By foggy.brain 
Top Migraine Treatment Options: Lifestyle Changes, Acute, and more! I will say the options have a big caveat, as everyone’s environment and health is very different. While everyone will experience a different outcome, there are many options to try and find the ones that make a difference to your condition. My preferred approach to treat my condition was making lifestyle changes and manage the triggers associated to my condition.
Acute Treatments
These treatments could be called “Attack treatments”. Acute Treatments are used to relieve the symptoms of a migraine attack, to provide quick relief. Most importantly these treatments should be used when a migraine attack is experienced or better yet at first sign of symptoms. This can help to increase the effectiveness of the treatment and may reduce the duration and severity of the migraine.
Options available are:
| Generic | Brand | |
| Analgesics | Acetaminophen | Tylenol |
| Anti-inflammatories | Aspirin Diclofenac Ibuprofen Ketorolac Mefenamic acid Nabumetone Naproxen | Aspirin Cambia, Voltaren Advil, Motrin Toradol Ponstan No brand anymore Aleve, Anaprox |
| Triptans | Almotriptan Eletriptan Frovatriptan Naratriptan Rizatriptan Sumatriptan Zolmitriptan | Axert Relpax Frova Amerge Maxalt Imitrex Zomig |
| Ergot derivatives | Dihydroergotamine Ergotamine | DHE, Migranal Cafergot (rare) |
| Anti-emetics | Dimenhydrinate Chlorpromazine Prochlorperazine Metoclopramide Odansetron | Gravol Largactil Stémétil Maxeran, Metonia Zofran |
| Others | Essential oils Mint gels and rollers | |
| Combined analgesics *** DANGER of chronification | Acetaminophen or aspirin combined with caffeine, barbiturates or codeine and oxycodone | Fiorinal Tylenol 1,2,3,4 Anacin Oxycocet Percocet Tramacet |
| Opioids Short acting Long acting *** DANGER of chronification and side effects | Buprenorphine Codeine Fentanyl Hydromorphone Morphine Tramadol Oxycodone | Butrans Emtec Dilaudid Statex Zytram Supeudol |
| Ditans | Lasmiditan | NOT AVAILABLE YET IN CANADA |
| Gepants | Rimegepant Ubrogepant | NOT AVAILABLE YET IN CANADA |
Preventive Treatments
Preventive treatments for migraines are medications or lifestyle changes that are used to reduce the frequency and severity of migraine attacks. These treatments are intended to be taken on a regular basis, often daily, to prevent or decrease the occurrence of migraines.
There are several types of preventive treatments available for migraines. These may include:
| Generic | Brand | |
| Anti-hypertensive | Amlodipine Candesartan Nadolol Propranolol Verapamil | Norvasc Atacand Corgard Inderal Isoptin |
| Anti-seizure | Gabapentin Topiramate Pregabalin Valproic acid | Neurontin Topamax Lyrica Epival |
| Anti-depressants | Amitriptyline Nortriptyline Venlafaxine | Elavil Aventyl Effexor |
| Botox ** Chronic migraine only | Botulinum toxin | Botox |
| CGRP antibodies | Erenumab Fremanezumab Galcanezumab | Aimovig Ajovy (NOT AVAILABLE YET) Emgality |
| Supplements | Coenzyme Q10 Magnesium Vitamin B2 (Butterbur or Petadolex at risk for liver toxicity) | Different brands and combinations |
| Others (NOT first line therapy but can be used in selected patients) | Acetazolamide Flunarizine Lamotrigine Memantine Pizotifen Tizanidine | Diamox Sibelium Lamictal Namenda Sandomigran Zanaflex |
| Cannabinoids (NOT supported by research yet) | Synthetic From the plant:Inhaled, edibles, oils, tinctures | Cesamet Many |
Procedures, Devices and Injections
| Target Procedure | Comment | |
| Nerve blocks | Auriculotemporal Greater occipital Lesser occipital Supra-orbital Supra trochlear | Can be done in the clinic by a trained physician |
| Needling techniques | Acupuncture Dry needling Trigger point injections | Can be done by physiotherapists, acupuncture specialists, physicians |
| Facet blocks | Cervical Lumbar | Done with X-ray supervision by specialists |
| Sphenopalatine Ganglion blocks | Usually done by ENT doctors Some devices used by other physicians | |
| Median branch block | C2-C3 and other levels in the neck | Done with X-ray supervision by specialists |
| Glasses | FL41 tint | Theraspecs Axon Optics |
| Cold / heat application | Different ways to apply cold and hot | Migraine Hat |
| Neuromodulation | Transcutaneous Transcranial magnetic Vagus nerve Peripheral stim | Cefaly eNEURA (NOT YET) Gamma Core |
| Daith Piercing *** NO evidence |
Lifestyle Changes
This is the area that I have and will focus the most on my Blog. You will find lots of resources and material which includes my personal experience for your benefit. As I have noted before there are many different circumstances and everyone experience and situation is different. Making lifestyle changes can possibly allow you to have a migraine free life. Or could help reduce the frequency and severity of migraine attacks.
| Basic | Advanced | |
| Information | Learn about migraine. The more you know, the better you can self-manage. Knowledge is power. | Some situations are complex and information found online may not answer all your questions. |
| Migraine Tracker | Paper and app versions. Use either and bring to appointments | Diaries can be very detailed but more details can make the analysis difficult. |
| Trigger management | Identification Management when possible | Try an App like Curelator for a detailed trigger analysis Avoid obsession and anxiety |
| Diet | Avoid demonstrated food triggers Drink 2-3 liters of water daily Avoid skipping meals Avoid high sugar loads Eat more protein | See a nutritionist to try more restrictive diets like ketogenic, elimination, FODMAP etc |
| Sleep | Sleep hygiene and routine Avoid sleep medications, or use sparingly. Include supplements instead. | Cognitive Behavioral Therapy Sleep Clinic Detect and treat sleep apnea |
| Pacing | Setup reasonable expectations Time management and planning Learn to saying no, and or delegate | Occupational therapy Psychotherapy Professional coaching |
| Relaxation techniques | Breathing exercises Progressive Muscle Relaxation Yin Yoga | Mindfulness program Biofeedback with a therapist Psychotherapy |
| Exercise | Regular gentle exercise: walk, stationary bike, stretching, Adapt to capacity | Kinesiology and physiotherapy to find adapted exercises or increase performance |
| Posture | Desktop adaptation Pillows Supported bed position | Occupational therapy Physiotherapy |
| Use medications optimally | Basic use of acute and preventive medications | Use of injections at home Special combinations for severe attacks Combination of multiple preventives |
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