Drugs can be very effective at controlling migraine symptoms – if it’s the right drug at the right time!

Acute treatment

Acute migraine treatment can be with painkillers or triptans. Not all painkillers work well for migraine: most find aspirin or ibuprofen better than paracetamol or codeine. Triptans are not painkillers but usually work well for migraine, because they mimic serotonin: sumatriptan is available without prescription. Other useful migraine medications include stronger versions of ibuprofen, called non-steroidal anti-inflammatory drugs (NSAIDs), and anti-sickness drugs.

Migraine needs early acute treatment: there is a “window of opportunity” that can take some time and experimentation to establish, for each patient. Sometimes aspirin or NSAIDs work well at prodrome or aura, but triptan use may need to wait until headache begins. When you know what works for you, always keep a small supply with you.

During a migraine attack the stomach can stop working, so drugs are not well absorbed. Ways around this include using large doses of drugs (e.g. aspirin 900mg or ibuprofen 600mg), dissolving the drug in water (some recommend a fizzy drink) and adding an anti-sickness drug that also promotes the normal emptying of the stomach, such as domperidone 20mg (only available by prescription from your GP). The combination of a triptan, plus domperidone, plus either aspirin or ibuprofen, all taken together at the start of an attack, can be better than the same drugs used one after the other over a few hours. Another way to avoid poor drug absorption (or vomiting of drugs) is to use suppositories.

Preventative treatment

Frequent attacks, or poor response to acute treatment, may lead to treatment every day with a preventative drug. These mostly work on serotonin, which needs gradual change, so take a few months to work. It is often difficult to identify benefit or failure, unless a migraine diary is recorded. Preventative drugs usually have only a partial benefit: no-one has yet found a way of guaranteeing freedom from migraine.

Usually it is best to start with acute treatment, keep a migraine diary, address migraine triggers, then later think about migraine prevention.