Read more about how migraines are treated on this page. When you feel a migraine attack coming up, it is important to rest as soon as possible and not to exert yourself. You can also take medication if you feel a migraine coming up. Always follow the doctor’s prescription. The following medications can be taken as soon as the headache starts:
The first choice for treating migraine during an attack is paracetamol. This painkiller has the least side effects. Paracetamol may work better if taken at the same time as anti-nausea medicine, such as Domperidone or Metoclopramide. If you do not suffer from nausea during a migraine, then it is not necessary to take an anti-nausea medicine. After two or three attacks, it is assessed whether paracetamol helps sufficiently; if not, you should stop taking paracetamol and another painkiller may be prescribed.
2. NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
If paracetamol does not help sufficiently, another painkiller may be chosen. These painkillers are called NSAIDs. Ibuprofen, Naproxen, Diclofenac and Acetylsalicylic acid belong to NSAIDs. After two or three attacks, it is assessed whether an NSAID is helping sufficiently against the headache. Sometimes you must take a stomach protector in addition to the NSAID. If, after a few migraine attacks, it appears that an NSAID is not working, you should stop taking the NSAID and another painkiller may be prescribed.
If an NSAID is not enough to relieve the pain, triptans may be prescribed. There are several types of triptans and administration forms, the most used: Sumatriptan, Rizatriptan and Zolmitriptan. Based on your preference and medical history, a choice will be made as to which triptan, and which form of administration is best for you. If, after a few migraine attacks, it appears that a triptan does not work sufficiently, a combination of painkillers may be prescribed.
4. A combination of painkillers
If the use of triptans is still insufficient for the headache, a combination of painkillers can be prescribed. To start with, a combination of paracetamol and NSAID can be taken if paracetamol alone has an insufficient effect. If this combination does not help against the pain, a combination of a triptan with paracetamol or an NSAID can be chosen.
In addition to headache medication, nausea medication may also be given. The nausea medicine should be taken at the same time as or before the medication for a headache. There are two types of anti-nausea medication: Domperidone and Metoclopramide. Which medicine suits you best depends on several factors such as your medical history and the side effects of the medicine. After two or three attacks, the doctor will check whether the medicine is helping sufficiently against nausea. If the anti-nausea medicine does not help, its use must be stopped.
Treatment during pregnancy
During pregnancy and breastfeeding, you should be careful with taking medicines because the medicines may affect the baby. During pregnancy, paracetamol can be used safely if you suffer from a migraine. If paracetamol does not help sufficiently against the headache, NSAIDs may be used occasionally in the first and second semesters. NSAIDs should not be used in the third trimester. If NSAIDs still do not relieve the headache, Sumatriptan may be taken occasionally at the lowest possible dose.
Metoclopramide may be used during pregnancy for nausea in migraine. The medicine domperidone should not be used during pregnancy.
Treatment during the breastfeeding period
During the breastfeeding period, paracetamol and NSAIDs may be used to treat migraine. Sumatriptan may be used if the headache has not yet subsided. Both metoclopramide and domperidone may be used for nausea.
Treatment of Chronic Migraine
More than 8 days of migraine per month is called chronic migraine. Painkillers are prescribed for the treatment of migraine. Sometimes, if you keep taking these painkillers for too long, you may get more migraine. This is called medication dependent headache. Chronic migraine is often caused by the long-term use of painkillers. The dose of the painkiller does not matter, but it does matter how often you take painkillers. The following medications can cause medication-related headaches.
– Paracetamol or NSAIDs
If you take paracetamol or NSAIDs for 15 days or more per month for 3 months, you may experience medication-related headaches.
– Triptans or opioids
If you take triptans or opioids for 10 days or more per month for 3 months, you may experience medication-related headaches.
– Combination painkillers
If you take a combination of painkillers for 10 days or more per month for 3 months, you may experience medication-dependent headaches.
If you suffer from chronic migraine, the doctor should first check whether you take painkillers several days a month. To find out if these painkillers are the cause of chronic migraine, you should stop using them. First, consult your doctor about stopping these painkillers.