Understanding Migraine Treatment Options

A migraine is more than just a bad headache - the intense throbbing head pain can last for hours to days and can come with symptoms involving the whole body. 

Affecting 1 in 7 people, migraines are generally more common in women but can happen to anyone and can be disruptive. Fortunately, there are many different treatments to help with the pain and to reduce how often migraines happen. 

What is a migraine? 

A migraine is a condition which causes various symptoms including a severe headache. 

A complex neurological condition, migraines may require specific treatments though some may respond to general painkillers. 

Typical migraine symptoms

Typical symptoms of a migraine include:

• A severe headache, characterised by pain that's throbbing or pulsating. Usually the pain only occurs on one side of the head (unilateral) though it may also occur on both sides (bilateral)

• Nausea and vomiting

• Sensitivity to light/sound - which is why most migraine sufferers want to lie down in a dark, quiet room.

Symptoms of a migraine can last from 4 hours and may last up to 3 days in some.

Leading up to, or during a migraine, around 15-30% of people also experience something called an aura. 

An aura is a variety of symptoms that occur for a short period of time – typically between 5-60 minutes and are

• Usually visual - such as seeing light flashes, zig zags or blind spots

• Can affect speech

• Sensations in the body/face, such as numbness, tingling or pins and needles. 

Occasionally aura can affect body movement leading to weakness. 

Although typically present before or during a headache, aura can sometimes happen without a headache. 

Aura symptoms should not last longer than an hour. If the symptoms continue for longer, it may be the sign of a stroke or mini stroke. In this situation, it’s important to seek immediate medical attention.

Migraine causes and triggers

The cause of a migraine is not fully understood but is likely due to irregular brain activity affecting blood flow, nerves, and chemical signals in the brain.

Whether you’ll develop migraines is also related to your genes. Around 50% of people with migraines have a close family member that also experiences them. 

While we may not understand exactly why migraines happen, we do know that certain things can trigger them. There’s not always a clear migraine trigger, but potential triggers include:

• Stress 

• Lack of sleep or varying sleep patterns

• Hormonal changes (such as during your menstrual cycle)

• Low blood sugar/skipping meals 

• Dehydration

• Certain foods and drinks (like alcohol, caffeine, chocolate, or citrus fruits)

• Anxiety or low mood/depression

• Weather changes

• Bright lights

• Loud sounds

• Strong smells

• Smoke

• Intense exercise or not getting enough exercise

• Muscle tension or poor posture

• Certain medications (including hormonal medication like the contraceptive pill)

People have different migraine triggers, and if you’re not sure what’s triggering yours it can be helping to keep a migraine diary. 

Migraines affect people differently

Migraines don’t always show up in the same way. One person may experience very severe headaches a few times a year with no other symptoms while someone else may have migraines with aura several times a month. 

How long they last, how often they happen, the triggers, and response to treatment can also vary from person to person. For this reason, migraine treatment is usually personalised for optimum effectiveness. 

How to treat migraines

There’s no way to permanently treat migraines and stop them from coming back, but there are ways to manage the symptoms and limit how bad the attack is.

One of the best ways to deal with migraines is to identify your triggers and avoid them. A great way to do this is by using a migraine diary. This is where you record what you do each day and track your headaches so you can start to identify a pattern. It’s then easier to work out what your triggers are and avoid them where possible.

But avoiding triggers doesn’t work for everyone. It’s not always possible to remove triggers and sometimes there’s not a clear trigger at all. In many cases, medications are still needed.

Managing migraine pain

The most commonly used medications for migraines are painkillers to deal with the pain. Additional medications can be used to deal with the associated symptoms and to reduce how often migraine attacks happen.

Standard painkillers

Over the counter painkillers like ibuprofen, paracetamol, or aspirin are commonly used to treat migraine pain. They work best when taken as soon as the pain starts.

Failing these, a healthcare professional may decide to prescribe something a little stronger, which is only available on prescription, 

Triptans

Triptans are a specific class of medications which work by constricting (squeezing) blood vessels in the brain and reducing inflammation. This combination can reduce or even stop the brain from processing pain signals during a migraine attack. 

They can also improve other migraine symptoms like nausea (feeling sick), vomiting (being sick), and sensitivity to noise/light. 

Triptans are available most commonly as tablets but some are also available as nasal sprays and injections - helpful for those who cannot take tablets due to nausea. They can also be taken in combination with other painkillers if needed. 

You should take your triptan when the migraine headache starts, not when the aura starts (unless they both happen at the same time). 

When taken at the right time, they can be an effective treatment though they do not work for everyone. Additionally, triptans are not suitable for those with certain underlying health conditions such as heart conditions. 

Triptans are effective at improving symptoms of an attack that's occurring but have no impact on reducing the number of attacks that occur.

Taking triptans too often, usually more than 10 times a month can lead to migraine overuse headaches. They can also cause side effects like dizziness, feeling/being sick, flushing or feeling hot/cold.

Dealing with other migraine symptoms

Nausea and vomiting are often associated with migraine headaches. Anti-emetics can be prescribed by a healthcare professional to help. 

Usually a tablet, these should be taken as soon as migraine symptoms start but exercise caution as they may cause drowsiness, or other side effects like diarrhoea. 

Preventing migraines

Those who experience migraines more often than once a week may benefit from taking a preventative treatment. These can help reduce migraine frequency and severity when they do occur.

Even when taking medication, people tend to only experience 30-50% fewer/less severe migraine attacks at best. It’s not possible to stop migraines completely with preventative medications.

Treatment can take up to 6 weeks to start working and should only be used alongside other medications and avoiding triggers.

Which preventative medication you can take depends on your health, whether you want to get pregnant soon, and that you understand the potential risks. 

The most common preventative medications are:

Propranolol – a beta blocker (also used for managing high blood pressure) that regulates blood flow and nerve signals in the brain.

Topiramate – an anti-epileptic drug that affects brain chemical and nerve signals. Topiramate isn’t safe during pregnancy and women of childbearing age must be willing to use a highly effective form of contraception before starting this medicine. 

Amitriptyline – a type of anti-depressant that affects pain perception.

Newer migraine treatments: gepants

A new class of medication called gepants are the first treatment that’s been developed specifically for migraines. 

Currently two gepants are available on the NHS for treating migraines: rimegepant (Vydura) and atogepant (Aquipta). Vydura is also available from private online pharmacies like Quick Meds 

Gepants work by limiting the release of a chemical called calcitonin gene related peptide (CGRP). High levels of CGRP are usually released during a migraine attack, but gepants can reduce this and help with migraine symptoms.

Not only do gepants improve migraine symptoms during an attack, they can also reduce how often attacks happen. 

As gepants work in a different way to other migraine medications, they may be suitable for people who are unable to take triptans or who get migraine overuse headaches from them.

Under current guidelines from the National Institute for Clinical Excellence (NICE), gepants can only be prescribed in certain circumstances.

Vydura

Vydura contains the active ingredient rimegepant and is taken as a tablet that disintegrates on your tongue with no need for water. 

It is prescribed for:

People with 4-14 migraines a month who’ve tried (or are unable to take) at least 3 other preventative medications with no success/side effects that meant they had to stop

OR

As a medication to relieve migraine symptoms for people who’ve tried (or are unable to take) at least 2 triptans. 

Aquipta

Aquipta contains the ingredient atogepant and is taken as a normal tablet with water.

It’s prescribed as a preventative medication for people with 4-14 migraines a month who’ve tried (or are unable to take) at least 3 other preventative medications that haven’t worked or have been stopped due to side effects.

Although gepants can be effective, they may cause side effects such as nausea, mouth dryness, tiredness, a rash, or airway/throat infections. 

Migraine treatments at Quick Meds

Quick Meds offer a variety of clinically approved migraine treatments. Our team of experienced pharmacists are here to provide personalised advice on the best treatment for you.

As a UK-based GPhC-regulated online pharmacy, you know the medication we provide is genuine and our service is professional, attentive, and reliable. 

Start managing your migraines with an online consultation today.