Two Pillars of Migraine Care
Managing migraines effectively typically involves two complementary strategies: acute (abortive) treatment and preventive (prophylactic) treatment. Understanding the difference — and knowing when each is appropriate — is fundamental to building a successful migraine management plan with your doctor.
Acute Treatment: Stopping an Attack
Acute migraine treatments are taken at the onset of a migraine attack with the goal of stopping it as quickly as possible or reducing its severity. These medications are not taken daily; they are used on-demand.
Common Acute Migraine Medications
- Triptans (sumatriptan, rizatriptan, etc.) — targeted serotonin receptor agonists
- NSAIDs (ibuprofen, naproxen) — anti-inflammatory pain relievers
- Gepants (ubrogepant/Ubrelvy, rimegepant/Nurtec) — newer CGRP receptor antagonists
- Ditans (lasmiditan/Reyvow) — selective 5-HT1F receptor agonists
- Ergotamines (dihydroergotamine) — older vasoconstrictors, less commonly used
- Anti-nausea medications (metoclopramide, prochlorperazine) — often used alongside pain treatments
When Acute Treatment Works Best
Acute treatments work best when taken early in an attack. Waiting until pain becomes severe significantly reduces their effectiveness. It's important to avoid overusing any acute medication, as taking it more than 10–15 days per month can lead to medication overuse headache (MOH), also known as rebound headache.
Preventive Treatment: Reducing Attack Frequency
Preventive treatments are taken daily, regardless of whether a migraine is occurring. The goal is to reduce the frequency, duration, and severity of migraine attacks over time.
Who Should Consider Preventive Therapy?
Preventive treatment is generally recommended if you experience:
- Four or more migraine days per month
- Migraines that significantly disrupt daily life despite acute treatment
- Frequent use of acute medications (risk of MOH)
- Migraines with prolonged or uncomfortable aura
Common Preventive Migraine Medications
| Drug Class | Examples | Notes |
|---|---|---|
| Beta-blockers | Propranolol, metoprolol | First-line; also treats blood pressure |
| Antidepressants | Amitriptyline, venlafaxine | Effective, especially with comorbid depression |
| Anticonvulsants | Topiramate, valproate | FDA-approved for migraine prevention |
| CGRP Monoclonal Antibodies | Aimovig, Ajovy, Emgality | Newer injectable monthly treatments |
| Botox (OnabotulinumtoxinA) | Botox injections | FDA-approved for chronic migraine |
Combining Both Approaches
Many migraine patients benefit from using both a preventive medication and an acute medication. Preventive therapy can lower the number of attacks, while a reliable acute treatment ensures you have a way to address breakthrough migraines when they do occur.
Talking to Your Doctor
The right treatment plan depends on your migraine frequency, overall health, other medications you take, and personal preferences. Keep a migraine diary to track frequency, severity, and potential triggers — this information is invaluable when your doctor tailors a treatment approach for you.
Always work with a qualified healthcare provider before starting, changing, or stopping any migraine medication.