    • Pain, Memory and Migraine – Jack D. Schim, MD
    • Autoimmune Diseases and Facial Pain – Hossein Ansari, MD

Day 5: Triggers

• • • Weather, Food, and More: The Truth About Triggers – Vince Martin, MD
    • How Fasting, Weight and Dehydration Affect Your Brain – Elizabeth Leroux, MD, FRCPC
    • Pros and Cons of Blocking CGRP – Antoinette Maassen van den Brink, PhD
    • The Science of Light Sensitivity and How to Manage It – Rami Burstein, PhD

Day 6: Alternative Treatments

• • • Supplements and Natural Alternatives – Alexander Mauskop, MD
    • CBD Oil for Migraine – Stephen Silberstein, MD
    • Mindfulness-Based Stress Reduction – Rebecca Wells, MD, MPH
    • Food and Nutrition For Migraine – Cynthia E. Armand, MD

Day 7: Treatments

• • • The Latest New Treatment Innovations – Peter Goadsby, MD
    • Are Migraine Surgeries Worth It? – William Young, MD
    • Real-World Use of CGRP Medications – Brian Grosberg, MD
    • Multi-Disciplined Approach to Migraine Management – Tina Poole, MD

Day 8: Taking Control

• • • Migraine and Psychological Comorbidities – Paul Martin, PhD
    • Cognition and Aging Well with Migraine – Shivang Joshi, MD, MPH, RPh
    • Navigating Insurance and Access Issues – Katie Golden
    • Migraine at Work: Issues and Progress – Elena Ruiz de la Torre

Day 9: MWS Onstage Presentations

• • • Are You Really Just Fine? – William Young, MD
    • Why 2020 Is the Time to Feel Better – Dawn Buse, PhD
    • How Can You Stand Up Against Migraine? – Amaal Starling, MD
    • Migraine Is No Joke For This Comedian – Whitney Cummings

Welcome to your 2020 VIP Pass add-on package!

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

The VIP Access Pass gives you unlimited access via our online portal to all 2020 Expert Videos, Audios, Transcripts, Online Streaming, and Online Downloading. PLUS you also have access to our Private Support Group, a Treatment Directory with a list of 290 options, and Guideline Recommended Treatment Report.

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

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

THESE 17 TRIGGER GUIDES CAN HELP YOU IDENTIFY AND BETTER MANAGE YOUR MIGRAINE TRIGGERS.

Click to View/Download the guides (PDF)

---

• • • 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

2020 Migraine Treatment Guidelines Summary

Introduction

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

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

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

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

How to read this report

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

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

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

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

Important notes

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

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

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

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

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

---

New in 2019 and 2020

NEW Guidelines

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

NEW MEDICAL ACUTE TREATMENTS

Aprepitant (Emend) – nausea relief

Dimenhydrinate (Gravol+) – nausea/vomiting relief

Diphenhydramine (Benadryl+) – antihistamine

Fosaprepitant (Emend) – nausea/vomiting relief

Lasmiditan (Reyvow)**

Rimegepant (Nurtec ODT)**

Ubrogepant (Ubrelvy)**

Neurolief device (Relivion)***

Remote electrical neuromodulation device (Nerivio)**

Allay narrow-band green light lamp**

NEW Acute and Preventive Treatments

Telcagepant

Vazegepant

NEW PREVENTIVE TREATMENTS

Atogepant

Eptizenumab (Vyepti)**

Erenumab (Aimovig)**

Estrogen Patch

Intrauterine Device (IUD)*

Fremanezumab (Ajovy)**

Galcenezumab (Emgality)**

Omega Procedure

Reed Procedure

NEW NONMEDICAL PREVENTIVE TREATMENTS

L-carnitine Dietary Supplement

N1-Headache Smartphone App

THC (Tetrahydrocannabinol)

Trauma-focused Cognitive Behavioral Therapy

Important Notes:

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

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

---

Preventative treatment of migraine in adults

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

Level A: Established as effective

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

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

Level B: Probably effective

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

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

Level C: Possibly effective

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

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

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

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

Other: treatments that are established as possibly or probably ineffective

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

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

---

Acute treatment of migraine in adults

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

Level A: Established as effective

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

Level B: Probably effective

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

Level C: Possibly effective

Phenazone*
Butalbital
Lidocaine intranasal

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

Celecoxib
Ketorolac tromethamine nasal spray

Level C Negative

Ketorolac tromethamine nasal spray

*Classification may vary by country

---

Migraine with Menstruation

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

Level A: Established as effective

Frovatriptan

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

Level B: Probably effective

Naratriptan
Zolmitriptan

Level C: Possibly effective

Estrogen

---

Children & Adolescents

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

Low Confidence in Evidence

Ibuprofen OS 7.5-10 mg/kg

Acetaminophen / paracetamol

Very Low Confidence in Evidence

Sumatriptan nasal spray 5-10 mg

Sumatriptan oral tablet 25-50 mg

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

Moderate Confidence in Evidence

Sumatriptan nasal spray 5 mg (nausea and vomiting)

Low Confidence in Evidence

Sumatriptan nasal spray 10 mg (vomiting)

Very Low Confidence in Evidence

Sumatriptan nasal spray 10 mg (nausea)

Moderate: Probably no more likely than placebo.

Low: Possibly no more likely than placebo.

Results Summary (2019 AAN):

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

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

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

---

Emergency Treatment

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

Level B: Probably effective

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

Level C: Possibly effective

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

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

Lidocaine IV
Hydrocortisone IV

Level B Negative: Medication is probably ineffective.

Octreotide SC

Level C Negative: Medication is possibly ineffective.

Chlorpromazine IM
Granisetron IV
Acetaminophen IV

---

SOURCES:

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

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

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

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

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

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

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

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

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

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

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 five words we never want to hear from our doctors are “We’re simply out of options.”

Methodology

That’s why we’ve crowd-sourced more than 300 medicinal and nonmedicinal treatments that those with migraine have self-reported they are using. Several are new in this 2020 edition of the Migraine World Summit Treatment Directory.

Once we identified all the treatments, we then researched all the basic information about those treatments. However, this Directory is not designed to be a comprehensive reference for any individual treatment. By including side effects, contraindications, 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 labelled as “Natural” are not always safe.

For example, certain supplements proven to be effective in preventing migraine aren’t always produced with consistent quality control. Certain essential oils – 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.

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	Barbiturate	X	Tablets	Acute	Acetaminophen is a known 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.
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, 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.
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.
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, 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		Gepant/ small molecule CGRP receptor antagonist	X		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 atagonist for the acute treatment of migraine. Atogepant has a longer half-life, making it suitable for preventive treatment. Not FDA-approved as of February 2020.
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.
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.
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	Nonsteroidal anti-inflammatory drugs (NSAIDs)	X	Tablets	Acute	Celecoxib is a nonsteroidal anti-inflammatory drug (NSAID). It works by reducing hormones that cause inflammation and pain in the body. Celecoxib is used to treat pain or inflammation caused by many conditions such as arthritis, ankylosing spondylitis, and menstrual pain. Celecoxib is also used in the treatment of hereditary polyps in the colon.
Celecoxib	Celebrex is the only one available in the U.S. Vioxx and Bextra are no longer available due to increased risk of heart attack and stroke.	COX inhibitor	X	Tablets	Acute/Preventive	A sub-class 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.
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.
CGRP	Fremanezumab, Galcanezumab, Eptinezumab, Erenumab	CGRP monoclonal antibody	X	Tablets, injection	Acute/Preventive	Calcitonin gene-related peptides (CGRPs) treatments for migraine most commonly refer to a new class of monoclonal antibodies that block the CGRP pathway. CGRP is a peptide of amino acids that is elevated in migraine. If blocked, it can inhibit a migraine attack. The antibodies either act on the CGRP receptor or the CGRP peptide itself. Research findings to date suggest CGRP medications are extraordinarily well tolerated.
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	Narcotic	X	Capsule, tablets, rectal suppository	Acute	Codeine is an opioid pain medication. An opioid is also known as a narcotic. 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.
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 headache that has already begun. It will not prevent migraine or reduce the number of migraine attacks.
Dihydroergotamine mesylate	Dihydergot, DHE 45, Migranal	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.
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.
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 (Vyepti) is an intravenous preventive monoclonal antibody FDA approved in February 2020. CGRP monoclonal antibodies attach to the calcitonin gene related peptide (CGRP) and inactivate it. Eptinezumab is given as a quarterly IV infusion four times a year.
Erenumab	Aimovig	CGRP monoclonal antibody	X	Injection	Preventive	Erenumab (Aimovig) is a preventive monoclonal antibody FDA approved in May 2018. This CGRP monoclonal antibody attaches to the calcitonin gene related peptide (CGRP) receptor to inhibit its function. Aimovig is self-administered monthly.
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 (Ajovy) is a preventive monoclonal antibody approved by FDA in September 2018 for the prevention of migraine. CGRP monoclonal antibodies attach to the calcitonin gene related peptide (CGRP) and inactivate it. Ajovy is self-administered monthly or quarterly as your physician advises.
Frovatriptan	Frova, Migard	Serotonin 5-HT1 agonists or triptans	X	Tablets	Acute	Frovatriptan is a serotonin 5-HT1 receptor agonist, also known as a Òtriptan.Ó 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 (Emgality) is a preventive monoclonal antibody approved by FDA in September 2018 for prevention of migraine, and for treatment of episodic cluster headache in June 2019. CGRP monoclonal antibodies attach to the calcitonin gene related peptide (CGRP) and inactivate 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 Block	Steroid/Lidocaine	Other - steroid & anesthetic	X	Injection	Preventive	The occipital nerves are two pairs of nerves originating in the upper cervical vertebrae. The greater occipital nerve (GON) is located just 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 sub-occipital region of the skull. The purpose of a GON block is to block pain messages to the brain from the GON. 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	Narcotic	X	Tablets, suppository, intranasal	Acute	Hydrocodone is an opioid pain medication. An opioid is also referred to as a narcotic. Zohydro ER and Hysingla ER are extended-release forms of hydrocodone that are used for around-the-clock treatment of severe pain. Extended-release hydrocodone is not for use on an as-needed basis for pain.
Hydromorphone	Dilaudid-HP, Jurnista	Narcotic	X	Tablets	Acute	Hydromorphone is an opioid (narcotic) analgesic. It works in the brain and nervous system to reduce pain. It is used to treat moderate to severe pain in narcotic-tolerant patients who require larger than usual doses to provide adequate pain relief.
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.
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	Serotonin 5-HT1 agonists or Ditan	X	Tablets	Acute	Ditans are related to triptans. Like triptans, they also 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.
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.
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	Narcotic	X	Tablets, injection	Acute	Meperidine is a narcotic 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.
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	Narcotic	X	Tablets, injection, suppository, inhalation	Acute	Morphine is an opioid or narcotic pain medication. Morphine is used to treat moderate to severe pain. Short-acting formulations are taken as needed for pain. The extended-release form of this medicine is for around-the-clock treatment of pain. This form of morphine is not for use on an as-needed basis for pain.
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 (Neurolief)	Neuromodulation device		Device applied to forehead and head	Acute	RRelivion is a smartphone-controlled, cloud-connected, multichannel neuromodulation device. It offers precise, personalized care by delivering unparalleled 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. OTC in Europe, approved 7/2019.
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	Narcotic	X	Tablets, injection, suppository	Acute	Oxycodone is an opioid/narcotic pain medication. It is used to treat moderate to severe pain.
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 a number of 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, 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.
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 device	Nerivio	Remote electrical neuromodulation (REN) wearable	X	Device applied directly to the skin of the outer upper arm	Acute	Nerivio is a wireless non-invasive remote electrical stimulation wearable 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.
Rimegepant	Nurtec ODT	Gepant/ small molecule CGRP receptor antagonist	X	Orally-dissolving Tablets	Acute	Rimegepant (Nurtec ODT) is a non-narcotic, orally-dissolving tablet 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. Nurtec ODT takes effect within an hour and can provide relief for up to 48 hours. FDA approved February 2020.
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	Narcotic-like painkiller	X	Tablets, injection, suppository	Acute	Tramadol is a narcotic-like pain reliever that is used to treat moderate to severe pain. Tramadol is a centrally acting, oral narcotic-like analgesic and is approved for the treatment of moderate to moderately severe pain in adults. The extended-release form of tramadol is for around-the-clock treatment of pain and not for use on an as-needed basis for pain.
Tramadol, Paracetamol/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	Gepant/small molecule CGRP receptor antagonist	X	Tablets	Acute	Ubrogepant (Ubrelvy) is a non-narcotic pill designed to treat migraine with or without aura as well as the symptoms of light sensitivity, sound sensitivity, or nausea. CGRP is a brain chemical that causes vasodilation, inflammation and pain at sites along the trigeminovascular pathway. Ubrelvy is the first acute treatment for migraine that targets CGRP receptors, blocking CGRP from attaching. FDA approved December 2019.
Vagus-Nerve Stimulation (VNS) device	Gammacore	Neuromodulation	X	Device	Acute	The vagus-nerve runs from the brainstem through the chest and abdomen on each side of the body. Vagus nerve stimulation appears to inhibit cortical spreading depression as well as calm the brainÕs 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.
Vazegepant		Gepant/ small molecule CGRP receptor antagonist	X	In testing as an intranasal formulation		Vazegepant is a small molecule CGRP receptor antagonist currently in clinical trials. Trial participants treated with vazegepant had rapid onset of pain relief at 15 minutes (10 mg and 20 mg) and return to normal function as early as 30 minutes (20 mg). The 10 mg and 20 mg vazegepant doses showed therapeutic benefits on both pain relief and return to normal function at 2 hours. Not yet FDA-approved as of March, 2020.
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.

Non Medicinal Migraine Treatments

This section includes a wide variety of Alternative, Complementary, Natural and Holistic treatments. They are categorized as Therapy, Behavioral Therapy, Physical Therapy, Product/Device, Procedure, Lifestyle and Vitamin/Supplement.

Although these are non-drug related treatments and generally non-prescription, they should be discussed with your doctor as part of your total treatment plan.

How to use this reference:

• Non-Medicinal Treatment: The therapy/vitamin/lifestyle practice/device/procedure being used i.e. Acupuncture.
• Format: The category of the treatment i.e. Acupuncture is listed as a ‘Therapy’
• Free or Paid: Is the treatment free to perform or does it involve a cost? Acupuncture involves a cost to see an acupuncturist.
• Preventive or Acute Treatment: ‘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.
• 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.

Nonmedical Treatment	Format	Acute or Preventive Treatment	Free or Paid	Description
5- HTP (5 Hydroxytryptophan)	Vitamin/Supplement	Preventive	Paid	Serotonin is a critical neuro-signaling chemical. A deficiency may result in chronic pain, sleep disturbances, anxiety, depression and a propensity to overeat. People with migraine may have low serotonin levels, and associated disorders include depression, irritable bowel syndrome, as well as other chronic pain syndromes. Serotonin can be increased naturally through behavioral health methods and/or dietary supplementation with pharmaceutical grade L-tryptophan or 5-HTP. 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. 5-HTP (5-hydroxytryptophan) is directly converted to serotonin (5-hydroxytryptamine) in nerve cells and the liver before it can reach the brain. The result is a significant increase in levels of serotonin in the blood while brain levels of serotonin are only slightly increased because blood serotonin has trouble entering the brain. In Europe, 5-HTP is often prescribed with a Parkinson drug (carbidopa) to delay conversion of 5-HTP to serotonin until it reaches the brain. In this setting, adequate 5-HTP crosses the blood-brain barrier, increasing serotonin in the brain and central nervous system (CNS). 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).
Acupressure	Physical Therapy	Acute	Paid	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.
Acupuncture	Procedure	Preventive	Paid	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 the body’s natural painkillers called endorphins.
Alexander Technique	Therapy	Preventive	Paid	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.
Aromatherapy	Product/Device	Preventive	Paid	Aromatherapy uses plant materials and aromatic plant oils to help alter one’s mood, cognitive, psychological or physical wellbeing. Blends of plant oils, essential oils and other aromatic compounds are often utilised through topical application, massage inhalation or water immersion to stimulate a desired response.
Avoid Bright Screens	Lifestyle	Preventive	Free	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.
Avoid Fluorescent Lighting	Lifestyle	Preventive	Free	Fluorescent lights emit a particular spectrum of light. People with migraine may be sensitive to the spectrum of light emitted by fluorescent lights.
Avoid Loud, Sustained Noise	Lifestyle	Preventive	Free	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.
Avoid Odors/Smoke	Lifestyle	Preventive	Free	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.
Avoid Processed Foods	Lifestyle	Preventive	Free	Processed foods often contain artificial ingredients and preservatives that can contribute towards migraines. These include MSG, Soy, Sulfates/Sulfites, Nitrates, Nitrites, and Gluten amongst others. See Dietary Changes for more trigger ingredients and foods.
Ayurveda	Therapy	Preventive	Free	Ayurveda is an ancient Indian practice that involves a variety of treatments including yoga, massage, acupuncture, diet, and herbal medicine to encourage health and wellbeing. 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.
Barometer	Product	Preventive	Paid	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.
Biofeedback	Behavioral Therapy	Preventive	Paid	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.
Black Cohosh	Tablets/Liquid extract	Preventive	Paid	Black cohosh (Actaea racemosa) is a herb sometimes used to treat perimenopause and menopause symptoms. It is native to North America, and its roots and rhizomes, are made up of glycosides (sugar compounds), isoferulic acids (anti-inflammatory substances), and phytoestrogens (plant-based estrogens). Warning: the wrong variety can lead to liver toxicity symptoms.
Blood Test - Food Sensitivities/Nutrition	Other	Preventive	Paid	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 migraines. A food allergy blood test can also determine if supplementation is necessary, by seeing if magnesium or vitamin D are deficient, for example.
Blood Test – Genetic dysfunction	Other	Preventive	Paid	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.
Bowen Therapy	Physical Therapy	Preventive	Paid	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.
Breathing Relaxation Techniques	Therapy	Preventive	Free	Deep breathing is a simple way to reduce stress and relax. For example, taking 3 or 10 deep, slow breaths can help reduce anxiety and control stress. Also, left nostril breathing is a technique used in yoga that helps to control anxiety.
Butterbur	Vitamin/Supplement	Preventive	Paid	Butterbur is an herbal supplement that has been reported to be effective in reducing the frequency and severity of migraines in some people with migraine. Caution should be exercised with Butterbur as it contains components called pyrrolizidine alkaloids (PA’s) 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.
Caffeine	Vitamin/Supplement	Acute	Paid	Caffeine is a very common 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.
Calcium	Vitamin/Supplement	Preventive	Paid	Calcium is essential for building and maintaining bone, and is required for the healthy functioning of the heart, muscles, blood and nerves.
Capsaicin	Vitamin/Supplement	Acute	Paid	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.
Cervical Traction	Product/Device	Preventive	Paid	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.
Chinese Herbal Medicine	Vitamin/Supplement	Preventive	Paid	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.
Chiropractor	Physical Therapy	Preventive	Paid	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 the realignment may benefit corresponding nerves, muscles, or organs. Some medical doctors warn against allowing manipulation of the neck, which can result in a stroke.
Coenzyme Q10 (CoQ10)/Ubiquinol	Vitamin/Supplement	Preventive	Paid	CoQ10 is essential for the proper functioning of cells inside the body. CoQ10 can help minimise 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 CoQ10 in migraine treatment. A more concentrated form is known as Ubiquinol. Sources of CoQ10 can be found as a vitamin supplement or in soybean oil, canola oil, chicken, herring, mackerel, beef, roasted peanuts, sesame seeds, pistachio nuts, broccoli, cauliflower, orange, strawberries, and eggs.
Cognitive Behavioural Therapy (CBT)	Behavioral Therapy	Preventive	Paid	Cognitive behavior 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.
Cooling Gel Sheet	Product/Device	Acute	Paid	Applying cold items or ice packs to the head helps promote circulation and reduces the inflammation in the head caused by migraine.
Creative Therapy	Behavioral Therapy	Preventive	Free	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.
D-Ribose (Beta-D-ribofuranose)	Vitamin/Supplement	Preventive	Paid	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.
Daith Piercing	Procedure	Preventive	Paid	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.
Dark, quiet room	Lifestyle	Acute	Free	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.
Detoxification (Detox)	Therapy	Preventive	Paid	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.
Diet - 5:2 diet	Lifestyle	Preventive	Free	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.
Diet - Elimination Diet	Lifestyle	Preventive	Free	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 a several weeks to establish a baseline before gradually reintroducing foods one at a time, often several days apart. If a migraine attack occurs while a new food is being introduced, then it may be attributed to that food and consequently the food is removed from the diet.
Diet - Ketogenic Diet	Lifestyle	Preventive	Free	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 migraines have been shown to improve while on a ketogenic diet. Further study is needed.
Diet - Paleo Diet	Lifestyle	Preventive	Free	The Paleo diet, also known as the Caveman or Stone Age diet, mimics the hunter-gatherer diet of oura Paleolithic ancestors and promotes consumption habits which 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 produce reputable scientific evidence.
Diet - Vegan Diet	Lifestyle	Preventive	Free	Vegetarians do not eat meat, fish, or poultry. 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.
Diet - Vegetarian Diet	Lifestyle	Preventive	Free	Vegetarians do not eat meat, fish, or poultry. There is no evidence linked to migraine.
Diet – Gluten-Free	Lifestyle	Preventive	Free	Gluten has been linked to migraine and 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, diarrhoea, and constipation, as well as fatigue and mental “fog”, it may be worth trying a gluten-free diet. There is, however, no direct evidence linking this diet to migraine.
Dietary Changes	Lifestyle	Preventive	Free	What you eat can play a very significant role in your migraines. There are a number of foods that are problematic for a large number of migraine sufferers. Understanding which foods trigger your migraine attacks is 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 such as bacon, hot dogs, aspartame, and ice cream. If you are unsure, it may be worthwhile speaking with your doctor or seeing a dietician 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.
Eliminate Cigarette Smoking	Lifestyle	Preventive	Free	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 occurring to an individual’s health whilst smoking is likely to make existing health conditions worse.
Eliminating Alcohol	Lifestyle	Preventive	Free	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.
Eliminating Caffeine (e.g. Coffee, Tea, Sodas)	Lifestyle	Preventive	Free	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.
Eliminating Chocolate	Lifestyle	Preventive	Free	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.
Eliminating Dairy	Lifestyle	Preventive	Free	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 products.
Eliminating Gluten	Lifestyle	Preventive	Free	See ‘Diet – Gluten Free’
Eliminating MSG	Lifestyle	Preventive	Free	MSG or monosodium glutamate is an amino acid used as a food preservative and flavour enhancer. It has been named as a common migraine trigger. It’s not limited to Chinese food and it has many aliases making it difficult to detect on packaged foods.
Eliminating Nitrates/Nitrites	Lifestyle	Preventive	Free	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 a higher risk of cancer. Processed meats such as bacon, hot dogs, sausages, cured ham, cold cuts, and related products commonly have artificially added nitrates as a preservative.
Eliminating Soy	Lifestyle	Preventive	Free	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, some salad dressings, sauces, and breakfast bars, and other products, as well as soy sauce, soy lattes, tofu, and miso.
Eliminating Sulfates/Sulfites	Lifestyle	Preventive	Free	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. Sulphate is also used as a preservative in dried fruit and many dried-fruit products.
Eliminating Tyramine	Lifestyle	Preventive	Free	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.
Epsom salt baths	Product	Acute/Preventive	Paid	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.
Evening Primrose Oil	Vitamin/Supplement	Acute	Paid	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.
Exercise	Lifestyle	Preventive	Free	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 (, i.e. jogging, swimming, cycling etc). If you can find things you enjoy doing then you’re more likely to be consistent. Many people find yoga, Pilates, or t’ai chi to be a great option. Anything is better than nothing. If exercise triggers migraines, however, start small. If you’re outside, wear polarized sunglasses. Ensure that you’ve eaten enough and take a water bottle so that you don’t get dehydrated. Starting small and building upwards is a much more successful approach then trying to jump in without any warm up or preparation.
Feverfew	Vitamin/Supplement	Preventive	Paid	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.
Folate	Vitamin/Supplement	Preventive	Paid	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.
Folic Acid (Vitamin B9)	Vitamin/Supplement	Preventive	Paid	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, Brussel sprouts, and spinach. Folic acid helps your body produce and maintain new cells, and also helps prevent changes to DNA that may lead to cancer. As a medication, folic acid is used to treat folic acid deficiency and certain types of anemia (lack of red blood cells) caused by folic acid deficiency.
Forest bathing	Lifestyle	Preventive	Free	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.
Ginger (including ginger powder, natural ginger & supplements)	Vitamin/Supplement	Acute/Preventive	Paid	Ginger is a commonly used cooking spice known for its antinausea, antidiarrhea, and digestion-aiding properties. Ginger is used for a 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. GelStat, a supplement brand presented findings to the American Academy of Neurology in 2006 claimed that 1 in 5 people experienced complete relief after taking their Ginger and Feverfew multivitamin. Note: this study was not independently conducted.
Glucosamine	Vitamin/Supplement	Preventive	Paid	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.
Green-Light Lamp	Narrow-Band Green Light	Preventive	Paid	Therapeutic light device designed to reduce anxiety and migraine intensity during an attack.
Heat creams, gels, balms & rubs	Product/Device	Acute	Paid	Heat-producing creams, gels, and products in other formats are commonly used to help relieve muscle tension, tightness, minor aches, pains, or stiffness in the muscles or joints.
Heat Pack, Bean Bags, or Wheat pack	Product/Device	Acute	Paid	Heat stimulates your sensory receptors to block the transmission of pain signals to the brain and can result in pain relief. Heat helps reduce muscle tension, increases blood flow, and brings nutrients to the affected area faster.
Herbal teas (e.g. Dandelion, Chamomile, Ginger, Mint tea)	Product/Device	Preventive	Paid	Herbal teas contain vitamins and nutrients. Drinking hot herbal tea can also be a calming and relaxing activity. It also helps keep up hydration levels.
Homeopathy	Therapy	Preventive	Paid	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.
Hot shower	Lifestyle	Acute	Free	Like heat packs, a hot shower can stimulate blood circulation and can be relaxing, which may help provide comfort from a variety of symptoms.
Hydration (Drinking water)	Lifestyle	Preventive	Free	Dehydration is a common migraine trigger. Keeping water on hand throughout the day helps ensure you get the recommended 8 glasses per day.
Hydrotherapy	Lifestyle	Acute	Free	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.
Hyperbaric Oxygen Therapy	Therapy	Preventive	Paid	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.
Hypnotherapy/Hypnosis	Therapy	Preventive	Paid	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.
Ice therapy/ice packs	Product/Device	Acute	Free	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 to painful areas on the head. Wearable ice packs permit sleeping and movement while worn.
Improving posture	Lifestyle	Preventive	Free	Poor posture can result in tightening muscles in the neck or scalp, which may lead to headache and migraines. Extended reading looking down at a mobile phone or hunching over a computer, laptop, or gaming console can lead to neck and back pain and can trigger an attack. Modern laptops encourage poor posture. Correcting postural issues may help relieve migraine and reduce the frequency of attacks.
Iron supplements	Vitamin/Supplement	Preventive	Paid	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.
Isoflavones (e.g. Promensil)	Vitamin/Supplement	Preventive	Paid	Isoflavones 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.
Kinesiology	Physical Therapy	Preventive	Paid	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.
Krill Oil	Vitamin/Supplement	Preventive	Paid	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).
L-carnitine	Dietary supplement	Preventive	Paid	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.
L-methylfolate/Levomefolic acid	Vitamin/Supplement	Preventive	Paid	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.
Lavender oil	Product/Device	Preventive	Paid	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.
Magnesium (including variants i.e., citrate, glycinate)	Vitamin/Supplement	Preventive	Paid	Magnesium is one of the most common minerals in the human body. It plays an important role in the production of protein, the transport and production of energy, normal muscle operation, nerve function, a steady heart rhythm, and supports a healthy immune system. During a migraine attack, low levels of magnesium have been shown in the brain. It’s thought that magnesium deficiency and migraines may be related since magnesium is required for proper nerve function. Sources of magnesium include legumes, nuts, whole grains, seeds, leafy green vegetables, soy products, bananas, dried apricots, avocados, and magnesium supplements. Dr Mark Hyman recommends a high dose of Magnesium citrate or glycinate at 300-600mg twice per day to help prevent attacks.
Magnetic acupressure bracelets	Device	Acute/Preventive	Paid	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.
Magnotherapy	Therapy	Preventive	Paid	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.
Manage Stress	Lifestyle	Preventive	Free	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.
Meditation	Behavioral Therapy	Preventive	Free	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.
Melatonin	Vitamin/Supplement	Preventive	Paid	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.
Menthol/Mint	Product/Device	Acute	Paid	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.
Migraine Buddy	Product/Device	Preventive	Free	Using a migraine app means being able to go to your doctor with proper documentation, and be able 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 migraines evolved with the treatment provided and the level of relief with those treatments.
Migraine Support Formula	Vitamin/Supplement	Preventive	Paid	This is a multivitamin product designed specifically for people with migraine, which combines several well-known vitamins and supplements to help relieve migraine. Vitamins included are Riboflavin, Niacin, Vitamin B6, Magnesium, Ginger, CoQ10, White Willow, Feverfew, Butterbur & Black Pepper.
Mindfulness	Meditation	Acute/Preventive	Free	A form of meditation based on a moment-by-moment awareness of thoughts, feelings, bodily sensations, and surrounding environment. It means tuning into 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.
Myofascial release	Physical Therapy	Preventive	Paid	Myofascial release (or MFR) is a soft-tissue therapy for the treatment of skeletal muscle immobility and pain. This alternative medicine therapy aims to relax contracted muscles, improve blood and lymphatic circulation, and stimulate the stretch reflex in muscles.
N1-Headache	Smartphone app	Preventive	Paid	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.
Naturopathy	Therapy	Preventive	Paid	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 criticised for its lack of scientific evidence and conflicts with evidence-based medicine. For example, many naturopaths oppose vaccination.
Neck/Scalp Massage	Physical Therapy	Acute	Paid	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, temporarily, and reduce blood pressure and heart rate.
Niacin (Vitamin B3)	Vitamin/Supplement	Preventive	Paid	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.
Occipital Lift Technique	Physical Therapy	Acute	Paid	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.
Occlusal splint	Product/Device	Preventive	Paid	A dentist prescribed mouthguard to protect teeth against clenching/grinding.
Omega-3	Vitamin/Supplement	Preventive	Paid	Fish oil contains omega-3 fatty acids, which are found mostly in fish 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, amongst others.
Osteopathy	Physical Therapy	Preventive	Paid	Osteopathy can be used to correct misalignments, which may trigger migraine attacks in some people.
Passage of time	Lifestyle	Acute	Free	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.
Peppermint Oil	Product/Device	Preventive	Paid	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.
Petadolex (Butterbur Extract)	Vitamin/Supplement	Preventive	Paid	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, which are toxic to the liver and may cause cancer. The concentrations of this toxin vary depending on which part of the plant is harvested and where the plant is grown. Petadolex is a brand name of the vitamin producer whose makers claim that it doesn’t contain the harmful chemicals (PAs) within butterbur.
Physiotherapy (physical therapy)	Physical Therapy	Preventive	Paid	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 migraines, particularly if you feel your migraine attacks are caused by neck issues.
Pilates	Lifestyle or Physical Therapy	Preventive	Paid	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.
Placebo response	NA	Acute/Preventive	Free	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.
Prayer	Lifestyle	Preventive	Free	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.
Probiotics	Vitamin/Supplement	Preventive	Paid	Probiotics are live bacteria and yeasts that are good for your health, especially your digestive system. We usually think of bacteria as something that causes diseases, but your body is full of bacteria, both good and bad. Probiotics are often called "good" or "helpful" bacteria because they help keep your gut healthy. Increasing evidence considers the gut to be the “second brain,” and the gut-brain connection to be a significant factor in our wellbeing. Probiotics facilitate digestion so toxins do not build up in your gut.
Reflexology	Physical Therapy	Preventive	Paid	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 effects a physical change to the body.
Reiki	Physical Therapy	Preventive	Paid	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.
Relaxation techniques	Behavioral Therapy	Preventive	Free	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.
Remedial massage	Physical Therapy	Preventive	Paid	Remedial massage can reduce headaches by relieving muscle tension throughout the body.
Rub/pressure temples	Lifestyle	Acute	Free	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.
Saffron	Product/Device	Preventive	Paid	Saffron contains several plant-derived chemical compounds that are known to have been antioxidant, disease preventing, and health promoting. It is also an excellent source of vitamins and minerals including vitamin A, folic acid, riboflavin, niacin, vitamin C copper, potassium, calcium, manganese, iron, selenium, zinc and magnesium.
Salt Crystals/Salt Lamps	Vitamin/Supplement	Acute	Paid	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 with 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.
SEEDS	Lifestyle	Preventive	Free	SEEDS stands for regular sleep, regular eating, regular exercise, drinking (staying well-hydrated and avoiding caffeine and alcohol), and stress reduction.
Self-acupressure	Physical Therapy	Acute/Preventive	Free	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.
Shiatsu	Physical Therapy	Preventive	Paid	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.
Sleep	Lifestyle	Acute/Preventive	Free	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.
Sleeping mask	Therapy Product	Acute	Paid	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.
St. John’s Wort	Vitamin/Supplement	Preventive	Paid	St. John’s Wort is most commonly 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.
Stretching	Lifestyle	Preventive	Free	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.
T’ai Chi	Lifestyle	Preventive	Paid	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.
THC (Tetrahydrocannabinol)	Various forms	Natural compound in the cannabis plant (marijuana)	Paid	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.
Tinted Migraine Glasses	Therapy Product	Preventive	Paid	If the glare from fluorescent lights or computer screens at school or work triggers your migraine attacks, migraine glasses fitted with an FL-41 tint may help. These are offered in indoor and outdoor tints.
Trauma-focused cognitive behavioral therapy	Short-term intervention, talk therapy	Preventive	Paid	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.
Triphala	Tablets/Powder/Liquid extract	Preventive	Paid	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.
Turmeric	Product/Device	Preventive	Paid	Turmeric contains curcumin, a substance with powerful anti-inflammatory and antioxidant properties.
Valerian	Vitamin/Supplement	Preventive	Paid	Valerian is an herb. The roots of this herb are used as a muscle relaxer. Outside of migraine treatment, valerian is most commonly used as a sleep aid. It can also be helpful for stress and anxiety. You can find valerian as a supplement as it is not easily found in food.
Vapor Inhaler Stick	Therapy Product	Acute	Paid	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.
Vestibular Rehabilitation	Physical Therapy	Preventive	Paid	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.
Visceral Manipulation (Barral Institute)	Physical Therapy	Preventive	Paid	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.
Vision/Eye Therapy, Exercises or Training	Therapy	Preventive	Paid	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.
Vitamin B2/Riboflavin	Vitamin/Supplement	Preventive	Paid	Riboflavin/vitamin B2 has being reported as useful in migraine treatment due to its role in helping heal and strengthen brain cells. This can be taken as a supplement or by consuming foods high in vitamin B such as milk, cheese, leafy vegetables, liver, kidneys, legumes, yeast, mushrooms, almonds, soybeans, wheat bran, salmon and sun-dried tomatoes.
Vitamin B6/Pyridoxine	Vitamin/Supplement	Preventive	Paid	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.
Vitamin B12/Cobalamin	Vitamin/Supplement	Preventive	Paid	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.
Vitamin B complex	Vitamin/Supplement	Preventive	Paid	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.
Vitamin D3 (Cholecalciferol)	Vitamin/Supplement	Preventive	Paid	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.
Vitex Agnus-Castus	Tablets/Liquid extract	Preventive	Paid	Vitex agnus-castus, also called vitex, chaste tree, or chasteberry is used to balance hormones.
Walking in Nature	Lifestyle	Preventive	Free	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.
Wearing Sunglasses	Therapy Product	Preventive	Free	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 with the smallest amount of sunshine if you are sensitive to sunlight.
White Willow	Vitamin/Supplement	Preventive	Paid	White Willow Bark is an anti-inflammatory supplement that is thought to restrict prostaglandins and reduce pain.
Yoga	Lifestyle	Preventive	Free	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.
Zinc	Vitamin/Supplement	Preventive	Paid	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 amongst other conditions.

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 five words we never want to hear from our doctors are “We’re simply out of options.”

Methodology

That’s why we’ve crowd-sourced more than 300 medicinal and nonmedicinal treatments that those with migraine have self-reported they are using. Several are new in this 2019 edition of the Migraine World Summit Treatment Directory.

Once we identified all the treatments, we then researched all the basic information about those treatments. However, this Directory is not designed to be a comprehensive reference for any individual treatment. By including side effects, contraindications, 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 labelled as “Natural” are not always safe.

For example, certain supplements proven to be effective in preventing migraine aren’t always produced with consistent quality control. Certain essential oils – 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.

Summary of Treatment Options in this Directory

Non Medicinal Migraine Treatments

This section includes a wide variety of Alternative, Complementary, Natural and Holistic treatments. They are categorized as Therapy, Behavioral Therapy, Physical Therapy, Product/Device, Procedure, Lifestyle and Vitamin/Supplement.

Although these are non-drug related treatments and generally non-prescription, they should be discussed with your doctor as part of your total treatment plan.

How to use this reference:

• Non-Medicinal Treatment: The therapy/vitamin/lifestyle practice/device/procedure being used i.e. Acupuncture.
• Format: The category of the treatment i.e. Acupuncture is listed as a ‘Therapy’
• Free or Paid: Is the treatment free to perform or does it involve a cost? Acupuncture involves a cost to see an acupuncturist.
• Preventive or Acute Treatment: ‘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.
• 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.

Nonmedical Treatment	Format	Acute or Preventive Treatment	Free or Paid	Description
5- HTP (5 Hydroxytryptophan)	Vitamin/Supplement	Preventive	Paid	Serotonin is a critical neuro-signaling chemical. A deficiency may result in chronic pain, sleep disturbances, anxiety, depression and a propensity to overeat. People with migraine may have low serotonin levels, and associated disorders include depression, irritable bowel syndrome, as well as other chronic pain syndromes. Serotonin can be increased naturally through behavioral health methods and/or dietary supplementation with pharmaceutical grade L-tryptophan or 5-HTP. 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. 5-HTP (5-hydroxytryptophan) is directly converted to serotonin (5-hydroxytryptamine) in nerve cells and the liver before it can reach the brain. The result is a significant increase in levels of serotonin in the blood while brain levels of serotonin are only slightly increased because blood serotonin has trouble entering the brain. In Europe, 5-HTP is often prescribed with a Parkinson drug (carbidopa) to delay conversion of 5-HTP to serotonin until it reaches the brain. In this setting, adequate 5-HTP crosses the blood-brain barrier, increasing serotonin in the brain and central nervous system (CNS). 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).
Acupressure	Physical Therapy	Acute	Paid	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.
Acupuncture	Procedure	Preventive	Paid	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 the body’s natural painkillers called endorphins.
Alexander Technique	Therapy	Preventive	Paid	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.
Aromatherapy	Product/Device	Preventive	Paid	Aromatherapy uses plant materials and aromatic plant oils to help alter one’s mood, cognitive, psychological or physical wellbeing. Blends of plant oils, essential oils and other aromatic compounds are often utilised through topical application, massage inhalation or water immersion to stimulate a desired response.
Avoid Bright Screens	Lifestyle	Preventive	Free	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.
Avoid Fluorescent Lighting	Lifestyle	Preventive	Free	Fluorescent lights emit a particular spectrum of light. People with migraine may be sensitive to the spectrum of light emitted by fluorescent lights.
Avoid Loud, Sustained Noise	Lifestyle	Preventive	Free	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.
Avoid Odors/Smoke	Lifestyle	Preventive	Free	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.
Avoid Processed Foods	Lifestyle	Preventive	Free	Processed foods often contain artificial ingredients and preservatives that can contribute towards migraines. These include MSG, Soy, Sulfates/Sulfites, Nitrates, Nitrites, and Gluten amongst others. See Dietary Changes for more trigger ingredients and foods.
Ayurveda	Therapy	Preventive	Free	Ayurveda is an ancient Indian practice that involves a variety of treatments including yoga, massage, acupuncture, diet, and herbal medicine to encourage health and wellbeing. 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.
Barometer	Product	Preventive	Paid	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.
Biofeedback	Behavioral Therapy	Preventive	Paid	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.
Black Cohosh	Tablets/Liquid extract	Preventive	Paid	Black cohosh (Actaea racemosa) is a herb sometimes used to treat perimenopause and menopause symptoms. It is native to North America, and its roots and rhizomes, are made up of glycosides (sugar compounds), isoferulic acids (anti-inflammatory substances), and phytoestrogens (plant-based estrogens). Warning: the wrong variety can lead to liver toxicity symptoms.
Blood Test - Food Sensitivities/Nutrition	Other	Preventive	Paid	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 migraines. A food allergy blood test can also determine if supplementation is necessary, by seeing if magnesium or vitamin D are deficient, for example.
Blood Test – Genetic dysfunction	Other	Preventive	Paid	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.
Bowen Therapy	Physical Therapy	Preventive	Paid	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.
Breathing Relaxation Techniques	Therapy	Preventive	Free	Deep breathing is a simple way to reduce stress and relax. For example, taking 3 or 10 deep, slow breaths can help reduce anxiety and control stress. Also, left nostril breathing is a technique used in yoga that helps to control anxiety.
Butterbur	Vitamin/Supplement	Preventive	Paid	Butterbur is an herbal supplement that has been reported to be effective in reducing the frequency and severity of migraines in some people with migraine. Caution should be exercised with Butterbur as it contains components called pyrrolizidine alkaloids (PA’s) 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.
Caffeine	Vitamin/Supplement	Acute	Paid	Caffeine is a very common 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.
Calcium	Vitamin/Supplement	Preventive	Paid	Calcium is essential for building and maintaining bone, and is required for the healthy functioning of the heart, muscles, blood and nerves.
Capsaicin	Vitamin/Supplement	Acute	Paid	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.
Cervical Traction	Product/Device	Preventive	Paid	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.
Chinese Herbal Medicine	Vitamin/Supplement	Preventive	Paid	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.
Chiropractor	Physical Therapy	Preventive	Paid	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 the realignment may benefit corresponding nerves, muscles, or organs. Some medical doctors warn against allowing manipulation of the neck, which can result in a stroke.
Coenzyme Q10 (CoQ10)/Ubiquinol	Vitamin/Supplement	Preventive	Paid	CoQ10 is essential for the proper functioning of cells inside the body. CoQ10 can help minimise 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 CoQ10 in migraine treatment. A more concentrated form is known as Ubiquinol. Sources of CoQ10 can be found as a vitamin supplement or in soybean oil, canola oil, chicken, herring, mackerel, beef, roasted peanuts, sesame seeds, pistachio nuts, broccoli, cauliflower, orange, strawberries, and eggs.
Cognitive Behavioural Therapy (CBT)	Behavioral Therapy	Preventive	Paid	Cognitive behavior 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.
Cooling Gel Sheet	Product/Device	Acute	Paid	Applying cold items or ice packs to the head helps promote circulation and reduces the inflammation in the head caused by migraine.
Creative Therapy	Behavioral Therapy	Preventive	Free	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.
D-Ribose (Beta-D-ribofuranose)	Vitamin/Supplement	Preventive	Paid	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.
Daith Piercing	Procedure	Preventive	Paid	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.
Dark, quiet room	Lifestyle	Acute	Free	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.
Detoxification (Detox)	Therapy	Preventive	Paid	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.
Diet - 5:2 diet	Lifestyle	Preventive	Free	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.
Diet - Elimination Diet	Lifestyle	Preventive	Free	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 a several weeks to establish a baseline before gradually reintroducing foods one at a time, often several days apart. If a migraine attack occurs while a new food is being introduced, then it may be attributed to that food and consequently the food is removed from the diet.
Diet - Ketogenic Diet	Lifestyle	Preventive	Free	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 migraines have been shown to improve while on a ketogenic diet. Further study is needed.
Diet - Paleo Diet	Lifestyle	Preventive	Free	The Paleo diet, also known as the Caveman or Stone Age diet, mimics the hunter-gatherer diet of oura Paleolithic ancestors and promotes consumption habits which 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 produce reputable scientific evidence.
Diet - Vegan Diet	Lifestyle	Preventive	Free	Vegetarians do not eat meat, fish, or poultry. 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.
Diet - Vegetarian Diet	Lifestyle	Preventive	Free	Vegetarians do not eat meat, fish, or poultry. There is no evidence linked to migraine.
Diet – Gluten-Free	Lifestyle	Preventive	Free	Gluten has been linked to migraine and 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, diarrhoea, and constipation, as well as fatigue and mental “fog”, it may be worth trying a gluten-free diet. There is, however, no direct evidence linking this diet to migraine.
Dietary Changes	Lifestyle	Preventive	Free	What you eat can play a very significant role in your migraines. There are a number of foods that are problematic for a large number of migraine sufferers. Understanding which foods trigger your migraine attacks is 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 such as bacon, hot dogs, aspartame, and ice cream. If you are unsure, it may be worthwhile speaking with your doctor or seeing a dietician 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.
Eliminate Cigarette Smoking	Lifestyle	Preventive	Free	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 occurring to an individual’s health whilst smoking is likely to make existing health conditions worse.
Eliminating Alcohol	Lifestyle	Preventive	Free	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.
Eliminating Caffeine (e.g. Coffee, Tea, Sodas)	Lifestyle	Preventive	Free	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.
Eliminating Chocolate	Lifestyle	Preventive	Free	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.
Eliminating Dairy	Lifestyle	Preventive	Free	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 products.
Eliminating Gluten	Lifestyle	Preventive	Free	See ‘Diet – Gluten Free’
Eliminating MSG	Lifestyle	Preventive	Free	MSG or monosodium glutamate is an amino acid used as a food preservative and flavour enhancer. It has been named as a common migraine trigger. It’s not limited to Chinese food and it has many aliases making it difficult to detect on packaged foods.
Eliminating Nitrates/Nitrites	Lifestyle	Preventive	Free	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 a higher risk of cancer. Processed meats such as bacon, hot dogs, sausages, cured ham, cold cuts, and related products commonly have artificially added nitrates as a preservative.
Eliminating Soy	Lifestyle	Preventive	Free	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, some salad dressings, sauces, and breakfast bars, and other products, as well as soy sauce, soy lattes, tofu, and miso.
Eliminating Sulfates/Sulfites	Lifestyle	Preventive	Free	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. Sulphate is also used as a preservative in dried fruit and many dried-fruit products.
Eliminating Tyramine	Lifestyle	Preventive	Free	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.
Epsom salt baths	Product	Acute/Preventive	Paid	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.
Evening Primrose Oil	Vitamin/Supplement	Acute	Paid	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.
Exercise	Lifestyle	Preventive	Free	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 (, i.e. jogging, swimming, cycling etc). If you can find things you enjoy doing then you’re more likely to be consistent. Many people find yoga, Pilates, or t’ai chi to be a great option. Anything is better than nothing. If exercise triggers migraines, however, start small. If you’re outside, wear polarized sunglasses. Ensure that you’ve eaten enough and take a water bottle so that you don’t get dehydrated. Starting small and building upwards is a much more successful approach then trying to jump in without any warm up or preparation.
Feverfew	Vitamin/Supplement	Preventive	Paid	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.
Folate	Vitamin/Supplement	Preventive	Paid	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.
Folic Acid (Vitamin B9)	Vitamin/Supplement	Preventive	Paid	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, Brussel sprouts, and spinach. Folic acid helps your body produce and maintain new cells, and also helps prevent changes to DNA that may lead to cancer. As a medication, folic acid is used to treat folic acid deficiency and certain types of anemia (lack of red blood cells) caused by folic acid deficiency.
Forest bathing	Lifestyle	Preventive	Free	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.
Ginger (including ginger powder, natural ginger & supplements)	Vitamin/Supplement	Acute/Preventive	Paid	Ginger is a commonly used cooking spice known for its antinausea, antidiarrhea, and digestion-aiding properties. Ginger is used for a 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. GelStat, a supplement brand presented findings to the American Academy of Neurology in 2006 claimed that 1 in 5 people experienced complete relief after taking their Ginger and Feverfew multivitamin. Note: this study was not independently conducted.
Glucosamine	Vitamin/Supplement	Preventive	Paid	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.
Heat creams, gels, balms & rubs	Product/Device	Acute	Paid	Heat-producing creams, gels, and products in other formats are commonly used to help relieve muscle tension, tightness, minor aches, pains, or stiffness in the muscles or joints.
Heat Pack, Bean Bags, or Wheat pack	Product/Device	Acute	Paid	Heat stimulates your sensory receptors to block the transmission of pain signals to the brain and can result in pain relief. Heat helps reduce muscle tension, increases blood flow, and brings nutrients to the affected area faster.
Herbal teas (e.g. Dandelion, Chamomile, Ginger, Mint tea)	Product/Device	Preventive	Paid	Herbal teas contain vitamins and nutrients. Drinking hot herbal tea can also be a calming and relaxing activity. It also helps keep up hydration levels.
Homeopathy	Therapy	Preventive	Paid	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.
Hot shower	Lifestyle	Acute	Free	Like heat packs, a hot shower can stimulate blood circulation and can be relaxing, which may help provide comfort from a variety of symptoms.
Hydration (Drinking water)	Lifestyle	Preventive	Free	Dehydration is a common migraine trigger. Keeping water on hand throughout the day helps ensure you get the recommended 8 glasses per day.
Hydrotherapy	Lifestyle	Acute	Free	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.
Hyperbaric Oxygen Therapy	Therapy	Preventive	Paid	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.
Hypnotherapy/Hypnosis	Therapy	Preventive	Paid	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.
Ice therapy/ice packs	Product/Device	Acute	Free	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 to painful areas on the head. Wearable ice packs permit sleeping and movement while worn.
Improving posture	Lifestyle	Preventive	Free	Poor posture can result in tightening muscles in the neck or scalp, which may lead to headache and migraines. Extended reading looking down at a mobile phone or hunching over a computer, laptop, or gaming console can lead to neck and back pain and can trigger an attack. Modern laptops encourage poor posture. Correcting postural issues may help relieve migraine and reduce the frequency of attacks.
Iron supplements	Vitamin/Supplement	Preventive	Paid	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.
Isoflavones (e.g. Promensil)	Vitamin/Supplement	Preventive	Paid	Isoflavones 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.
Kinesiology	Physical Therapy	Preventive	Paid	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.
Krill Oil	Vitamin/Supplement	Preventive	Paid	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).
L-methylfolate/Levomefolic acid	Vitamin/Supplement	Preventive	Paid	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.
Lavender oil	Product/Device	Preventive	Paid	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.
Magnesium (including variants i.e., citrate, glycinate)	Vitamin/Supplement	Preventive	Paid	Magnesium is one of the most common minerals in the human body. It plays an important role in the production of protein, the transport and production of energy, normal muscle operation, nerve function, a steady heart rhythm, and supports a healthy immune system. During a migraine attack, low levels of magnesium have been shown in the brain. It’s thought that magnesium deficiency and migraines may be related since magnesium is required for proper nerve function. Sources of magnesium include legumes, nuts, whole grains, seeds, leafy green vegetables, soy products, bananas, dried apricots, avocados, and magnesium supplements. Dr Mark Hyman recommends a high dose of Magnesium citrate or glycinate at 300-600mg twice per day to help prevent attacks.
Magnetic acupressure bracelets	Device	Acute/Preventive	Paid	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.
Magnotherapy	Therapy	Preventive	Paid	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.
Manage Stress	Lifestyle	Preventive	Free	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.
Meditation	Behavioral Therapy	Preventive	Free	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.
Melatonin	Vitamin/Supplement	Preventive	Paid	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.
Menthol/Mint	Product/Device	Acute	Paid	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.
Migraine Buddy	Product/Device	Preventive	Free	Using a migraine app means being able to go to your doctor with proper documentation, and be able 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 migraines evolved with the treatment provided and the level of relief with those treatments.
Migraine Support Formula	Vitamin/Supplement	Preventive	Paid	This is a multivitamin product designed specifically for people with migraine, which combines several well-known vitamins and supplements to help relieve migraine. Vitamins included are Riboflavin, Niacin, Vitamin B6, Magnesium, Ginger, CoQ10, White Willow, Feverfew, Butterbur & Black Pepper.
Mindfulness	Meditation	Acute/Preventive	Free	A form of meditation based on a moment-by-moment awareness of thoughts, feelings, bodily sensations, and surrounding environment. It means tuning into 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.
Myofascial release	Physical Therapy	Preventive	Paid	Myofascial release (or 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.
Naturopathy	Therapy	Preventive	Paid	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 criticised for its lack of scientific evidence and conflicts with evidence-based medicine. For example, many naturopaths oppose vaccination.
Neck/Scalp Massage	Physical Therapy	Acute	Paid	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, temporarily, and reduce blood pressure and heart rate.
Niacin (Vitamin B3)	Vitamin/Supplement	Preventive	Paid	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.
Occipital Lift Technique	Physical Therapy	Acute	Paid	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.
Occlusal splint	Product/Device	Preventive	Paid	A dentist prescribed mouthguard to protect teeth against clenching/grinding.
Omega-3	Vitamin/Supplement	Preventive	Paid	Fish oil contains omega-3 fatty acids, which are found mostly in fish 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, amongst others.
Osteopathy	Physical Therapy	Preventive	Paid	Osteopathy can be used to correct misalignments, which may trigger migraine attacks in some people.
Passage of time	Lifestyle	Acute	Free	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.
Peppermint Oil	Product/Device	Preventive	Paid	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.
Petadolex (Butterbur Extract)	Vitamin/Supplement	Preventive	Paid	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, which are toxic to the liver and may cause cancer. The concentrations of this toxin vary depending on which part of the plant is harvested and where the plant is grown. Petadolex is a brand name of the vitamin producer whose makers claim that it doesn’t contain the harmful chemicals (PAs) within butterbur.
Physiotherapy (physical therapy)	Physical Therapy	Preventive	Paid	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 migraines, particularly if you feel your migraine attacks are caused by neck issues.
Pilates	Lifestyle or Physical Therapy	Preventive	Paid	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.
Placebo response	NA	Acute/Preventive	Free	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.
Prayer	Lifestyle	Preventive	Free	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.
Probiotics	Vitamin/Supplement	Preventive	Paid	Probiotics are live bacteria and yeasts that are good for your health, especially your digestive system. We usually think of bacteria as something that causes diseases, but your body is full of bacteria, both good and bad. Probiotics are often called "good" or "helpful" bacteria because they help keep your gut healthy. Increasing evidence considers the gut to be the “second brain,” and the gut-brain connection to be a significant factor in our wellbeing. Probiotics facilitate digestion so toxins do not build up in your gut.
Reflexology	Physical Therapy	Preventive	Paid	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 effects a physical change to the body.
Reiki	Physical Therapy	Preventive	Paid	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.
Relaxation techniques	Behavioral Therapy	Preventive	Free	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.
Remedial massage	Physical Therapy	Preventive	Paid	Remedial massage can reduce headaches by relieving muscle tension throughout the body.
Rub/pressure temples	Lifestyle	Acute	Free	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.
Saffron	Product/Device	Preventive	Paid	Saffron contains several plant-derived chemical compounds that are known to have been antioxidant, disease preventing, and health promoting. It is also an excellent source of vitamins and minerals including vitamin A, folic acid, riboflavin, niacin, vitamin C copper, potassium, calcium, manganese, iron, selenium, zinc and magnesium.
Salt Crystals/Salt Lamps	Vitamin/Supplement	Acute	Paid	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 with 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.
SEEDS	Lifestyle	Preventive	Free	SEEDS stands for regular sleep, regular eating, regular exercise, drinking (staying well-hydrated and avoiding caffeine and alcohol), and stress reduction.
Self-acupressure	Physical Therapy	Acute/Preventive	Free	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.
Shiatsu	Physical Therapy	Preventive	Paid	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.
Sleep	Lifestyle	Acute/Preventive	Free	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.
Sleeping mask	Therapy Product	Acute	Paid	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.
St. John’s Wort	Vitamin/Supplement	Preventive	Paid	St. John’s Wort is most commonly 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.
Stretching	Lifestyle	Preventive	Free	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.
T’ai Chi	Lifestyle	Preventive	Paid	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.
Tinted Migraine Glasses	Therapy Product	Preventive	Paid	If the glare from fluorescent lights or computer screens at school or work triggers your migraine attacks, migraine glasses fitted with an FL-41 tint may help. These are offered in indoor and outdoor tints.
Triphala	Tablets/Powder/Liquid extract	Preventive	Paid	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.
Turmeric	Product/Device	Preventive	Paid	Turmeric contains curcumin, a substance with powerful anti-inflammatory and antioxidant properties.
Valerian	Vitamin/Supplement	Preventive	Paid	Valerian is an herb. The roots of this herb are used as a muscle relaxer. Outside of migraine treatment, valerian is most commonly used as a sleep aid. It can also be helpful for stress and anxiety. You can find valerian as a supplement as it is not easily found in food.
Vapor Inhaler Stick	Therapy Product	Acute	Paid	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.
Vestibular Rehabilitation	Physical Therapy	Preventive	Paid	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.
Visceral Manipulation (Barral Institute)	Physical Therapy	Preventive	Paid	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.
Vision/Eye Therapy, Exercises or Training	Therapy	Preventive	Paid	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.
Vitamin B2/Riboflavin	Vitamin/Supplement	Preventive	Paid	Riboflavin/vitamin B2 has being reported as useful in migraine treatment due to its role in helping heal and strengthen brain cells. This can be taken as a supplement or by consuming foods high in vitamin B such as milk, cheese, leafy vegetables, liver, kidneys, legumes, yeast, mushrooms, almonds, soybeans, wheat bran, salmon and sun-dried tomatoes.
Vitamin B6/Pyridoxine	Vitamin/Supplement	Preventive	Paid	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.
Vitamin B12/Cobalamin	Vitamin/Supplement	Preventive	Paid	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.
Vitamin B complex	Vitamin/Supplement	Preventive	Paid	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.
Vitamin D3 (Cholecalciferol)	Vitamin/Supplement	Preventive	Paid	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.
Vitex Agnus-Castus	Tablets/Liquid extract	Preventive	Paid	Vitex agnus-castus, also called vitex, chaste tree, or chasteberry is used to balance hormones.
Walking in Nature	Lifestyle	Preventive	Free	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.
Wearing Sunglasses	Therapy Product	Preventive	Free	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 with the smallest amount of sunshine if you are sensitive to sunlight.
White Willow	Vitamin/Supplement	Preventive	Paid	White Willow Bark is an anti-inflammatory supplement that is thought to restrict prostaglandins and reduce pain.
Yoga	Lifestyle	Preventive	Free	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.
Zinc	Vitamin/Supplement	Preventive	Paid	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 amongst other conditions.