Management of migraine

{{main|Prevention of migraine attacks}}

Because of the complexity of migraine, no preventive treatment modality is effective for all migraine sufferers.{{Cite journal |last=Silberstein |first=Stephen D. |date=August 8, 2015 |title=Preventive Migraine Treatment |journal= Continuum: Lifelong Learning in Neurology|volume=21 |issue=4 Headache |pages=973–989 |doi=10.1212/CON.0000000000000199 |issn=1080-2371 |pmc=4640499 |pmid=26252585}}

For example, lifestyle (including trigger avoidance), diet changes, diet supplements, and treating conditions such as sleep apnea may all help prevent migraines. Dental appliances such as the Nociceptive Trigeminal Inhibition Tension Suppression System might be used in specific circumstances. Preventive treatments can be sub-divided into non-drug treatments, and treatment with medication. There are several non drug treatments suggested in the literature including weight control, management of migraine comorbidities, lifestyle modification, behavioural treatment and biofeedback, patient education, using headache diaries, and improving patients' knowledge about the disease.{{Cite journal |last1=Haghdoost |first1=Faraidoon |last2=Togha |first2=Mansoureh |date=2022-01-01 |title=Migraine management: Non-pharmacological points for patients and health care professionals |journal=Open Medicine |language=en |volume=17 |issue=1 |pages=1869–1882 |doi=10.1515/med-2022-0598 |pmid=36475060 |pmc=9691984 |issn=2391-5463}}

Rescue treatment involves acute symptomatic control with medication.{{Cite journal|journal= Minn Med|vauthors=Bartleson JD, Cutrer FM |title= Migraine update. Diagnosis and treatment|volume=93|pages=36–41|year=2010|pmid= 20572569|issue=5}} Recommendations for rescue therapy of migraine include: (1) migraine-specific agents such as triptans, CGRP antagonists, or ditans for patients with severe headaches or for headaches that respond poorly to analgesics, (2) non-oral (typically nasal or injection) route of administration for patients with vomiting, (3)  avoid medication overuse headache by educating patients using prophylactic therapies.{{Cite journal |title= Migraine: Integrated approaches to clinical management and emerging treatments|journal= Lancet|date= 2021|pmid=33773612|author5= Peres MFP|volume= 397|issue= 10283|pages= 1505–1518|doi= 10.1016/S0140-6736(20)32342-4| vauthors = Ashina M, Buse DC, Ashina H, Pozo-Rosich P }} Medications are more effective if used earlier in an attack.

The frequent use of medication may result in medication overuse headache (MOH), in which the headaches become more severe and more frequent.{{Cite journal|title=The International Classification of Headache Disorders: 2nd edition |journal=Cephalalgia |volume=24 |issue=Suppl 1 |pages=9–160 |year=2004 |pmid=14979299 |doi=10.1111/j.1468-2982.2004.00653.x |author1= Headache Classification Subcommittee of the International Headache Society|s2cid=208215944 |doi-access=free }} [http://www.i-h-s.org/upload/ct_clas/ihc_II_main_no_print.pdf as PDF] {{webarchive|url=https://web.archive.org/web/20100331095113/http://www.i-h-s.org/upload/ct_clas/ihc_II_main_no_print.pdf |date=2010-03-31 }} This may occur with triptans, ergotamines, and analgesics, especially opioids or narcotic analgesics.{{cite journal | doi = 10.1002/14651858.CD008615.pub2 | pmid=22336849 | title=Sumatriptan (oral route of administration) for acute migraine attacks in adults | journal=Reviews| volume=2012 | issue=2 | pages=CD008615 | pmc=4167868| year=2012 | last1=Derry | first1=Christopher J. | last2=Derry | first2=Sheena | last3=Moore | first3=R Andrew }} Combination of opioids with other analgesics is thought to nearly double the risk of MOH.{{Citation |last1=Fischer |first1=Michelle A. |title=Medication-Overuse Headache |date=2023-08-22 |work=StatPearls |url=http://www.ncbi.nlm.nih.gov/books/NBK538150/ |access-date=2024-05-03 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=30844177 |last2=Jan |first2=Arif}}

Spinal manipulation for treating an ongoing migraine headache is not supported by evidence.{{cite journal |last=Posadzki |first=P |author2=Ernst, E |date=June 2011 |title=Spinal manipulations for the treatment of migraine: a systematic review of randomized clinical trials. |journal=Cephalalgia |volume=31 |issue=8 |pages=964–70 |doi=10.1177/0333102411405226 |pmid=21511952 |s2cid=31205541 |doi-access=free}}

Ditans are a class of abortive medication for the treatment of migraines.{{cite journal |vauthors=Qubty W, Patniyot I | title = Migraine Pathophysiology.| journal =Headache| date = 2020 | volume = 107| pages = 1–6| pmid = 32192818| doi = 10.1016/j.pediatrneurol.2019.12.014| s2cid = 213191464}} Oral lasmiditan (Reyvow) is approved in the US by the FDA for acute treatment of migraine in adults.{{Cite journal |title= Lasmiditan: First Approval|journal= Drugs|date= 2019|pmid=31749059|volume= 79|issue= 18|pages= 1989–1996|doi= 10.1007/s40265-019-01225-7| vauthors = Lamb YN }}

Recommended initial treatment for those with mild to moderate symptoms are simple analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) or the combination of acetaminophen (paracetamol), acetylsalicylic acid (aspirin), and caffeine, although caffeine overuse can be a contributor to migraine chronification as well as a migraine trigger for many patients.{{cite journal |last=Gilmore |first=B |author2=Michael, M |date=2011-02-01 |title=Treatment of acute migraine headache. |journal=American Family Physician |volume=83 |issue=3 |pages=271–80 |pmid=21302868}}{{cite journal |vauthors=Nowaczewska M, Wiciński M, Kaźmierczak W |date=July 2020 |title=The Ambiguous Role of Caffeine in Migraine Headache: From Trigger to Treatment |journal=Nutrients |volume=12 |issue=8 |page=2259 |doi=10.3390/nu12082259 |pmc=7468766 |pmid=32731623 |doi-access=free}} Aspirin (900 to 1000 mg) can relieve moderate to severe migraine pain, with an effectiveness similar to sumatriptan.{{Cite journal |last1=Kirthi |first1=Varo |last2=Derry |first2=Sheena |last3=Moore |first3=R. Andrew |date=2013-04-30 |title=Aspirin with or without an antiemetic for acute migraine headaches in adults |journal=The Cochrane Database of Systematic Reviews |volume=2019 |issue=4 |pages=CD008041 |doi=10.1002/14651858.CD008041.pub3 |issn=1469-493X |pmc=4163048 |pmid=23633350}}{{cite journal |vauthors=Kirthi V, Derry S, Moore RA |date=April 2013 |title=Aspirin with or without an antiemetic for acute migraine headaches in adults |journal=The Cochrane Database of Systematic Reviews |volume=2019 |issue=4 |pages=CD008041 |doi=10.1002/14651858.CD008041.pub3 |pmc=4163048 |pmid=23633350}} Paracetamol, either alone or in combination with metoclopramide (an anti-nausea drug), is an effective treatment with a low risk of adverse effects.{{Cite journal |last1=Derry |first1=Sheena |last2=Moore |first2=R. Andrew |date=2013-04-30 |title=Paracetamol (acetaminophen) with or without an antiemetic for acute migraine headaches in adults |journal=The Cochrane Database of Systematic Reviews |volume=2013 |issue=4 |pages=CD008040 |doi=10.1002/14651858.CD008040.pub3 |issn=1469-493X |pmc=4161111 |pmid=23633349}}{{cite journal |vauthors=Derry S, Moore RA |date=April 2013 |title=Paracetamol (acetaminophen) with or without an antiemetic for acute migraine headaches in adults |journal=The Cochrane Database of Systematic Reviews |volume=2019 |issue=4 |pages=CD008040 |doi=10.1002/14651858.CD008040.pub3 |pmc=4161111 |pmid=23633349}} In pregnancy, paracetamol and metoclopramide are deemed safe as are NSAIDs until the third trimester. Intravenous metoclopramide is also effective by itself.{{cite journal |vauthors=Eken C |date=March 2015 |title=Critical reappraisal of intravenous metoclopramide in migraine attack: a systematic review and meta-analysis |journal=The American Journal of Emergency Medicine |volume=33 |issue=3 |pages=331–7 |doi=10.1016/j.ajem.2014.11.013 |pmid=25579820}}{{cite journal |vauthors=Orr SL, Friedman BW, Christie S, Minen MT, Bamford C, Kelley NE, Tepper D |date=June 2016 |title=Management of Adults With Acute Migraine in the Emergency Department: The American Headache Society Evidence Assessment of Parenteral Pharmacotherapies |journal=Headache |volume=56 |issue=6 |pages=911–40 |doi=10.1111/head.12835 |pmid=27300483 |doi-access=free |title-link=doi}}

Several NSAIDs, including diclofenac and ibuprofen, have evidence to support their use.{{cite journal |vauthors=Rabbie R, Derry S, Moore RA |date=April 2013 |title=Ibuprofen with or without an antiemetic for acute migraine headaches in adults |journal=The Cochrane Database of Systematic Reviews |volume=2019 |issue=4 |pages=CD008039 |doi=10.1002/14651858.CD008039.pub3 |pmc=4161114 |pmid=23633348}}{{cite journal |vauthors=Derry S, Rabbie R, Moore RA |date=April 2013 |title=Diclofenac with or without an antiemetic for acute migraine headaches in adults |journal=The Cochrane Database of Systematic Reviews |volume=2019 |issue=4 |pages=CD008783 |doi=10.1002/14651858.CD008783.pub3 |pmc=4164457 |pmid=23633360}} Ibuprofen provides effective pain relief in about 50%.{{Cite journal|last1=Rabbie|first1=Roy|last2=Derry|first2=Sheena|last3=Moore|first3=R. Andrew|date=2013-04-30|title=Ibuprofen with or without an antiemetic for acute migraine headaches in adults|journal=The Cochrane Database of Systematic Reviews|volume=2019 |issue=4|pages=CD008039|doi=10.1002/14651858.CD008039.pub3|issn=1469-493X|pmid=23633348|pmc=4161114}} Diclofenac has been found effective. Ketorolac is available in intravenous and intramuscular formulation. The two main adverse drug reactions (ADRs) associated with NSAIDs relate to gastrointestinal (GI) effects and renal effects of the agents. Naproxen by itself may not be effective as a stand-alone medicine to stop a migraine headache as it is only weakly better than a placebo medication in clinical trials.{{cite journal |vauthors=Law S, Derry S, Moore RA |date=October 2013 |title=Naproxen with or without an antiemetic for acute migraine headaches in adults |journal=The Cochrane Database of Systematic Reviews |volume=2013 |issue=10 |pages=CD009455 |doi=10.1002/14651858.CD009455.pub2 |pmc=6540401 |pmid=24142263}}

Triptans such as sumatriptan are effective for both pain and nausea in up to 75% of migraineurs.{{cite journal |vauthors=Johnston MM, Rapoport AM |title=Triptans for the management of migraine |journal=Drugs |volume=70 |issue=12 |pages=1505–18 |date=August 2010 |pmid=20687618 |doi=10.2165/11537990-000000000-00000 |s2cid=41613179 }}{{cite book |url=https://www.ncbi.nlm.nih.gov/books/NBK566246/ |title=Acute Treatments for Episodic Migraine |vauthors=Singh RB, VanderPluym JH, Morrow AS, Urtecho M, Nayfeh T, Roldan VD, Farah MH, Hasan B, Saadi S, Shah S, Abd-Rabu R, Daraz L, Prokop LJ, Murad MH, Wang Z |date=December 2020 |publisher=Agency for Healthcare Research and Quality (US) |series=AHRQ Comparative Effectiveness Reviews |location=Rockville (MD) |pmid=33411427 |id=Bookshelf ID: NBK566246 |access-date=28 June 2021 |archive-url=https://web.archive.org/web/20210115180301/https://www.ncbi.nlm.nih.gov/books/NBK566246/ |archive-date=15 January 2021 |url-status=live}}{{cite journal |vauthors=Johnston MM, Rapoport AM |date=August 2010 |title=Triptans for the management of migraine |journal=Drugs |volume=70 |issue=12 |pages=1505–1518 |doi=10.2165/11537990-000000000-00000 |pmid=20687618 |s2cid=41613179}} They are the initially recommended treatments for those with moderate to severe pain or those with milder symptoms who do not respond to simple analgesics. The different forms available include oral, injectable, nasal spray, rectal, and oral dissolving tablets.{{cite journal |vauthors=Bartleson JD, Cutrer FM |date=May 2010 |title=Migraine update. Diagnosis and treatment |journal=Minnesota Medicine |volume=93 |issue=5 |pages=36–41 |pmid=20572569}}{{cite journal |vauthors=Derry CJ, Derry S, Moore RA |date=February 2012 |title=Sumatriptan (rectal route of administration) for acute migraine attacks in adults |journal=The Cochrane Database of Systematic Reviews |volume=2012 |issue=2 |pages=CD009664 |doi=10.1002/14651858.CD009664 |pmc=4170908 |pmid=22336868}}{{cite journal |vauthors=Derry CJ, Derry S, Moore RA |date=February 2012 |title=Sumatriptan (intranasal route of administration) for acute migraine attacks in adults |journal=The Cochrane Database of Systematic Reviews |volume=2012 |issue=2 |pages=CD009663 |doi=10.1002/14651858.CD009663 |pmc=4164476 |pmid=22336867}}{{cite journal |vauthors=Derry CJ, Derry S, Moore RA |date=February 2012 |title=Sumatriptan (subcutaneous route of administration) for acute migraine attacks in adults |journal=The Cochrane Database of Systematic Reviews |volume=2012 |issue=2 |pages=CD009665 |doi=10.1002/14651858.CD009665 |pmc=4164380 |pmid=22336869}} For people with migraine symptoms such as nausea or vomiting, taking the abortive medicine by mouth or through the nose may be difficult. All route of administration have been shown to be effective at reducing migraine symptoms, however, nasal and injectable subcutaneous administration may result in more side effects. The adverse effects associated with rectal administration have not been well studied. In general, all the triptans appear equally effective, with similar side effects. However, individuals may respond better to specific ones.

Most side effects are mild, including flushing; however, rare cases of myocardial ischemia have occurred. They are thus not recommended for people with cardiovascular disease, who have had a stroke, or have migraines that are accompanied by neurological problems.{{cite web |title=Generic migraine drug could relieve your pain and save you money |url=http://www.consumerreports.org/health/best-buy-drugs/triptan.htm |url-status=live |archive-url=https://web.archive.org/web/20130804055321/http://www.consumerreports.org/health/best-buy-drugs/triptan.htm |archive-date=4 August 2013 |work=Best Buy Drugs |publisher=Consumer Reports}} In addition, triptans should be prescribed with caution for those with risk factors for vascular disease. While historically not recommended in those with basilar migraines there is no specific evidence of harm from their use in this population to support this caution.{{cite journal |vauthors=Kaniecki RG |date=June 2009 |title=Basilar-type migraine |journal=Current Pain and Headache Reports |volume=13 |issue=3 |pages=217–20 |doi=10.1007/s11916-009-0036-7 |pmid=19457282 |s2cid=22242504}} Triptans are not addictive, but may cause medication overuse headaches if used more than 10 days per month.{{cite journal |vauthors=Tepper SJ, Tepper DE |date=April 2010 |title=Breaking the cycle of medication overuse headache |journal=Cleveland Clinic Journal of Medicine |volume=77 |issue=4 |pages=236–42 |doi=10.3949/ccjm.77a.09147 |pmid=20360117 |s2cid=36333666 |doi-access=free |title-link=doi}}{{cite journal |last1=Tepper Stewart J. |first1=S. J. |last2=Tepper |first2=Deborah E. |date=April 2010 |title=Breaking the cycle of medication overuse headache |journal=Cleveland Clinic Journal of Medicine |volume=77 |issue=4 |pages=236–42 |doi=10.3949/ccjm.77a.09147 |pmid=20360117 |s2cid=36333666 |doi-access=free}}

Sumatriptan does not prevent other migraine headaches from starting in the future. For increased effectiveness at stopping migraine symptoms, a combined therapy that includes sumatriptan and naproxen may be suggested.{{cite journal |vauthors=Law S, Derry S, Moore RA |date=April 2016 |title=Sumatriptan plus naproxen for the treatment of acute migraine attacks in adults |journal=The Cochrane Database of Systematic Reviews |volume=4 |issue=4 |pages=CD008541 |doi=10.1002/14651858.CD008541.pub3 |pmc=6485397 |pmid=27096438}}

The combination meloxicam/rizatriptan (Symbravo) was approved for medical use in the United States in January 2025.{{cite press release | title=Axsome Therapeutics Announces FDA Approval of Symbravo (meloxicam and rizatriptan) for the Acute Treatment of Migraine with or without Aura in Adults | publisher=Axsome Therapeutics | via=GlobeNewswire | date=30 January 2025 | url=https://www.globenewswire.com/news-release/2025/01/30/3018389/0/en/Axsome-Therapeutics-Announces-FDA-Approval-of-SYMBRAVO-meloxicam-and-rizatriptan-for-the-Acute-Treatment-of-Migraine-with-or-without-Aura-in-Adults.html | access-date=7 February 2025}}

Ergotamine and dihydroergotamine are older medications still prescribed for migraines, the latter in nasal spray and injectable forms.{{cite book |title=AHRQ Comparative Effectiveness Reviews |vauthors=Sumamo Schellenberg E, Dryden DM, Pasichnyk D, Ha C, Vandermeer B, Friedman BW, Colman I, Rowe BH |date=November 2012 |publisher=Agency for Healthcare Research and Quality (US) |location=Rockville (MD) |chapter=Acute Migraine Treatment in Emergency Settings |pmid=23304741 |id=Report No.: 12(13)-EHC142-EF |access-date=28 July 2023 |chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK115368/ |archive-url=https://web.archive.org/web/20230823052155/https://www.ncbi.nlm.nih.gov/books/NBK115368/ |archive-date=23 August 2023 |url-status=live}} They appear equally effective to the triptans,{{cite journal|last=Kelley|first=NE|author2=Tepper, DE|title=Rescue therapy for acute migraine, part 1: triptans, dihydroergotamine, and magnesium|journal=Headache|date=January 2012|volume=52|issue=1|pages=114–28|pmid=22211870|doi=10.1111/j.1526-4610.2011.02062.x|s2cid=45767513}}{{cite journal |vauthors=Kelley NE, Tepper DE |date=January 2012 |title=Rescue therapy for acute migraine, part 1: triptans, dihydroergotamine, and magnesium |journal=Headache |volume=52 |issue=1 |pages=114–28 |doi=10.1111/j.1526-4610.2011.02062.x |pmid=22211870 |s2cid=45767513}} are less expensive,{{cite book|last=Olesen|first= Jes|title=The headaches.|year=2006|publisher=Lippincott Williams & Wilkins|location=Philadelphia|isbn=9780781754002|pages=516|url=https://books.google.com/books?id=F5VMlANd9iYC&pg=PA516|edition=3.}} and experience adverse effects that typically are benign.{{cite journal |vauthors=Morren JA, Galvez-Jimenez N |date=December 2010 |title=Where is dihydroergotamine mesylate in the changing landscape of migraine therapy? |journal=Expert Opinion on Pharmacotherapy |volume=11 |issue=18 |pages=3085–93 |doi=10.1517/14656566.2010.533839 |pmid=21080856 |s2cid=44639896}} In the most debilitating cases, such as those with status migrainosus, they appear to be the most effective treatment option.{{cite journal|last=Morren|first=JA|author2=Galvez-Jimenez, N|title=Where is dihydroergotamine mesylate in the changing landscape of migraine therapy?|journal=Expert Opinion on Pharmacotherapy|date=December 2010|volume=11|issue=18|pages=3085–93|pmid=21080856|doi=10.1517/14656566.2010.533839|s2cid=44639896}} The most common adverse effects are nausea, vomiting, abdominal pain, generalized weakness, tiredness, malaise, paresthesia, coldness, muscle pains, diarrhea, and chest tightness. These are less common with DHE than with ergotamine tartrate.{{Cite journal|journal= Neurology|vauthors=Silberstein SD, Young WB |title= Safety and efficacy of ergotamine tartrate and dihydroergotamine in the treatment of migraine and status migrainosus. Working Panel of the Headache and Facial Pain Section of the American Academy of Neurology|volume=45|pages=577–84|year=1995|pmid= 7898722|issue=3 Pt 1|doi=10.1212/wnl.45.3.577|s2cid=72696344 }} Ergots can cause vasospasm including coronary vasospasm, and are contraindicated in people with coronary artery disease.{{cite journal |vauthors=Tfelt-Hansen P, Saxena PR, Dahlöf C, Pascual J, Láinez M, Henry P, Diener H, Schoenen J, Ferrari MD, Goadsby PJ |date=January 2000 |title=Ergotamine in the acute treatment of migraine: a review and European consensus |journal=Brain |volume=123 |issue=Pt 1 |pages=9–18 |doi=10.1093/brain/123.1.9 |pmid=10611116 |doi-access=free |title-link=doi}}

Phenothiazines, often used for the treatment of nausea and vomiting, are also effective for treating migraine headache.{{cite journal | last1=AM | first1=Kelly | last2=Al. | first2=Et | title= The Relative Efficacy of Phenothiazines for the Treatment of Acute Migraine: A Meta-Analysis| journal=Headache | volume=49 | issue=9 | pages=1324–32 | date=June 4, 2019 | pmid=19496829 | doi=10.1111/j.1526-4610.2009.01465.x | s2cid=23072214 }}{{cite journal | last=BW | first=Friedman | title= Review: Phenothiazines relieve acute migraine headaches in the ED and are better than other active agents for some outcomes| journal=Annals of Internal Medicine | volume=152 | issue=8 | pages=JC4-11 | date=April 20, 2010 | pmid=20404368 | doi=10.7326/0003-4819-152-8-201004200-02011 | s2cid=34078516 }} Prochlorperazine is typically used due to a more favorable treatment profile.{{Cite journal|title = Prochlorperazine vs. promethazine for headache treatment in the emergency department: a randomized controlled trial|date = Oct 2008|pmid=18534808|doi=10.1016/j.jemermed.2007.09.047|volume=35|issue = 3|journal=J Emerg Med|pages=247–53|vauthors=Callan JE, Kostic MA, Bachrach EA, Rieg TS}}

Gepants may be used for rescue as well as prevention. Some gepants are approved for different purposes in different jurisdictions. Zavegepant was approved for medical use in the United States in March 2023.{{cite web |date=9 March 2023 |title=Zavzpret- zavegepant spray |url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9c4a7aec-daef-4961-ba77-92f4b58be780 |url-status=live |archive-url=https://web.archive.org/web/20230825193108/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9c4a7aec-daef-4961-ba77-92f4b58be780 |archive-date=25 August 2023 |access-date=25 August 2023 |website=DailyMed}}{{cite web |date=3 April 2023 |title=Drug Approval Package: Zavzpret |url=https://www.accessdata.fda.gov/drugsatfda_docs/nda/2023/216386Orig1s000TOC.cfm |url-status=live |archive-url=https://web.archive.org/web/20230825193307/https://www.accessdata.fda.gov/drugsatfda_docs/nda/2023/216386Orig1s000TOC.cfm |archive-date=25 August 2023 |access-date=25 August 2023 |website=U.S. Food and Drug Administration (FDA)}}{{cite press release |url=https://www.businesswire.com/news/home/20230309005795/en/Pfizer%E2%80%99s-ZAVZPRET%E2%84%A2-zavegepant-Migraine-Nasal-Spray-Receives-FDA-Approval |title=Pfizer's Zavzpret (zavegepant) Migraine Nasal Spray Receives FDA Approval |date=10 March 2023 |publisher=Pfizer |via=businesswire.com |access-date=10 March 2023 |archive-date=8 April 2023 |archive-url=https://web.archive.org/web/20230408060103/https://www.businesswire.com/news/home/20230309005795/en/Pfizer%E2%80%99s-ZAVZPRET%E2%84%A2-zavegepant-Migraine-Nasal-Spray-Receives-FDA-Approval |url-status=live}}

Metoclopramide is a recommended treatment for those who present to the emergency department.

Intravenous metoclopramide, intravenous prochlorperazine, or intranasal lidocaine are other potential options. Metoclopramide or prochlorperazine are the recommended treatment for those who present to the emergency department. Haloperidol may also be useful in this group. A single dose of intravenous dexamethasone, when added to standard treatment of a migraine attack, is associated with a 26% decrease in headache recurrence in the following 72 hours.{{cite journal |vauthors=Colman I, Friedman BW, Brown MD, Innes GD, Grafstein E, Roberts TE, Rowe BH |date=June 2008 |title=Parenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence |journal=BMJ |volume=336 |issue=7657 |pages=1359–1361 |doi=10.1136/bmj.39566.806725.BE |pmc=2427093 |pmid=18541610}}{{Cite journal |author=Colman I |author2=Friedman BW |author3=Brown MD |last4=Innes |first4=G. D |last5=Grafstein |first5=E. |last6=Roberts |first6=T. E |last7=Rowe |first7=B. H |date=June 2008 |title=Parenteral dexamethasone for acute severe migraine headache: meta-analysis of randomized controlled trials for preventing recurrence |journal=BMJ |volume=336 |issue=7657 |pages=1359–61 |doi=10.1136/bmj.39566.806725.BE |pmc=2427093 |pmid=18541610}} Spinal manipulation for treating an ongoing migraine headache is not supported by evidence.{{cite journal |vauthors=Posadzki P, Ernst E |date=June 2011 |title=Spinal manipulations for the treatment of migraine: a systematic review of randomized clinical trials |journal=Cephalalgia |volume=31 |issue=8 |pages=964–70 |doi=10.1177/0333102411405226 |pmid=21511952 |s2cid=31205541 |doi-access=free |title-link=doi}} It is recommended that opioids and barbiturates not be used due to questionable efficacy, addictive potential, and the risk of rebound headache.{{cite journal |vauthors=Ashina M |date=November 2020 |title=Migraine |journal=The New England Journal of Medicine |volume=383 |issue=19 |pages=1866–1876 |doi=10.1056/NEJMra1915327 |pmid=33211930 |s2cid=227078662}} There is tentative evidence that propofol may be useful if other measures are not effective.{{cite journal |vauthors=Piatka C, Beckett RD |date=February 2020 |title=Propofol for Treatment of Acute Migraine in the Emergency Department: A Systematic Review |journal=Academic Emergency Medicine |volume=27 |issue=2 |pages=148–160 |doi=10.1111/acem.13870 |pmid=31621134 |doi-access=free |title-link=doi}}

Magnesium is recognized as an inexpensive, over-the-counter supplement which can be part of a multimodal approach to migraine reduction. Some studies have shown to be effective in both preventing and treating migraine in intravenous form.{{cite book |url=https://www.ncbi.nlm.nih.gov/books/NBK507271/ |title=Magnesium in the Central Nervous System |vauthors=Yablon LA, Mauskop A |date=2011 |publisher=University of Adelaide Press |isbn=978-0-9870730-5-1 |veditors=Vink R, Nechifor M |place=Adelaide (AU) |chapter=Magnesium in headache |pmid=29920023 |id=Bookshelf ID: NBK507271 |access-date=19 August 2020 |archive-url=https://web.archive.org/web/20200814030326/https://www.ncbi.nlm.nih.gov/books/NBK507271/ |archive-date=14 August 2020 |url-status=live}} The intravenous form reduces attacks as measured in approximately 15–45 minutes, 120 minutes, and 24-hour time periods, magnesium taken orally alleviates the frequency and intensity of migraines.{{cite journal |vauthors=Chiu HY, Yeh TH, Huang YC, Chen PY |date=January 2016 |title=Effects of Intravenous and Oral Magnesium on Reducing Migraine: A Meta-analysis of Randomized Controlled Trials |journal=Pain Physician |volume=19 |issue=1 |pages=E97-112 |pmid=26752497}}{{cite journal |vauthors=Veronese N, Demurtas J, Pesolillo G, Celotto S, Barnini T, Calusi G, Caruso MG, Notarnicola M, Reddavide R, Stubbs B, Solmi M, Maggi S, Vaona A, Firth J, Smith L, Koyanagi A, Dominguez L, Barbagallo M |date=February 2020 |title=Magnesium and health outcomes: an umbrella review of systematic reviews and meta-analyses of observational and intervention studies |url=https://arro.anglia.ac.uk/id/eprint/704022/3/Veronese_et_al_2019.docx |url-status=live |journal=European Journal of Nutrition |volume=59 |issue=1 |pages=263–272 |doi=10.1007/s00394-019-01905-w |pmid=30684032 |s2cid=59275463 |archive-url=https://web.archive.org/web/20230203041603/https://arro.anglia.ac.uk/id/eprint/704022/3/Veronese_et_al_2019.docx |archive-date=3 February 2023 |access-date=22 December 2022 |hdl-access=free |hdl=10447/360041}}

The combination meloxicam/rizatriptan (Symbravo) was approved for medical use in the United States in January 2025.

For children, ibuprofen or other NSAIDs help decrease pain.{{cite journal |vauthors=Oskoui M, Pringsheim T, Holler-Managan Y, Potrebic S, Billinghurst L, Gloss D, Hershey AD, Licking N, Sowell M, Victorio MC, Gersz EM, Leininger E, Zanitsch H, Yonker M, Mack K |date=September 2019 |title=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 |journal=Neurology |volume=93 |issue=11 |pages=487–499 |doi=10.1212/WNL.0000000000008095 |pmid=31413171 |doi-access=free |title-link=doi}}{{Cite journal |last1=Gibler |first1=Robert C. |last2=Knestrick |first2=Kaelynn E. |last3=Reidy |first3=Brooke L. |last4=Lax |first4=Daniel N. |last5=Powers |first5=Scott W. |date=2022-09-09 |title=Management of Chronic Migraine in Children and Adolescents: Where are We in 2022? |journal=Pediatric Health, Medicine and Therapeutics |language=English |volume=13 |pages=309–323 |doi=10.2147/PHMT.S334744 |pmc=9470380 |pmid=36110896 |doi-access=free}} Triptans are effective, though there is a risk of side effects such as nausea, coronary vasoconstriction, dizziness, paresthesia, flushing, tingling, neck pain, and chest tightness, known as "triptan sensations".{{Citation |last1=Nicolas |first1=Samar |title=Triptans |date=2023-03-07 |work=StatPearls |url=http://www.ncbi.nlm.nih.gov/books/NBK554507/ |access-date=2024-05-03 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=32119394 |last2=Nicolas |first2=Diala}} Additionally, a combination of Cognitive Behavioral Therapy, biofeedback, and relaxation may decrease migraine frequency in children.{{Cite report |url=https://effectivehealthcare.ahrq.gov/products/behavioral-interventions-migraine-prevention/research |title=Behavioral Interventions for Migraine Prevention |last=Treadwell |first=Jonathan R. |last2=Tsou |first2=Amy Y. |last3=Rouse |first3=Benjamin |last4=Ivlev |first4=Ilya |last5=Fricke |first5=Julie |last6=Buse |first6=Dawn |last7=Powers |first7=Scott W. |last8=Minen |first8=Mia |last9=Szperka |first9=Christina L. |date=2024-09-18 |publisher=Agency for Healthcare Research and Quality (AHRQ) |doi=10.23970/ahrqepccer270}}

Occipital nerve stimulation may be effective but has the downsides of being cost-expensive and has a significant amount of complications.{{cite journal |vauthors=Vukovic Cvetkovic V, Jensen RH |date=January 2019 |title=Neurostimulation for the treatment of chronic migraine and cluster headache |journal=Acta Neurologica Scandinavica |volume=139 |issue=1 |pages=4–17 |doi=10.1111/ane.13034 |pmid=30291633 |s2cid=52923061 |doi-access=free |title-link=doi}}

There is modest evidence for the effectiveness of non-invasive neuromodulatory devices, behavioral therapies and acupuncture in the treatment of migraine headaches. There is little to no evidence for the effectiveness of physical therapy, chiropractic manipulation and dietary approaches to the treatment of migraine headaches. Behavioral treatment of migraine headaches may be helpful for those who may not be able to take medications (for example pregnant women).

A PCORI systematic review released in September 2024 evaluated the viability of behavioral interventions for migraine prevention and found that all of or some combination of CBT, relaxation training, and education could yield positive outcomes for reducing the frequency of migraines on the scale of migraine days per month. The reduction with these non-pharmaceutical, non-surgical interventions was estimated to be about 1 migraine day/month which met the minimum clinical significance threshold.

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{{Antimigraine preparations}}

Category:Antimigraine drugs

Category:Migraine