Acute medicines for migraine

About acute medicines for migraine

Acute medicines for migraine are designed to stop or reduce symptoms of a migraine attack. These can include things like head pain, sickness and sensitivity to light and sounds.

It’s best to take acute medicines as soon as a migraine attack starts, when the head pain is still mild. For migraine with aura, take them as soon as the headache phase starts. If you only have aura and no head pain (‘silent migraine’), discuss this with your GP. Acute medicines don’t work for this type of migraine.

There are a range of different types of acute medicines that can help with migraine. These are listed below. Which ones you should take depend on several factors. These include:

• how severe your pain is
• what other symptoms you’re getting
• whether you have any other health conditions
• your own preference
• the type of treatments available in your area.

Simple painkillers (analgesics)

Simple painkillers for migraine include ibuprofen, aspirin and paracetamol. They can give effective pain relief for many people with migraine. Aspirin and ibuprofen may also help reduce associated symptoms of migraine. These include feeling or being sick and sensitivity to light and sound.

You can buy simple painkillers like these from a shop or pharmacy without a prescription. But it’s still important to check they are safe for you to take. Read the patient information leaflet and check with your pharmacist or GP if you’re not sure. It’s also worth checking with your pharmacist the correct dose to take for migraine. Your GP may be able to prescribe stronger painkillers for migraine if needed. These include naproxen and diclofenac.

How often can I take painkillers?

Taking painkillers for migraine too often and for too long can lead to your headaches getting worse. You may develop more frequent and more severe headaches. This is called medication overuse headache or rebound headache. Making sure you don’t regularly take acute medicines including painkillers on more than two days a week will reduce the risk of this happening. Talk to your GP if you need more advice.

What is the best painkiller for migraine?

Aspirin and ibuprofen are generally considered the most effective painkillers for migraine. But paracetamol can be a better option for some people. This can include:

• people with certain other health conditions, such as a stomach ulcer, severe heart or kidney failure, or high blood pressure
• pregnant or breastfeeding women
• children – paracetamol or ibuprofen are recommended for children, but not aspirin.

It’s best to avoid painkillers that contain opioids, such as codeine, for migraine. This is because they can be addictive. This can increase the chance of medication-overuse headache. They can also make any sickness you have worse.

Check with your pharmacist or GP if you’re not sure what painkiller is best for you.

Anti-sickness medicines (anti-emetics)

Anti-sickness medicines for migraine include metoclopramide, prochlorperazine and domperidone. These medicines can help with any sickness you may get with migraine attacks. They may also help any painkillers you’re taking work better. Prochlorperazine can also help with symptoms such as vertigo and dizziness.

During migraine attacks, absorption from your gut slows. This includes absorption of medicines you have taken by mouth. Anti-sickness medicine can help your body to absorb the painkillers. This may help with headache, even if you don’t get any sickness.

You have anti-sickness medication as a tablet or injection as soon as your migraine symptoms start.

How can I get anti-sickness medicine for migraine?

Anti-sickness medicines for migraine need to be prescribed by a GP or specialist. Metoclopramide is only licensed for adults. You should only take metoclopramide for short periods of time (up to five days). Long-term, frequent use is associated with side effects such as involuntary movements.

Prochlorperazine and domperidone can be prescribed for adults and children over 12. Some treatments designed for migraine include both a painkiller and an anti-sickness medication.

Triptans

Triptans are another type of migraine medicine that can be used to ease symptoms. The most common triptan is sumatriptan. Others include almotriptan, eletriptan, frovatriptan, naratriptan, rizatripan and zolmitriptan.

Your doctor may recommend you try a triptan if simple painkillers and anti-sickness treatments haven’t helped. They may also prescribe a triptan in combination with these other medicines.

You can try different types of triptan if one doesn’t work or it gives you side effects. Most triptans are tablets that you swallow. Some are available as:

• a wafer that melts on the tongue
• a nasal spray
• an injection under the skin.

These formulations can work faster than tablets that you swallow. They may also be a better option if sickness is a problem, making it harder to keep tablets down.

As with simple painkillers, taking triptans too often can lead to medication overuse headache. Making sure you are not regularly taking them on more than two days a week can reduce the risk of this.

You can’t take triptans if you have certain health conditions. These include heart disease and stroke.

We have more detailed information on triptans.

Gepants

These are a type of medicine designed to help treat and prevent migraine. They are also known as calcitonin gene-related peptide (CGRP) receptor antagonists. There is currently one gepant that is available on the NHS in the UK as an acute treatment for migraine. This is called rimegepant (Vydura).

Gepants can be a good option for people who can’t take triptans, don’t tolerate them, or for whom triptans don’t work. They don’t seem to cause medication overuse headache, like triptans and painkillers can.

Your GP may be able to prescribe rimegepant for the acute treatment of migraine. But local guidelines may prevent this in some areas.

We have more detailed information on gepants.

What to do if acute migraine medicines don’t help

Talk to your GP if:

• you are not getting enough relief from your acute migraine medicines
• you are regularly needing to take acute medicines on more than two days every week
• your headaches are getting more frequent or severe
• you are getting side effects from your medicines.

Taking painkillers and triptans too frequently can increase the risk of medication overuse headache. Read our information on medication overuse headache to find out more.

It’s useful to keep a headache diary to show how many headaches you are getting, and what medication you are taking.

Your doctor may be able to increase the dose of your medication, or try a different one. Medicines work differently for different people, and it can take time to find one that suits you. There are also medical devices you can try that can help with acute treatment of migraine.

When to start preventive treatment

If you are needing to take lots of acute medicines, or they’re not helping, your doctor may suggest preventive treatment. Preventive medicines for migraine aim to reduce the number of migraine attacks you get and how severe they are.

Last reviewed: December 2024

Next review due: December 2027

Reviewed by: The Migraine Trust Information and Support Services team and reviewer panel

If you have feedback on our information, please get in touch at: feedback@migrainetrust.org

References for our information are available on request.