Migraine – more than just a headache
Migraine is one of the most common neurological conditions. It is typically characterised by recurrent attacks of pulsating, often one-sided headache, frequently accompanied by nausea, vomiting and a marked sensitivity to light, sound or smells. In some people, the headache phase is preceded by a so-called aura – for example, visual disturbances or sensory changes.
Effective acute migraine treatment aims to relieve symptoms during an attack as quickly as possible and to restore the ability to function in everyday life. Which medications are suitable depends on the severity of the attacks, possible co-existing conditions and individual response.
Basic principles of acute migraine treatment
For migraine treatment during an acute attack, several general recommendations highlighted by medical guidelines apply:
- Early intake: Active substances generally work better when taken at the beginning of the pain phase.
- Adequate dosing: A dose that is too low can significantly reduce effectiveness.
- Treating accompanying symptoms: In the case of severe nausea, an additional anti-nausea agent (antiemetic) may be useful.
- Frequency of use: If acute medications are taken on more than ten days per month, the risk of so-called medication-overuse headache increases. In this case, preventive treatment (prophylaxis) should be discussed with a doctor.
Overview of drug groups
The main migraine medications for acute treatment can be divided into several groups.
1. Conventional painkillers and non-steroidal anti-inflammatory drugs (NSAIDs)
For mild to moderate attacks, over-the-counter painkillers are often used. These include active substances such as:
- ibuprofen
- acetylsalicylic acid (ASA)
- naproxen
- diclofenac
- paracetamol
- metamizole (prescription only)
Combination preparations containing ASA, paracetamol and caffeine are also used. It is important not to exceed the recommended maximum daily dose. With prolonged or frequent use, NSAIDs can cause gastrointestinal complaints as well as kidney or cardiovascular problems. People with stomach ulcers, kidney disease or certain cardiovascular conditions should consult their doctor before taking them.
2. Triptans – developed specifically for migraine
Triptans are prescription-only medicines developed specifically for the acute treatment of migraine attacks. They act via serotonin receptors and can ease both the headache and accompanying symptoms such as nausea or sensitivity to light. Available active substances include:
- sumatriptan
- zolmitriptan
- naratriptan
- rizatriptan
- almotriptan
- eletriptan
- frovatriptan
Triptans are available in various forms – as tablets, orodispersible tablets, nasal sprays or pre-filled syringes. In cases of severe vomiting, a non-oral form may be useful.
Triptans are not suitable for everyone. They are not recommended in certain pre-existing conditions such as coronary heart disease, previous stroke, poorly controlled high blood pressure or peripheral arterial disease. Their use during pregnancy should also be assessed by a doctor.
3. Ergot alkaloids (ergotamines)
Ergotamines such as ergotamine tartrate were used for decades in the acute treatment of migraine. Due to their less favourable side-effect profile and the availability of modern alternatives, they are now used only rarely. In selected cases, a doctor may still consider them.
4. Gepants – a newer drug group
So-called CGRP receptor antagonists ("gepants"), such as rimegepant, represent a newer option in acute treatment. They block the neuropeptide CGRP, which plays a role in the development of migraine attacks. In Austria, availability and reimbursement are evolving – whether these medicines are suitable for you is best assessed by a doctor.
5. Ditans
With lasmiditan, another newer active substance is available that acts specifically on a particular serotonin receptor without constricting blood vessels. It may be of interest in particular for people in whom triptans should not be used due to cardiovascular risks. Here, too, prescription should be reviewed by a doctor.
6. Anti-nausea medicines (antiemetics)
Nausea and vomiting are among the most distressing migraine symptoms and can also make it difficult to take tablets. Active substances such as metoclopramide or domperidone can ease these complaints and support the effect of other acute medicines. They are usually taken about 15 to 30 minutes before the actual painkiller.
Which treatment for whom?
The choice of the right medication is individual. The following aspects are considered during medical consultation:
- intensity and duration of the attacks
- presence of nausea or vomiting
- pre-existing conditions (e.g. cardiovascular, gastrointestinal, renal)
- age and pregnancy
- previous experience with painkillers
- frequency of attacks per month
If attacks are frequent or particularly severe, preventive medication (migraine prophylaxis) may be useful in addition to acute treatment. Non-pharmacological measures such as relaxation techniques, endurance exercise, sleep hygiene and identifying individual triggers also complement established therapies.
What you can do yourself
- Keep a headache diary: Note the frequency, duration, accompanying symptoms and medications taken. This makes medical assessment easier.
- Retreat to a quiet, darkened room: Many people find a low-stimulus environment soothing.
- Drink enough fluids: Dehydration can contribute to attacks.
- Maintain a regular daily routine: Sleep and meals at consistent times can have a stabilising effect.
- Act early: Start acute medication as soon as the pain phase begins.
When medical advice is particularly important
Seek medical help promptly if:
- the attacks become more frequent or more severe,
- acute medications are needed on more than ten days per month,
- the headache occurs suddenly, with unusual severity, or differs from your usual pattern,
- neurological symptoms such as paralysis, speech or visual disturbances appear for the first time or in an unusual way,
- you are pregnant or planning a pregnancy.
Careful diagnostic assessment helps to distinguish migraine from other types of headache and to find the strategy that suits you best.
Conclusion
Acute migraine treatment is based on well-established drug groups such as NSAIDs and triptans, as well as on newer options such as gepants and ditans. Combined with antiemetics and non-pharmacological measures, symptoms can be significantly eased in many people affected. The choice of the right medication should always be guided by a doctor – particularly in order to keep an eye on interactions, pre-existing conditions and the risk of medication-overuse headache.
This article does not replace medical advice.