Migraines are painful, throbbing headaches that last from 4 to 72 hours. They often occur on only one side of your head. But the pain may move from one side of your head to the other, or you may feel it on both sides at the same time. Migraines may be so painful that you aren't able to do your daily activities.
When you have a migraine, you may also feel sick to your stomach and vomit. Activity, light, noise, or certain smells may make your migraine worse.
Some people have an aura before their migraine starts. When you have an aura, you may first see spots, wavy lines, or flashing lights. Your hands, arms, or face may tingle or feel numb. The aura usually starts about 30 minutes before your headache. But most people don't have auras.
Migraines run in families. But it's not clear why some people get them and others don't.
The cause of migraines is not well understood. But experts think that they may have something to do with the blood vessels in your brain, certain foods, alcohol, and stress.
If your migraine symptoms are mild to moderate, doctors recommend that you first try over-the-counter pain medicines to manage your headaches. These medicines are safe and cost less than prescription migraine medicines. They include:
Some over-the-counter medicines (for example, Excedrin) combine acetaminophen, aspirin, and caffeine. Be safe with medicines. Read and follow all instructions on the label.
If these medicines don't help, your doctor may prescribe a medicine that can quickly stop a migraine after it has started. A group of drugs called triptans is most often tried first. But these can cause serious side effects, especially for people who have heart disease and high blood pressure.
If over-the-counter pain medicines or triptans don't work, and if you get bad migraines often, you may want to take a daily medicine to help prevent them.
There are several types of medicines that help prevent migraines. These medicines were first approved to treat other medical problems such as seizures, depression, high blood pressure, and heart disease. But they also help to prevent migraines.
Medicines used to prevent migraines include:
Medicines to prevent migraines may not stop every migraine. But studies have shown that:1
Even though calcium channel blockers may be used to prevent migraines, the evidence for how well they work is not as strong as it is for these other medicines.1
In studies, Botox shots worked to reduce the number of migraines people had only if they were having more than 15 migraines a month before treatment. These people had about 2 fewer migraines a month after treatment with Botox.2
For most of these medicines, you'll need to take pills every day—even when you don't have a headache. Botox for chronic migraines involves getting up to 31 injections in the face and neck every year. This can be expensive.
It could take up to 2 to 3 months for the medicine to work. If you don't see any improvement after several weeks, talk to your doctor. You may need to try several different medicines to find one that works for you.
Medicine that you take daily may not prevent all migraines, so there may be times when you need to take another medicine to stop a migraine after it has started.
Medicines to prevent migraines may cause side effects. Some of these side effects may last for as long as you take the medicine. Or they may go away within a few weeks. You may need to decide which bothers you more—the side effects of the medicine or your migraines.
Common side effects include:
Serious side effects can also happen. Anticonvulsants can cause birth defects when they are taken during pregnancy. Botox can cause severe weakness in the muscles of the face or head. In very rare cases, the botulinum toxin can spread and cause weakness in the muscles that control breathing or swallowing.
There are other things you can try to prevent migraines. These work for some people:
Here are some things you can do at home:
Your doctor may advise you to take medicine every day to prevent migraines if:
|Take medicine to prevent migraines||Don't take medicine to prevent migraines|
|What is usually involved?|
|What are the benefits?|
|What are the risks and side effects?|
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"I had my first migraine when I started taking birth control pills. I saw wavy lines and had distorted vision at first, then I felt nauseous, and then developed a horrible, throbbing headache on one side of my head. I took some ibuprofen and laid down in a dark room. Even when the headache went away the next day, I felt achy all over and "fuzzy" in my head. I have had two migraines since I started taking the pill 3 months ago. I never had a migraine before that. My doctor recommended that I stop taking the pill and wait to see if my migraines stop too. I'm going to wait and see if that helps before I decide about taking medicine every day to prevent migraines."
— Shelby, age 24
"I first got migraines when I was a teenager. The medicines used to treat migraines at that time didn't really help me, so I quit taking them. Recently, I developed high blood pressure that we can't seem to get under control. I still get migraines, but not very often. I can usually stop the symptoms by taking an aspirin and lying down for awhile. When I was at my doctor's office for my high blood pressure, I asked about the newer antimigraine medicines. I am told they are much more effective at reducing migraine symptoms. But I am at risk for some of their more serious side effects until I get my blood pressure under control. My doctor suggested treating my high blood pressure and trying to prevent migraines with a single medicine such as a beta-blocker."
— Helen, age 59
"I started getting migraines when I was a kid, although they didn't occur very often. Recently, my migraine attacks are much more frequent, about two a month. I tried taking ibuprofen, but it didn't help. The symptoms have been so bad that I had to go to the emergency room for a shot several times in the past few months. My doctor recommends that I start taking a preventive medicine every day to try to prevent the migraine attacks. He also recommends I have medicine close by to stop headaches that I might still get. Since I have missed so much work due to the migraines, I have decided to take preventive medicines to see if this helps."
— George, age 35
"I have had migraines off and on for years. I was usually able to control them by taking an aspirin and lying down, but that is not helping anymore. I am also getting them close to my menstrual cycle and nearly every month. I am not taking birth control pills, and I don't smoke. I am in pretty good health other than for these migraines. My doctor recommended I try taking a medicine to prevent migraines just around my menstrual cycle (right before and during the first few days)."
— Kasey, age 32
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to take medicine to prevent migraines
Reasons not to take medicine to prevent migraines
I'm willing to take medicine every day if it will help my symptoms.
I don't want to take medicine every day.
I don't think the side effects of the medicine could be as bad as my migraine symptoms.
I think the side effects of the medicine may bother me more than my symptoms.
My migraines are affecting my work and relationships with friends and family.
My migraines are not affecting my work and relationships with friends and family.
My other important reasons:
My other important reasons:
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Taking medicine to prevent migraines
NOT taking medicine to prevent migraines
1. I may still get a migraine, even if I take medicine to prevent them.
2. If I only get a migraine every now and then, and if my symptoms don't bother me too much, I should take medicine every day to prevent them.
1. Do you understand the options available to you?
2. Are you clear about which benefits and side effects matter most to you?
3. Do you have enough support and advice from others to make a choice?
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
3. Use the following space to list questions, concerns, and next steps.
|Primary Medical Reviewer||Anne C. Poinier, MD - Internal Medicine|
|Specialist Medical Reviewer||Colin Chalk, MD, CM, FRCPC - Neurology|
Holland S, et al. (2012). Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology, 78(17): 1346–1353.
Haghighi AB, et al. (2010). Cutaneous application of menthol 10% solution as an abortive treatment of migraine without aura: A randomised, double-blind, placebo-controlled, crossed-over study. International Journal of Clinical Practice, 64(4): 451–456.