Diagnosis
If you have migraines or a family history of migraines, a doctor trained in treating headaches (neurologist) will likely diagnose migraines based on your medical history, symptoms, and a physical and neurological examination.
If your condition is unusual, complex or suddenly becomes severe, tests to rule out other causes for your pain might include:
- MRI. An MRI scan uses a powerful magnetic field and radio waves to produce detailed images of the brain and blood vessels. MRI scans help doctors diagnose tumors, strokes, bleeding in the brain, infections, and other brain and nervous system (neurological) conditions.
- CT scan. A CT scan uses a series of X-rays to create detailed cross-sectional images of the brain. This helps doctors diagnose tumors, infections, brain damage, bleeding in the brain and other possible medical problems that may be causing headaches.
Treatment
Migraine treatment is aimed at stopping symptoms and preventing future attacks.
Many medications have been designed to treat migraines. Medications used to combat migraines fall into two broad categories:
- Pain-relieving medications. Also known as acute or abortive treatment, these types of drugs are taken during migraine attacks and are designed to stop symptoms.
- Preventive medications. These types of drugs are taken regularly, often daily, to reduce the severity or frequency of migraines.
Your treatment choices depend on the frequency and severity of your headaches, whether you have nausea and vomiting with your headaches, how disabling your headaches are, and other medical conditions you have.
Medications for relief
Medications used to relieve migraine pain work best when taken at the first sign of an oncoming migraine — as soon as signs and symptoms of a migraine begin. Medications that can be used to treat it include:
- Pain relievers. These over-the-counter or prescription pain relievers include aspirin or ibuprofen (Advil, Motrin IB, others). When taken too long, these might cause medication-overuse headaches, and possibly ulcers and bleeding in the gastrointestinal tract.Migraine relief medications that combine caffeine, aspirin and acetaminophen (Excedrin Migraine) may be helpful, but usually only against mild migraine pain.
- Triptans. These are prescription drugs such as sumatriptan (Imitrex, Tosymra) and rizatriptan (Maxalt) are prescription drugs used for migraine because they block pain pathways in the brain. Taken as pills, shots or nasal sprays, they can relieve many symptoms of migraine. They might not be safe for those at risk of a stroke or heart attack.
- Dihydroergotamines (D.H.E. 45, Migranal). Available as a nasal spray or injection, these are most effective when taken shortly after the start of migraine symptoms for migraines that tend to last longer than 24 hours. Side effects can include worsening of migraine-related vomiting and nausea.People with coronary artery disease, high blood pressure, or kidney or liver disease should avoid dihydrogergotamines.
- Opioid medications. People who have migraines who can’t take other migraine medications, narcotic opioid medications, especially those that contain codeine, might help. Because they can be highly addictive, these are usually used only if no other treatments are effective.
- Anti-nausea drugs. These can help if your migraine with aura is accompanied by nausea and vomiting. Anti-nausea drugs include chlorpromazine, metoclopramide (Reglan) or prochlorperazine (Compro). These are usually taken with pain medications.
Preventive medications
Medications can help prevent frequent migraines. Your doctor might recommend preventive medications if you have frequent, long-lasting or severe headaches that don’t respond well to treatment.
Preventive medication is aimed at reducing how often you get a migraine how severe the attacks are and how long they last. Options include:
- Blood pressure-lowering medications. These include beta blockers such as propranolol (Inderal, Innopran XL, others) and metoprolol tartrate (Lopressor). Calcium channel blockers such as verapamil (Calan, Verelan, others) can be helpful in preventing migraines with aura.
- Antidepressants., A tricyclic antidepressant (amitriptyline), can prevent migraines. Because of the side effects of amitriptyline, such as sleepiness and weight gain, other antidepressants might be prescribed instead.
- Anti-seizure drugs. Valproate (Depacon) and topiramate (Topamax) might help you have less frequent migraines, but can cause side effects such as dizziness, weight changes, nausea and more.
- Botox injections. Injections of onabotulinumtoxinA (Botox) about every 12 weeks help prevent migraines in some adults.
- Calcitonin gene-related peptide (CGRP) monoclonal antibodies. Erenumab-aooe (Aimovig), fremanezumab-vfrm (Ajovy) and galcanezumab-gnlm (Emgality) are newer drugs approved by the Food and Drug Administration to treat migraines. They’re given monthly by injection. The most common side effect is a reaction at the injection site.
