Acute medicines

Taken when a migraine attack occurs to treat the symptoms

What they are used for

Acute medicines for migraine are taken to stop or shorten the symptoms of a migraine attack. They are taken once an attack starts, not beforehand, and should have a quick effect on the migraine attack.

There are a range of different acute medicines that can be taken. They have different strengths and you should match the severity of symptoms of a migraine attack with the strength of the medicine. This should be discussed with your doctor.

Types of acute migraine medicine

The acute medicines that are recommended to treat migraine fall into three categories. Here is an overview of each category, and tables of the different types of drugs in these categories and how they are taken can be downloaded here (tables from current page).

Simple analgesics

This is medication that treats the pain of a migraine attack at the time they are taken and includes paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. It is medication that does not have opioids such a codeine in it. Painkillers that contain opioids are best avoided in migraine as benefits may be short-lived and they can be addictive.

Anti-emetics

This is medication that treats sickness (nausea and vomiting) that some people get with migraine attacks. They are also known as ‘anti-sickness’ medication.

During migraine attacks, gut absorption slows and medication absorption may be improved when taken with an anti-sickness medicine. Two anti-emetics, metoclopramide and domperidone, also help your body absorb the analgesics. Metoclopramide is associated with side effects (resulting in symptoms very like Parkinson’s disease, which is reversible) and should be avoided in children and young adults.

Anti-emetics should be taken before or at the same time as any analgesics you are taking for the migraine attack.

Triptans

This is medication that was designed to treat migraine attacks. They reduce the pain and sickness of a migraine attack at the time they are taken.

Triptans are very safe when used appropriately by the people for whom they are prescribed. You should take them at the start of the head pain. If a triptan works, but the pain comes back you can usually take a second dose within 24 hours.  As with all medication triptans can have side effects. Common side effects include nausea; jaw, neck or chest tightness, pressure or squeezing; rapid heart rate; fatigue; numbness or tingling (especially involving the face); or a burning sensation over the skin. If side effects are intolerable, or if their effects trouble you, you should always contact your doctor for review.

If the side effects are too much, or the triptan you’ve been prescribed doesn’t work you should ask your doctor to try a different one. Other triptans may be more effective and have fewer side effects. It’s usually suggested you try a triptan for three separate attacks before deciding whether it’s suitable. You could also try different formulations such as a nasal spray or a tablet that dissolves on the tongue.

People with coronary heart disease, cerebrovascular disease, peripheral vascular disease, uncontrolled hypertension, and acute vascular conditions should not take them.

Taking different acute migraine medicines together

It is possible to combine a triptan with a NSAID especially for people with longer lasting attacks or those in whom migraine attacks tend to recur.

Several combination medicines are available. The most commonly used contain aspirin or paracetamol combined with codeine, caffeine and/or an antiemetic. Paracetamol is generally not effective for migraine attacks but may be combined in some treatments to improve the effectiveness e.g. Migraleve, Migramax. However, it is best to avoid codeine and opiates in migraine treatment as their benefits can be short term, with dependency and medication overuse headache risks being high.

Taking acute migraine medicines

Frequent use of drugs particularly ergotamine, triptans, codeine, paracetamol, NSAIDs and caffeine can lead to in chronic daily headache and medication-overuse headache in patients with migraine.

If you are experiencing four or more migraine attacks per month you should consider the use of preventive treatment to avoid attacks. Use of acute treatment on more than eight days a month has been reported to result in worsening of migraine and a reduction of the effect of any preventive treatment until the frequent use is addressed. Thus, although the use of a preventive medication taken daily for your migraine disorder seems unnecessary for four days a month, with acute treatment alone, the frequency may worsen and your migraine may become less responsive to treatment.

Future treatments not yet available in the UK

Ditans and Gepants are new migraine treatments that are specifically designed to target the migraine process. They are expected in the near future and come with fewer side effects than other migraine medicines.

Ditans and gepants are medicines that can be taken acutely. They come as a tablet to be taken at the start of an attack to treat pain and associated migraine symptoms (e.g. pain, nausea, light/noise sensitivity).

  • The gepants (ubrogepant, rimegepant): Compared to a triptan, the proportion of people who will be pain free in two hours is smaller. However, gepants don’t have other effects affects that triptans do such as constricting blood vessels. They will be beneficial to the significant group of people who cannot take a triptan for those reasons.
  • Ditans (lasmiditan): Ditans are also migraine-specific and do not affect blood vessels. Possible side effects are dizziness and tiredness in about 15% of people.