Treatments for Quick Migraine Relief
Treating migraine symptoms right away can shorten the attack, which otherwise can last from hours to days.
The types of medications that can alleviate symptoms once a migraine attack has started are known as acute, or abortive, medications. These include OTC pain relievers such as aspirin and ibuprofen, prescription medications such as triptans, and a new class of drugs called CGRP receptor antagonists (gepants).
Not everyone with migraine will respond to all of these drugs. You may need to try several before finding the drug or combination of drugs — and the doses — that work best for you.
Triptans The triptan drugs available in the United States are almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), sumatriptan (Imitrex), and zolmitriptan (Zomig). All triptans are available in pill form. Sumatriptan and zolmitriptan also come as a nasal spray, and sumatriptan is available in an injectable form, too. Rizatriptan is available in pill form (Maxalt) and as a dissolving oral film (RizaFilm). A combination of rizatriptan and meloxicam (Symbravo) comes in pill form.
Triptan injections start working in about 10 minutes, nasal sprays start working in 10 to 15 minutes, and most pills start working in 30 to 60 minutes. The exceptions are the longer-acting triptans, frovatriptan and naratriptan, which take one to three hours to start working. In general, taking medications on a full stomach may delay absorption and time to peak effectiveness.
CGRP Receptor Antagonists Referred to as gepants, three CGRP receptor antagonists are available for the acute treatment of migraine: rimegepant (Nurtec ODT), ubrogepant (Ubrelvy), and zavegepant (Zavzpret). Rimegepant and ubrogepant are oral tablets that start reducing pain in about one hour. Zavegepant is a nasal spray that starts working as fast as 15 minutes for some people. Gepants may be alternatives for those who can’t take triptans or don’t get relief from them. Another medication in this class, atogepant (Qulipta), is available as a preventive migraine treatment.
Dihydroergotamine (DHE) Intravenous DHE is used in emergency departments to relieve intractable migraine. For home use, it’s available as a nasal spray (Migranal, Trudhesa, Atzumi) and an injection (D.H.E. 45, Brekiya). It’s most effective when taken soon after the onset of migraine symptoms for attacks that typically last longer than 24 hours.
While Migranal and Trudhesa contain the same drug, Trudhesa delivers the drug higher in the nasal cavity, an area rich in blood vessels, meaning it should start working faster.
Ergotamine Combinations of ergotamine and caffeine — Cafergot, a rarely used tablet, and Migergot, a rectal suppository — are less effective than triptans at resolving migraine pain but may be appropriate for some people. They can relieve pain within 30 minutes.
Neurostimulation Devices A helpful nondrug companion to migraine medications, a neurostimulation (or neuromodulation) device delivers electric or magnetic pulses to nerves that are directly or indirectly involved in pain processing. Several devices targeting different nerves are available, and all can be used for acute treatment of migraine. They are most effective when used as early as possible after the start of symptoms.
Anti-Nausea Drugs The drugs used to treat migraine pain may also relieve other symptoms, including nausea and vomiting. But if your migraine therapies are not relieving nausea and vomiting, speak to your doctor about prescription anti-nausea drugs.
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