The Migraine Clinic

Treatments

Acute medication for migraine

Acute medication is about more than ordinary painkillers such as paracetamol and ibuprofen, which you can buy yourself. There are specific medicines that bring relief straight away during an attack. This is not a one-size-fits-all solution: we work with you to find the most effective treatment.

Acute medication for migraine

  • Triptans are the most effective acute medication for migraine
  • A sumatriptan injection is the fastest and most powerful option
  • The gepants rimegepant and atogepant are a newer option in tablet form
TriptansGepantsPainkillersMedication overuse

Our approach

Effective treatment for migraine attacks

Migraine affects more than a billion people worldwide and is the number one cause of healthy years of life lost among women. At The Migraine Clinic we treat migraine attacks with targeted acute medication that reduces the symptoms when an attack begins.

Acute medication works best when it is taken right at the start of an attack. The sooner you take it, the better the chance that the symptoms stay under control.

It is important to wait until you are sure that it is migraine, to avoid medication overuse. We give you personal guidance towards less trouble from migraine.

Acute medication

What we prescribe

Triptans

Triptans are the first-line treatment for migraine attacks. The available triptans are sumatriptan, almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan and zolmitriptan. These medicines specifically target migraine, which sets them apart from ordinary painkillers.

Triptans are generally safe, but can cause side effects that mean some patients cannot use them. Sumatriptan is the only triptan available as an injection, the most powerful form of acute treatment.

Finding the right triptan and the right form requires an individual assessment. About a third of people with migraine get too little effect from triptans. New treatment options exist for this group.

Gepants

Gepants are small-molecule medicines that block the receptor CGRP acts on. They are an option for patients who do not respond well enough to triptans.

Rimegepant and atogepant are modern medicines for the acute treatment of migraine attacks. They inhibit CGRP activity, similar to the CGRP inhibitors used as preventive treatment.

Painkillers

What we don't prescribe

Painkillers without a prescription

Paracetamol gives limited relief from migraine, even though it is often the first thing people take. Unfortunately, this encourages overuse.

NSAIDs (non-steroidal anti-inflammatory drugs) such as naproxen, ibuprofen and diclofenac are generally more effective for migraine symptoms and reduce both the pain and the symptoms that come with it. Long-term use carries risks, however, including stomach bleeding and kidney problems. Careful management and medical advice are essential with frequent use.

We do not prescribe these painkillers: you can buy them yourself.

Painkillers on prescription

For severe or persistent migraine, stronger painkillers such as opioids (tramadol, oxycodone) are sometimes considered. They are only available on prescription.

The Migraine Clinic does not prescribe opioids for migraine, for two reasons: they are highly addictive with long-term use, and they have no treatment benefit specific to migraine. Opioids also often make the nausea that comes with migraine worse.

Overuse of acute medication

Frequent use of acute medication can lead to medication overuse headache. Although there is no strict scientific limit, the guideline is: more days without medication than with it. Using triptans more than twelve times a month, or on more than three days a week, probably points to dependence.

There are two approaches: stopping acute medication completely (detox) or better preventive migraine treatment. A detox means months without migraine treatment, accepting withdrawal symptoms. The first weeks are particularly hard, with severe, flu-like symptoms. After that, patients gradually feel better, but it takes perseverance.

Our view on detox

The Migraine Clinic usually takes a different approach: when patients use acute medication regularly, we start better preventive treatment. A growing body of research supports this method.

Studies show that patients with medication overuse headache and migraine who use effective preventive medication need significantly fewer painkillers and triptans, without a detox first.

We believe that patients who have been through a detox before without success do not need to repeat that process.

Prevention

Preventive treatments

Alongside acute medication, we offer preventive treatments to reduce the number of migraine attacks.

Gepants for prevention

Gepants can be used both to stop an attack and to prevent attacks. As a preventive, the gepants atogepant and rimegepant are tablets that block the CGRP receptor to reduce the frequency, intensity and duration of future attacks.

Read more

Monoclonal CGRP antibodies

Erenumab, fremanezumab and galcanezumab: treatments developed specifically for migraine that reduce the frequency, duration and intensity of attacks.

Read more

Frequently asked questions

What is acute medication for migraine?
Acute medication is medication you take when a migraine attack starts, to stop the attack or reduce the symptoms. At The Migraine Clinic that means triptans (such as sumatriptan) and gepants (rimegepant and atogepant).
What are triptans and how do they work?
Triptans are the first-line treatment for migraine attacks. They were developed specifically for migraine and work by narrowing the blood vessels in the head and damping down pain signals. Seven different triptans are available, including sumatriptan, rizatriptan and eletriptan. About two thirds of people with migraine get relief from triptans.
When should I take acute medication?
Acute medication works best when you take it as early as possible at the start of an attack. The sooner you take it, the better the chance that the symptoms stay under control. It is important to be sure that it is migraine.
What is medication overuse headache?
Medication overuse headache is headache caused by taking acute medication too often. As a guideline: do not use acute medication on more days than you go without it. The Migraine Clinic tackles this by starting better preventive treatment, often without the need for a full detox.
What if triptans do not work?
For about a third of patients, triptans do not work well enough. In that case there is a newer option: the gepants rimegepant and atogepant (CGRP inhibitors in tablet form). A sumatriptan injection can also be a more powerful alternative. At The Migraine Clinic we always look for the treatment that suits you best.

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