Migraine medication: what helps during an attack

Migraine medication for an attack (acute treatment) aims to stop the pain and the other symptoms as quickly as possible. For most people the most effective option is a triptan, a medicine developed specifically for migraine. Newer medicines called gepants offer an alternative for people who cannot take triptans or do not get on with them.

Do over-the-counter painkillers help with migraine?

Paracetamol and anti-inflammatory painkillers (NSAIDs) such as ibuprofen, naproxen and aspirin are available without a prescription. Some people find them helpful for milder attacks, but they are not specific to migraine, and paracetamol on its own often has only a limited effect. Combination products, for example with added caffeine, are also sold.

Whatever you use, keep an eye on how often you take it. Taking simple painkillers on 15 or more days a month, or combination painkillers or triptans on 10 or more days a month, can lead to medication overuse headache. Long-term use of anti-inflammatory painkillers can also cause side effects such as stomach bleeding and kidney problems, especially in older people.

The Migraine Clinic does not prescribe painkillers. Your GP or pharmacist can advise you on them.

What are triptans and how do they work?

Triptans were developed specifically to treat migraine attacks, and for most people they are the most effective acute medication. They act on the trigeminal nerve and reduce the release of CGRP, a protein that plays a central role in migraine. Narrowing blood vessels is a much smaller part of how they work than was once thought.

There are seven triptans, and our migraine specialists can prescribe all of them:

• sumatriptan
• rizatriptan
• zolmitriptan
• naratriptan
• almotriptan
• eletriptan
• frovatriptan

They differ in how quickly they work, how long they last and the forms they come in: tablets, tablets that melt on the tongue, nasal sprays and, for sumatriptan, injections. If one triptan does not work well for you, another often does.

When should you take a triptan?

Speed matters. A triptan works best when you take it early, as soon as the headache starts and while the pain is still mild. If the migraine comes back after first improving, you may be able to take a second dose after a set interval (for sumatriptan, at least 2 hours). The patient leaflet and your migraine specialist tell you the maximum dose in 24 hours.

Triptans are safe for most people, yet worry about side effects is common. Some people notice a feeling of pressure or tightness in the chest or throat after taking one. This is a known side effect, it passes, and it is not a sign of heart trouble. Triptans are not suitable for people with certain heart or circulation conditions, which is why your migraine specialist asks about your medical history first.

How to use sumatriptan nasal spray?

A nasal spray can help when nausea or vomiting makes tablets hard to keep down, or when you want relief to start sooner. In general:

1. Gently blow your nose first.
2. Keep your head upright, close one nostril with a finger and place the nozzle in the other.
3. Press the spray once while breathing in gently through your nose. Do not sniff hard.
4. Breathe out through your mouth and keep your head upright for a few seconds.

Each spray unit usually holds a single dose. A bitter taste afterwards is common. Always follow the patient leaflet and the instructions from your migraine specialist.

What are gepants?

Gepants are a newer group of migraine medicines that block the effect of CGRP directly. They do not narrow blood vessels, so they can be an option for people who cannot take triptans, for example because of heart or circulation problems, and for people for whom triptans do not work well or cause too many side effects. We prescribe two gepants, atogepant and rimegepant, and use them for both acute treatment and prevention. Both are tablets, so no injections are needed.

What are the differences between rimegepant and sumatriptan?

• How they work: sumatriptan is a triptan that acts on serotonin receptors; rimegepant blocks the CGRP receptor.
• Blood vessels: sumatriptan has a mild narrowing effect and is not suitable for some heart conditions; rimegepant does not narrow blood vessels.
• Forms: sumatriptan comes as a tablet, nasal spray or injection; rimegepant is a tablet that melts on the tongue.
• Use: sumatriptan treats attacks only; rimegepant can treat attacks and, taken regularly, help prevent them.
• Who it suits: rimegepant is often considered for people who do not respond to triptans, cannot take them, have hormone-related migraine or are at risk of medication overuse headache.

Which one suits you best depends on your attacks, your medical history and what you have tried before.

Which drugs are the most effective for acute migraine?

For most people triptans are the most effective acute migraine medication, especially when taken early in the attack. Gepants are an effective alternative, particularly when triptans are unsuitable or have not worked. Painkillers can help with milder attacks but are generally less effective against migraine.

There is no single strongest migraine medicine that works for everyone. The right choice is personal, and it can take trying more than one triptan to find the one that works best for you.

How do you get migraine medication from The Migraine Clinic?

You see one of our migraine specialists by video, and you do not need a referral from your GP. If a triptan or a gepant is right for you, you pay for your medication in the App and our partner pharmacy delivers it to your door. Our care is self-pay; you can find out more on our pricing page.

Not sure whether your headaches are migraine? Take our migraine test, read more about acute medication and preventive medication, or see how to start.