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Directrices de Tratamiento
Este resumen de las directrices de tratamiento fue creado por la Cumbre Mundial de la Migraña basado en directrices oficiales publicadas por las principales sociedades médicas, incluidas la American Headache Society (AHS), la American Academy of Neurology (AAN), la European Headache Foundation (EHF) y el US Headache Consortium. Estas directrices también han sido interpretadas en revistas médicas como Headache: The Journal of Headache and Facial Pain y el European Journal of Headache.
Las dosis específicas generalmente no se proporcionan, ya que varían según el país y pueden ser altamente individualizables. Consulta con tu profesional de atención médica para determinar el medicamento y la dosis adecuadas para ti. Si un determinado tratamiento no está disponible en tu país, consulta con tu profesional de atención médica para obtener medicamentos similares. Las Directrices de la Cumbre se publican anualmente en marzo y pueden quedar desactualizadas durante el año. Este resumen no ha sido revisado por ninguna sociedad médica ni profesional de la salud, y no constituye un consejo médico.
Las evaluaciones de tratamiento para la migraña comúnmente emplean una escala para evaluar tanto la cantidad como la calidad de la evidencia que respalda la eficacia de un tratamiento específico. Esta escala tiene en cuenta varios tipos de estudios realizados para cada tratamiento, que van desde ensayos clínicos sólidos hasta aquellos con menor rigor científico. Los estudios se categorizan en diferentes clases según las designaciones de la Academia Americana de Neurología, siendo la Clase I la que representa investigaciones más rigurosas en comparación con la Clase III. La calidad general de la evidencia para un tratamiento se determina por la prevalencia de estudios de Clase I que demuestran una fuerte efectividad. En esencia, un mayor número de estudios de Clase I contribuye a un nivel de evidencia más alto para ese tratamiento en particular. Los estudios se califican, resumen y se colocan en los siguientes “Niveles:”
Esta sección se centra en los tratamientos preventivos para adultos con migraña, generalmente disponibles con receta médica, para su uso en casa. Otros preventivos pueden estar disponibles para su compra o visitando a un profesional de la salud. La clasificación puede variar según el país.
En 2024, la American Headache Society (AHS) publicó una Declaración de Posición de Consenso reconociendo el impacto transformador de las terapias preventivas de la migraña que se dirigen al CGRP. Estas terapias, que incluyen anticuerpos monoclonales y gepantes,
han demostrado una eficacia, tolerabilidad y seguridad sustanciales en numerosos estudios clínicos y experiencias del mundo real. Superan a los tratamientos de primera línea anteriores en evidencia y efectividad. Como tal, la AHS aboga por la consideración de las terapias dirigidas al CGRP como opciones de primera línea para la prevención de la migraña, eliminando el requisito de prueba y fracaso previo de medicamentos no específicos. Los medicamentos que son terapias preventivas específicas para la migraña se señalan como tales en la sección farmacológica del Directorio de Tratamientos.
Las siguientes clasificaciones se derivan de la Guía de Declaración de Consenso de la AHS de 2021 sobre tratamientos preventivos para la migraña. Si bien reconocemos que la Declaración de Posición de Consenso de 2024 puede introducir revisiones a estas directrices, cualquier terapia farmacológica mencionada en la declaración de 2024 se incorpora en la sección subsecuente.
Nivel A: Establecido como efectivo
Estos tratamientos pueden ser ofrecidos por tu proveedor de atención médica si necesitas prevención de migrañas
Nivel B: Probablemente efectivo
Estos tratamientos pueden ser considerados por tu proveedor de atención médica si necesitas prevención de migrañas
Notas sobre terapias conductuales y con dispositivos
Estas terapias bioconductuales tienen evidencia de Grado A que respalda su uso según el documento de Consenso de la AHS de 2021:
Estas terapias bioconductuales tienen evidencia creciente para su uso en migraña:
Cinco dispositivos de neuromodulación han sido aprobados o autorizados por la FDA:
Notas:
En 2021, la AHS actualizó su guía sobre el uso de tratamientos para la migraña. Esta sección se centra en los tratamientos agudos para adultos con migraña, generalmente disponibles con receta médica para uso en casa. La clasificación puede variar según el país.
Nivel A: Establecido como efectivo
Específicos para la migraña
Nota: Las Directrices de la AHS recomiendan considerar dispositivos neuromoduladores en pacientes que prefieren tratamientos no farmacológicos o en quienes el tratamiento farmacológico es ineficaz, intolerable o está contraindicado.
No específicos
Nivel B: Probablemente efectivo
Específicos para la migraña
No específicos
Antieméticos no específicos
En 2013, la AAN y la AHS actualizaron las directrices sobre el tratamiento para la prevención de la migraña episódica. Los siguientes tratamientos son apropiados para la prevención a corto plazo de la migraña asociada con la menstruación.
Nivel A: Establecido como efectivo
Nota: Se utilizó una dosis de carga en la que se administra una dosis inicial más alta al comienzo del tratamiento antes de reducirla a una dosis de mantenimiento.
Nivel B: Probablemente efectivo
Nivel C: Posiblemente efectivo
En 2019, la AAN y la AHS actualizaron las directrices de práctica para el tratamiento agudo de la migraña en niños y adolescentes. Evaluaron la eficacia de los tratamientos agudos en comparación con el placebo (es decir, un tratamiento que no contiene medicación activa):
Sin dolor de cabeza a las 2 horas
Alta confianza (más probable que el placebo)
Confianza moderada (seguramente más probable que el placebo)
Baja confianza (seguramente más probable que el placebo)
Baja confianza (posiblemente no más probable que el placebo)
Muy baja confianza (evidencia insuficiente)
Alivio de náuseas a las 2 horas
Confianza moderada (seguramente no más probable que el placebo)
Baja confianza (posiblemente no más probable que el placebo)
Muy baja confianza (evidencia insuficiente)
En 2016, la AHS evaluó los tratamientos para la migraña aguda en el entorno de la sala de emergencias y los clasificó por niveles de eficacia:
Nivel B (debería ofrecerse)
Nivel C (puede ofrecerse)
Nivel U (sin recomendación)
Ailani, J., Burch, R. C., & Robbins, M. S. (2021). The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache: The Journal of Head and Face Pain, 61(7), 1021–1039. https://doi.org/10.1111/head.14153
Charles, A. C., Digre, K. B., Goadsby, P. J., Robbins, M. S., & Hershey, A. (2024, March 11). Calcitonin gene‐related peptide‐targeting therapies are a first‐line option for the prevention of migraine: An American Headache Society position statement update. Headache: The Journal of Head and Face Pain. https://doi.org/10.1111/head.14692
Evers, S., Áfra, J., Frese, A., Goadsby, P. J., Linde, M., May, A., & Sándor, P. S. (2009). EFNS guideline on the drug treatment of migraine – revised report of an EFNS task force. European Journal of Neurology, 16(9), 968–981. https://doi.org/10.1111/j.1468-1331.2009.02748.x
Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. (2013). Neurology, 80(9), 871–871. https://doi.org/10.1212/wnl.0b013e318287dc4e
Orr, S. L., Friedman, B. W., Christie, S., Minen, M. T., Bamford, C., Kelley, N. E., & Tepper, D. (2016). Management of Adults With Acute Migraine in the Emergency Department: The American Headache Society Evidence Assessment of Parenteral Pharmacotherapies. Headache: The Journal of Head and Face Pain, 56(6), 911–940. https://doi.org/10.1111/head.12835
Oskoui, M., Pringsheim, T., Holler-Managan, Y., Potrebic, S., Billinghurst, L., Gloss, D., Hershey, A. D., Licking, N., Sowell, M., Victorio, M. C., Gersz, E. M., Leininger, E., Zanitsch, H., Yonker, M., & Mack, K. (2019). Practice guideline update summary: Acute treatment of migraine in children and adolescents. Neurology, 93(11), 487–499. https://doi.org/10.1212/wnl.0000000000008095
Silberstein, S. D., Holland, S., Freitag, F., Dodick, D. W., Argoff, C., & Ashman, E. (2012). Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults: Table 1. Neurology, 78(17), 1337–1345. https://doi.org/10.1212/wnl.0b013e3182535d20
The table below summarizes significant medical treatments newly available in various regions since 2017. These include preventive and acute therapies approved for the treatment of migraine or certain types of headaches by the regulatory authority of at least one of these regions. Please consult the complete Treatment Directory for additional information.
| NEW MEDICAL TREATMENTS (as of March 2023) | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Anti-CGRPs | Brand Name | Class | USA | AUS | CAN | ENG | IRE | ESP | ARG | CHI | MEX | |||
| Eptinezumab | Vyepti | CGRP monoclonal antibody | Preventive | Preventive | Preventive | Preventive | N/A | Preventivo | N/A | N/A | Preventivo | |||
| Erenumab | Aimovig | CGRP monoclonal antibody | Preventive | Preventive | Preventive | Preventive | Preventive | Preventivo | Preventivo | Preventivo | Preventivo | |||
| Fremanezumab | Ajovy | CGRP monoclonal antibody | Preventive | Preventive | Preventive | Preventive | Preventive | Preventivo | Preventivo | Preventivo | N/A | |||
| Galcanezumab | Emgality | CGRP monoclonal antibody | Preventive | Preventive | Preventive | Preventive | Preventive | Preventivo | N/A | N/A | Preventivo | |||
| Ditans | Brand Name | Class | USA | AUS | CAN | ENG | IRE | ESP | ARG | CHI | MEX | |||
| Lasmiditan | Reyvow | 5-HTIF receptor agonist | Acute | N/A | N/A | N/A | N/A | Agudo | N/A | N/A | Agudo | |||
| Ergot alkaloid-derivatives | Brand Name | Class | USA | AUS | CAN | ENG | IRE | ESP | ARG | CHI | MEX | |||
| Dihydroergotamine mesylate (DHE) | Trudhesa | Ergot alkaloid-derivative | Acute | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||
| Gepants | Brand Name | Class | USA | AUS | CAN | ENG | IRE | ESP | ARG | CHI | MEX | |||
| Atogepant | Qulipta | CGRP receptor antagonist | Preventive | N/A | Preventive | N/A | N/A | Preventivo | N/A | N/A | Preventivo | |||
| Rimegepant | Vydura, Nurtec ODT | CGRP receptor antagonist | Both | N/A | N/A | N/A | N/A | Ambos | Ambos | Ambos | Ambos | |||
| Ubrogepant | Ubrelvy | CGRP receptor antagonist | Acute | N/A | Acute | N/A | N/A | N/A | N/A | N/A | N/A | |||
| Zavegepant | Zavzpret | CGRP receptor antagonist | Acute | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||
| Neuromodulation Devices | Brand Name | Class | USA | AUS | CAN | ENG | IRE | ESP | ARG | CHI | MEX | |||
| External combined occipital and trigeminal neurostimulation | Relivion MG | Neuromodulation | Acute | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||
| Remote wearable neuromodulation (REN) | Nerivio | Neuromodulation | Both | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||
| Supraorbital TNS unit or external | Cefaly | Neuromodulation | Both | Both | Both | Both | Both | N/A | Ambos | N/A | N/A | |||
| Transcranial magnetic stimulation (TMS) device | SAVI Dual | Neuromodulation | Both | N/A | N/A | Both | N/A | N/A | N/A | N/A | N/A | |||
| Vagus nerve stimulation (VNS) | gammaCore | Neuromodulation device | Both | Both | Both | Both (cluster) | Both (cluster) | N/A | N/A | N/A | N/A | |||
| Nonsteroidal Anti-inflammatory Drug | Brand Name | Class | USA | AUS | CAN | ENG | IRE | ESP | ARG | CHI | MEX | |||
| Celecoxib liquid | Elyxyb | NSAID | Acute | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||
| Triptans | Brand Name | Class | USA | AUS | CAN | ENG | IRE | ESP | ARG | CHI | MEX | |||
| Sumatriptan (as nasal spray) | Tosymra | Serotonin 5-HTI agonist | Acute | N/A | N/A | N/A | N/A | Agudo | N/A | N/A | Agudo | |||
| Benzoato de rizatriptán (como película oral) | RizaPelícula, Maxalt Max | Agonista 5-HTI de la serotonina | Agudo | N/A | N/A | Agudo | ||||||||
© Copyright 2024 Migraine World Summit. All Rights Reserved. Consult your healthcare provider for personal medical advice or more information.
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Migraine World Summit Editorial Team
Welcome to the Migraine World Summit (MWS) Quarterly Research Report. The Quarterly Research Report highlights recent research publications related to migraine and headache.
We hope you find the MWS Quarterly Research Report a helpful way to discover some of the latest findings related to migraine and headache from published research papers.
Each individual report is intentionally brief in order to provide a quick overview. The goal is to give you an idea of current research and to share some insights that may improve your understanding of migraine.
Consult your headache specialist or primary care physician to discuss how any of the research findings might apply to you.
Some medical publications don’t provide free online access. In some cases, your health care professional may be able to print a copy for you.
Please note that our volunteer support team members are patients themselves and are not able to reply to questions about the research or comment on these medical studies.
Authors highlighted in bold are those who have spoken at the Migraine World Summit.
Quotes are taken directly from the research paper.
We welcome your feedback on this new report. Please share via email to info@migraineworldsummit.com.
The views reflected in this research report do not represent the views of the Migraine World Summit. This report is not designed to replace a consultation with your doctor. Seek medical advice before making any changes to your treatment plan.
The table below summarizes significant medical treatments newly available in various regions since 2017. These include preventive and acute therapies approved for the treatment of migraine or certain types of headaches by the regulatory authority of at least one of these regions. Please consult the complete Treatment Directory for additional information.
| NEW MEDICAL TREATMENTS (as of March 2023) | |||||||
|---|---|---|---|---|---|---|---|
| Anti-CGRPs | Brand Name | Class | USA | AUS | CAN | ENG | IRE |
| Eptinezumab | Vyepti | CGRP monoclonal antibody | Preventive | Preventive | Preventive | Preventive | N/A |
| Erenumab | Aimovig | CGRP monoclonal antibody | Preventive | Preventive | Preventive | Preventive | Preventive |
| Fremanezumab | Ajovy | CGRP monoclonal antibody | Preventive | Preventive | Preventive | Preventive | Preventive |
| Galcanezumab | Emgality | CGRP monoclonal antibody | Preventive | Preventive | Preventive | Preventive | Preventive |
| Ditans | Brand Name | Class | USA | AUS | CAN | ENG | IRE |
| Lasmiditan | Reyvow | 5-HTIF receptor agonist | Acute | N/A | N/A | N/A | N/A |
| Ergot alkaloid-derivatives | Brand Name | Class | USA | AUS | CAN | ENG | IRE |
| Dihydroergotamine mesylate (DHE) | Trudhesa | Ergot alkaloid-derivative | Acute | N/A | N/A | N/A | N/A |
| Gepants | Brand Name | Class | USA | AUS | CAN | ENG | IRE |
| Atogepant | Qulipta | CGRP receptor antagonist | Preventive | N/A | Preventive | N/A | N/A |
| Rimegepant | Nurtec ODT | CGRP receptor antagonist | Both | N/A | N/A | N/A | N/A |
| Ubrogepant | Ubrelvy | CGRP receptor antagonist | Acute | N/A | Acute | N/A | N/A |
| Zavegepant | Zavzpret | CGRP receptor antagonist | Acute | N/A | N/A | N/A | N/A |
| Neuromodulation Devices | Brand Name | Class | USA | AUS | CAN | ENG | IRE |
| External combined occipital and trigeminal neurostimulation | Relivion MG | Neuromodulation | Acute | N/A | N/A | N/A | N/A |
| Remote wearable neuromodulation (REN) | Nerivio | Neuromodulation | Both | N/A | N/A | N/A | N/A |
| Supraorbital TNS unit or external | Cefaly | Neuromodulation | Both | Both | Both | Both | Both |
| Transcranial magnetic stimulation (TMS) device | SAVI Dual | Neuromodulation | Both | N/A | N/A | Both | N/A |
| Vagus nerve stimulation (VNS) | gammaCore | Neuromodulation device | Both | Both | Both | Both (cluster) | Both (cluster) |
| Nonsteroidal Anti-inflammatory Drug | Brand Name | Class | USA | AUS | CAN | ENG | IRE |
| Celecoxib liquid | Elyxyb | NSAID | Acute | N/A | N/A | N/A | N/A |
| Triptans | Brand Name | Class | USA | AUS | CAN | ENG | IRE |
| Sumatriptan (as nasal spray) | Tosymra | Serotonin 5-HTI agonist | Acute | N/A | N/A | N/A | N/A |
© Copyright 2023 Migraine World Summit. All Rights Reserved. Consult your healthcare provider for personal medical advice or more information.
Treatments are listed in alphabetical order.
Search any term by using the search field. Sort on any column. Show more rows by increasing the display number.
| Complementary & Nonmedical Treatment | Treatment Type | Cost | Format | Description |
|---|---|---|---|---|
| 5-HTP (5 Hydroxytryptophan) | Preventive | Paid | Vitamin/Supplement | 5-HTP is a nonessential amino acid that contributes to increased production of serotonin, melatonin, dopamine, norepinephrine, and beta-endorphins, which all play a role in sleep, mood and pain regulation. People with migraine may have low serotonin levels. 5-HTP is directly converted to serotonin in nerve cells and the liver before it can reach the brain. Several publications have raised concern of a significant risk of heart valve disease from high levels of serotonin in the blood because of its direct effect on the heart. The supplement 5-HTP is made from a natural plant source (Griffonia simplicifolia). |
| Acceptance and Commitment Therapy (ACT) | Preventive | Paid | Behavioral therapy | Acceptance and Commitment Therapy (ACT) is a form of mindfulness-based therapy theorizing that greater well-being can be attained by accepting the difficulties that come with life, and by overcoming negative thoughts and feelings. |
| Acupressure | Acute & Preventive | Paid | Physical therapy | Acupressure has been practiced in Asia for thousands of years. By learning how to stimulate pressure points, you may be able to relieve minor or moderate symptoms of migraine head pain and gastrointestinal distress. Acupressure can be self-administered to specific pressure points using a deep, probing pressure with fingertip, knuckle or soft, pointed object, such as a pencil eraser. If you have not found relief after the first point, try the same points on the opposite side of the body. |
| Acupressure bracelets | Acute & Preventive | Paid | Product/Device | Bands that apply pressure on the meridian point on the inside of the wrist that is said to be associated with nausea and motion sickness. Some studies suggest there is a therapeutic benefit to magnets in alleviating pain or other health concerns. Common types include magnetic bands and Sea-Bands. |
| Acupuncture | Preventive | Paid | Lifestyle | A Traditional Chinese Medicine technique that involves the insertion of very fine, solid needles into certain points of the body. According to Traditional Chinese Medicine, acupuncture helps headaches by encouraging the production of the body’s natural painkillers called endorphins. |
| Advocacy | Preventive | Free | Lifestyle | Advocacy is the public support of a particular cause. An example of advocacy would be supporting greater funding of migraine research, which would benefit the migraine community as a whole. |
| Alexander Technique | Preventive | Paid | Physical therapy | The Alexander Technique is a system designed to retrain poor posture to ensure minimum effort and strain on the body. This can help prevent headaches that result from poor posture. |
| Altruism | Preventive | Free | Lifestyle | Altruism, or the principle and practice of concerning oneself with the well-being of others, activates the reward center in the brain. Volunteering, donating to charity, or even reaching out to help a friend in need can have the added benefit of boosting your own health, happiness, and sense of purpose. |
| Applied Kinesiology (AK) | Preventive | Paid | Physical therapy | Kinesiology is the study of body movement. Applied Kinesiology (AK) is a system using basic muscle testing to evaluate areas of dysfunction within the body. AK methodology is primarily concerned with neuromuscular function and how it relates to the regulation of structural, chemical and mental physiology. It uses the principle that the body is a self-maintaining, self-correcting mechanism. |
| Aromatherapy | Acute & Preventive | Paid | Product/Device | Aromatherapy uses plant materials and aromatic plant oils to help alter one’s mood, cognitive, psychological or physical well-being. Blends of plant oils, essential oils and other aromatic compounds are often utilized through topical application, massage inhalation, or water immersion to stimulate a desired response. Aromatherapy oils often for migraine include lavendar oil, peppermint oil, and Damascus rose oil. |
| Ashwaghandha | Preventive | Paid | Vitamin/supplement | Ashwagandha, also known as Indian ginseng or withania somnifera, is an herb used in traditional Indian medicine (i.e., Ayurveda). It is most often used to relieve stress and anxiety but may be used to treat other conditions or symptoms, such as migraine, epilepsy, joint pain, and diabetes. Ashwagandha comes in various forms, including pills, liquids, and powders. |
| Avoid bright screens | Acute & Preventive | Free | Lifestyle | Bright screens such as TVs, computer screens, phones, and other LED screens emit a particular spectrum of light that people with migraine may be sensitive to. Avoiding bright screens can be a way to reduce this visual trigger for those who are sensitive to bright lights. Wearing special blue-light blocking glasses can help reduce digital eye strain and fatigue when staring at computer and TV screens for prolonged periods of time. |
| Avoid fluorescent lighting | Acute & Preventive | Free | Lifestyle | Fluorescent lights emit a particular spectrum of light. People with migraine may be sensitive to the spectrum of light emitted by fluorescent lights. |
| Avoid loud, sustained noise | Acute & Preventive | Free | Lifestyle | Loud noise, constant noise, piercing, or ringing sounds are migraine triggers for some, and may worsen a person’s migraine condition for those who are vulnerable. |
| Avoid odors/smoke | Acute & Preventive | Free | Lifestyle | Strong odors, incense, perfume, deodorants, chemical smells, cleaning products, cigarette smoke, air pollution, vehicle exhaust, and other pungent or unnatural scents are known to be migraine triggers for some. Exposure may trigger an attack or worsen an attack in progress. |
| Avoid processed foods | Preventive | Free | Lifestyle | Processed foods often contain artificial ingredients and preservatives that can contribute to migraine. These include MSG, soy, sulfates/sulfites, nitrates, nitrites, and gluten among others. See Dietary Changes for more trigger ingredients and foods. |
| Ayurveda | Acute & Preventive | Free | Lifestyle | Ayurveda is an ancient Indian practice that involves a variety of treatments including yoga, massage, acupuncture, diet, and herbal medicine to encourage health and well-being. Ayurveda names three elemental substances, the doshas (called Vata, Pitta, and Kapha), and states that a balance of the doshas results in health, while imbalance results in disease. |
| Barometer | Preventive | Paid | Product/Device | Barometric pressure changes might affect the pressure in the brain or the way the brain blocks pain, though it’s not well understood at this stage. However, a barometer can help people with migraine who are sensitive to pressure changes to better anticipate this trigger and avoid other controllable triggers (e.g. food, stress) during risky weather. |
| Behavioral therapy apps & online tools | Acute & Preventive | Paid | Behavioral therapy, Digital Therapeutics | There are an increasing number of online therapy and self-care apps available to help with a variety of issues, including mental health and pain. Examples of therapy based options include Betterhelp, Talkspace and Online-Therapy.com. Mental-health and Mindfulness focused ones include Calm, Headspace, Insight Timer, Curable, iCBT, Sanvello, and MindShift. |
| Bio-behavioral therapy | Acute & Preventive | Paid | Behavioral therapy | Bio-behavioral therapy is a pain management therapy that teaches skills for controlling physical reactions to stress and pain through relaxation and stress reduction. The idea is that stress is perhaps one of the most common behavioral factors that interacts with physical factors in the perpetuation of pain. |
| Biofeedback | Acute & Preventive | Free & Paid | Behavioral therapy | Biofeedback is a technique that teaches people how to control certain body functions such as blood pressure, heart rate, and spasms in the arteries supplying the brain with the help of a sensory device. Once skills are learned, they can be practiced anywhere. |
| Black cohosh | Preventive | Paid | Vitamin/Supplement | Black cohosh (Actaea racemosa) is an herb sometimes used to treat perimenopause and menopause symptoms. It is native to North America, and its roots and rhizomes are made up of glycosides (sugar compounds), isoferulic acids (anti-inflammatory substances), and phytoestrogens (plant-based estrogens). Warning: the wrong variety can lead to liver toxicity symptoms. |
| Blood test - Food sensitivities/nutrition | Preventive | Paid | Diagnostics | A food-allergy blood test may offer clues to which foods the body is reacting to, as these foods may be affecting an individual’s health and migraine. A food-allergy blood test can also determine if supplementation is necessary, by seeing if magnesium or vitamin D are deficient, for example. A food-allergy blood test may offer clues to which foods the body is reacting to, as these foods may be affecting an individual’s health and migraine. A food-allergy blood test can also determine if supplementation is necessary, by seeing if magnesium or vitamin D are deficient, for example. |
| Blood test – Genetic dysfunction | Preventive | Paid | Diagnostics | Testing for genetic dysfunctions can help uncover potential causes that may be provoking migraine attacks. For example an MTHFR and homocysteine blood test can indicate a deficiency in the processing of folate and require a specific treatment that may lead to reduced migraine. |
| Blue menthol gel | Acute | Paid | Product/Device | There are several forms of blue menthol gel on the market. It is a topical cooling gel used for pain relief, inflammation, joint swelling, etc. Blue gel can cause skin irritation. |
| Boswellia / Indian frankincense | Preventive | Paid | Vitamin/Supplement | Boswellia is an herbal extract from the Boswellia serrata tree. It is available as a resin, pill, or cream. Boswellia has been shown to reduce inflammation in the body by preventing the formation of leukotrienes. A 2012 study indicated boswellia extract can reduce the intensity and frequency of cluster headaches. |
| Bowen therapy | Preventive | Paid | Physical therapy | Bowen therapy is a holistic remedial body technique that works on the soft connective tissue of the body. It is used to treat musculoskeletal or related neurological issues, including acute sports injuries and chronic or organic conditions. Practitioners claim it is a gentle, relaxing method that does not use forceful manipulation. |
| Breathing relaxation techniques | Acute & Preventive | Free | Behavioral therapy | Deep breathing is a simple way to relax and reduce stress. For example, taking 3 or 10 deep, slow breaths can help reduce anxiety and control stress. Also, alternate-nostril breathing, called nadi shodhana pranayama in yoga, can help control anxiety. |
| Butterbur | Preventive | Paid | Vitamin/Supplement | Butterbur is an herbal supplement that has been reported to be effective in reducing the frequency and severity of migraine attacks in some people with migraine. Caution should be exercised with butterbur as it contains components called pyrrolizidine alkaloids (PAs) that are toxic to the liver and may cause cancer. The concentrations of this toxin vary depending on which part of the plant is harvested and where the plant is grown. Getting butterbur from a reputable source is important. The brand name Petadolex is regarded as one of the most pure and PA-free. The long-term health effects of butterbur have not been studied. |
| Caffeine | Acute & Preventive | Paid | Lifestyle | Caffeine is a stimulant found in coffee, tea, chocolate, and soft drinks. Caffeine is addictive. If used in excess, caffeine can be overstimulating and cause anxiety and sleep problems; for people with migraine consuming less than 200mg/day is recommended. Caffeine can help the body absorb some medications faster, some sources suggest it can assist pain relievers by up to 40 percent. Any change in caffeine levels can contribute to an attack in some people whether by consuming too much, too little, or skipping a day. |
| Calcium | Preventive | Paid | Vitamin/Supplement | Calcium is essential for building and maintaining bone, and is required for the healthy functioning of the heart, muscles, blood and nerves. |
| Capsaicin | Acute | Paid | Vitamin/Supplement | Hot peppers (chilis) contain a substance known as capsaicin, a natural ingredient found in many topical pain-relief creams and ointments. Capsaicin has the ability to draw something called substance-P out of your nerves. Substance-P is a chemical messenger that carries a signal to the brain that is translated as pain. When you effectively block the messenger, you block the pain, too. Use caution, as contact with skin or eyes can be dangerous. |
| Cervical traction | Preventive | Paid | Product/Device | Also known as Neck Traction. This is a method to relieve neck pain by providing an opportunity for your neck muscles and pinched nerves to be released. Tension is placed on the head to pull it up and away from the neck, stretching muscles and ligaments around the vertebrae of the spine and expanding the space between the vertebrae. Also see Occipital Lift Technique. |
| Chinese herbal medicine | Preventive | Paid | Vitamin/Supplement | Chinese herbal medicine is part of the ancient Chinese practice of Traditional Chinese Medicine. Chinese herbal medicine takes a holistic approach to understanding the body’s normal function and disease processes, and focuses on prevention. Herbs are prescribed to restore balance to the opposing forces of energy, Yin and Yang. A Chinese herbal practitioner prescribes a specific Chinese herbal formula designed to match and treat your health problems. |
| Chiropractor | Preventive | Paid | Physical therapy | Chiropractors seek to relieve headache disorders based on the diagnosis and manipulative treatment of misalignments of the joints, particularly those of the spinal column. Manual techniques such as realignment may benefit corresponding nerves, muscles, or organs. Some medical doctors warn against allowing manipulation of the neck, which can result in a stroke. |
| Ctrl M Health app | Preventive | Paid | Digital therapeutics | Developed by Jefferson Headache Center, Ctrl M Health provides active support by establishing regular accessible guidance through their mobile app. The app links users to the knowledge, tools, and support that enable them to better manage headache and migraine. It claims to integrate the latest science with the best practices of health psychology to help improve users' quality of life. |
| Coenzyme Q10 (CoQ10)/ Ubiquinol | Preventive | Paid | Vitamin/Supplement | CoQ10 is a chemical naturally produced by the body and is essential for the proper functioning of cells. CoQ10 can help minimize damage to cells caused by the environment and other factors. There haven’t been many high quality trials but preliminary findings support the use of added CoQ10 for migraine treatment. A more concentrated form is known as ubiquinol. Sources of CoQ10 can be found as a supplement and naturally in most foods, with highest concentrations in the organs of animals (livers, hearts, and brains), soybeans, broccoli, dairy, avocados, the germ in grains, and most oils nuts and seeds. |
| Cognitive Behavior Therapy (trauma focused) | Preventive | Paid | Behavioral Therapy | Trauma-focused cognitive behavioral therapy is a short-term intervention therapy for children, adolescents, adult survivors and families trying to overcome the destructive effects of early trauma such as abuse, violence, or grief. |
| Cognitive behavioral therapy (CBT) | Acute & Preventive | Free & Paid | Behavioral therapy | Cognitive behavioral therapy (CBT) is a type of psychotherapy that helps people to change unhelpful or unhealthy thinking habits, feelings, and behaviors. CBT may be used to treat problems including anxiety, depression, low self-esteem, uncontrollable anger, substance abuse, eating disorders, and other problems. There is scientific evidence that supports the use of CBT for migraine. |
| Cognitive behavioral therapy for insomnia (CBT-I) | Preventive | Paid | Behavioral therapy | Cognitive behavioral therapy for insomnia (CBT-I) is a structured program that helps people identify and replace thoughts and behaviors that cause or worsen sleep problems with habits that promote sound sleep. Treatment takes approximately 6-8 sessions and can be done with a therapist or via an app. |
| Combination Therapy | Acute & Preventive | Paid & Free | Behavioral therapy | Combination therapy uses more than one method of treatment for a condition. An example of combination therapy for migraine prevention is using both Botox and a CGRP monoclonal antibody. An example of combination therapy for a migraine attack is using both a neuromodulation device and a triptan. |
| Cooling gel sheet | Acute | Paid | Product/Device | Applying cold items or ice packs to the head helps promote circulation and reduces the inflammation in the head caused by migraine. |
| Cove | Acute & Preventive | Paid | Diagnostics, Digital therapeutics | Cove is a telehealth company that offers migraine care. Users can complete an online consultation to help the medical provider find the best treatment plan for them. The provider-recommended treatment is delivered directly to them on the schedule they choose. If adjustments need to be made, the Cove team claim they will work with them to make sure they get the care they need. |
| Craniosacral Therapy (CST) | Acute & Preventive | Paid | Physical therapy | Craniosacral therapy (CST) is a gentle hands-on treatment that may provide relief from a variety of symptoms including headaches, neck pain, and side effects of cancer treatment. CST uses a light touch to examine membranes and movement of fluids in and around the central nervous system, which can promote a feeling of well-being by eliminating pain. Efficiacy has not been scientifically established despite usage among people who experience migraine. |
| Creative therapy | Preventive | Free | Behavioral therapy | Creative therapy includes a variety of hands-on artistic activities that slow down your mind, increase your concentration, and help you feel more present. This art-induced meditative state comes with many proven health benefits for pain relief, and less anxiety and depression. Forms include music therapy, dance/movement therapy, visual art therapy and expressive writing. |
| Daith piercing | Preventive | Paid | Lifestyle | The daith piercing punctures the upper lobe of the ear with an earring, and is said to correspond to an acupressure point within the ear that lines up with the digestive system. It is typically performed at a tattoo parlor. The procedure takes a long time to heal and runs the risk of infection. Experts believe it offers a temporary placebo effect for migraine relief and no lasting therapeutic value. There is currently no evidence supporting its use. |
| Dark, quiet room | Acute | Free | Lifestyle | When a migraine attack occurs, it’s been described as a malfunction where normal sensory inputs such as light, sound, or smell can cause pain. Removing yourself from these irritants can expedite your recovery, and many people find moderate to major relief in a dark, quiet room. |
| Detoxification (Detox) | Preventive | Free & Paid | Lifestyle | A detox is a diet plan that requires you to follow a particular diet over a certain period of time in order to cleanse the body. It may also include (paid) herbal supplements or other methods, such as colonic irrigation, all of which aim to remove environmental and dietary toxins from the body. There is no evidence supporting its benefits or its use for migraine prevention. |
| Dialectical Behavior Therapy (DBT) | Preventive | Paid | Behavioral therapy | Dialectical behavior therapy (DBT) is a modified type of cognitive behavioral therapy (CBT). Its main goals are to teach people how to live in the moment, develop healthy ways to cope with stress, regulate their emotions, and improve their relationships with others. |
| Diet - 5:2 diet | Preventive | Free | Lifestyle | The 5:2 diet is an intermittent fasting diet that has become popular after Dr Michael Mosley’s documentary on the benefits of intermittent fasting. This diet involves eating normally for five days out of a seven-day period and greatly restricting the amount of food eaten on the other two days. Preliminary studies have shown that intermittent fasting can fend off illnesses including cancer, diabetes, heart disease, and neurodegenerative disorders. It is not highly recommended for people with migraine, however, who typically respond better to a diet regime that promotes regular meals. |
| Diet - Anti-inflammatory diet | Preventive | Free | Lifestyle | An anti-inflammatory diet is a style of eating that centers on foods that lower inflammation in the body. Mainstays of an anti-inflammatory diet include fruits and vegetables, whole grains, beans and nuts, fish, and fresh herbs and spices. The diet is high in omega-3 fatty acids and omits foods that are processed, greasy, or sugary. Widely regarded as a healthy lifestyle choice, an anti-inflammatory diet may help in the reduction of chronic pain. |
| Diet - Elimination diet | Preventive | Free | Lifestyle | An elimination diet is often conducted under the guidance of a doctor or nutritionist to establish which foods are triggering migraine attacks. An elimination diet requires an individual to strip back to a few safe foods for several weeks to establish a baseline before gradually reintroducing foods one at a time, often several days apart. If a migraine attack occurs while a new food is being introduced, then it may be attributed to that food and consequently the food is removed from the diet. |
| Diet – Gluten-free diet | Preventive | Free | Lifestyle | Going gluten-free has been reported to help some people with migraine. Celiac disease occurs when the small intestine is hypersensitive to gluten, leading to difficulty in digesting food. Although people with migraine do not necessarily have celiac disease, some patients may be gluten sensitive. These patients’ test results often are negative for traditional reactions to gluten, but instead show signs of a different immune reaction. If you experience gastrointestinal symptoms such as bloating, diarrhea, and constipation, as well as fatigue and mental “fog,” it may be worth trying a gluten-free diet. There is, however, no strong evidence linking this diet to migraine. |
| Diet - High in omega-3/low in omega-6 | Preventive | Free | Lifestyle | Eating a diet high in omega-3 fatty acids can decrease the frequency of headaches in persons with migraine. Eating a diet high in omega-3 fatty acids and low in omega-6 fatty acids can further decrease headache frequency in persons with migraine. Foods that are high in omega-3 fatty acids include deep cold-water fishes (e.g., mackerel, salmon, sardines), krill, and flax seeds. Intake of omega-6 fatty acids can be reduced by avoiding processed foods and adding in more fruits and vegetables. |
| Diet - Ketogenic diet | Preventive | Free | Lifestyle | This is a high-fat, adequate-protein, low-carbohydrate, low-sugar diet that in medicine is used primarily to treat difficult-to-control epilepsy in children. In small case studies, migraine has been shown to improve while on a ketogenic diet. Further study is needed. |
| Diet - Mediterranean diet | Preventive | Free | Lifestyle | The Mediterranean diet is modeled after the traditional diets of Mediterranean countries like Italy and Greece. The diet is considered anti-inflammatory and is often recommended as a means of preventing disease and promoting longevity. Main components include a high intake of vegetables, fruits, whole grains, and healthy fats (such as olive oil); frequent consumption of fish, poultry, nuts, and eggs; and limited consumption of dairy and red meat. |
| Diet - Paleo diet | Preventive | Free | Lifestyle | The Paleo diet, also known as the Caveman or Stone Age diet, mimics the hunter-gatherer diet of our Paleolithic ancestors. It promotes consumption habits that avoids grains, legumes, and some dairy products in favor of the foods available to our ancestors during this period. Caution should be taken, as any diet that excludes entire food groups may be detrimental. Published studies for the diet are small, with too few participants to claim reputable scientific evidence. |
| Diet - Vegan diet | Preventive | Free | Lifestyle | Vegans, in addition to being vegetarian, do not use other animal products and by-products such as eggs, dairy products, honey, leather, fur, silk, wool, cosmetics, and soaps derived from animal products. There is no evidence linked to migraine improvement. |
| Diet - Vegetarian diet | Preventive | Free | Lifestyle | Vegetarians do not eat meat, fish, or poultry. There is no evidence linked to migraine improvement. |
| Dietary changes | Preventive | Free | Lifestyle | What you eat can play a significant role in your migraine. There are a number of foods that are problematic for a large number of migraine sufferers. Understanding which foods, if any, trigger your migraine attacks can be essential to successful migraine management. Common food triggers to be aware of are food additives such as nitrites and MSG (monosodium glutamate), food coloring, chocolate, aged cheese, red wine, beer, caffeine, citrus fruits, cured meats, aspartame and ice cream. If you are unsure, it may be worthwhile speaking with your doctor or seeing a dietitian or nutritionist to manage your diet. They can also help determine if you have any food allergies that may be contributing to your migraine attacks. |
| Digital Therapeutics | Acute & Preventive | Free & Paid | Digital Therapeutics | Digital Therapeutics are therapeutic treatment options driven by software programs that can be accessed online or on your phone. They can include biofeedback and behavioral therapy apps and virtual therapy (e.g., BetterHelp, Happify, Juva), telehealth offerings (e.g., Cove, NeuraHealth), mindfulness apps (e.g., Calm, Headspace), diary tracking apps (e.g., Migraine Buddy), and more. They can be especially helpful for people who are not able to access in-person medical and psychological services, and can be a complement to other therapies. |
| D-Ribose (Beta-D-ribofuranose) | Preventive | Paid | Vitamin/Supplement | D-Ribose is a type of sugar that is produced by the body which can be used as a supplement. It’s often used to improve athletic performance and the ability to exercise by boosting muscle energy. It has also been used to help prevent cramping, pain, and stiffness after exercise in those with genetic disorders. |
| Dry needling | Acute & Preventive | Paid | Physical therapy | Dry needling is a treatment performed by trained physiotherapists (or physical therapists) that involves inserting thin, filament needles into trigger points — knotted parts of the muscle that affect function and motion and can cause pain. Dry needling can help alleviate tension and allow muscles to return to a relaxed state. In a person with migraine, dry needling could especially help improve pain in the muscles of the temples, jaw, neck, shoulders, and back of the head. For those for whom muscle tightness is a trigger, dry needling could serve as a preventive treatment for migraine. |
| Electrolyte Drinks | Acute | Paid | Product/Device | Electrolyte drinks like Pedialyte or sport drinks like Gatorade and Powerade aid in rehydration and contain a mixture of helpful electrolytes including sodium and potassium, as well as sugar and water. Electrolytes are required for hydration and proper nerve and muscle function. |
| Eliminate cigarette smoking | Preventive | Free | Lifestyle | Quitting smoking is a smart choice for your health. Cigarette smoke contains over 4,000 chemicals including 43 known cancer-causing (carcinogenic) compounds and 400 other toxins. Apart from the obvious health benefits, cigarette smoke is a trigger for some people with migraine, and the chemical damage to an individual’s health that results from smoking is likely to make existing health conditions worse. |
| Eliminating alcohol | Preventive | Free | Lifestyle | Alcohol causes headaches even for people who don’t experience migraine. If you are susceptible to migraine and you drink alcohol, it is almost always a contributing factor. It is one of the least disputed food triggers for migraine because it is so common. About a third of migraine sufferers list alcohol as a trigger. |
| Eliminating caffeine | Preventive | Free | Lifestyle | While caffeine has its advantages (see Caffeine for detail), for many people with migraine, the disadvantages outweigh the benefits. Consequently, a person with migraine may gradually wean down and eventually eliminate their caffeine consumption over time. |
| Eliminating chocolate | Preventive | Free | Lifestyle | Some people with migraine list chocolate as a trigger food. Some neurologists say it is a migraine trigger because it contains the amino acid tyramine. The connection could also be that some people tend to crave chocolate during stress and hormonal changes, both of which may also trigger headaches. |
| Eliminating dairy | Preventive | Free | Lifestyle | Dairy can be a migraine trigger for some. Much of the world's population is lactose intolerant and can't consume large amounts of dairy foods. |
| Eliminating gluten | Preventive | Free | Lifestyle | See ‘Diet – Gluten-Free’ |
| Eliminating MSG | Preventive | Free | Lifestyle | MSG, or monosodium glutamate, is an amino acid used as a food preservative and flavor enhancer. It has been named as a common migraine trigger. It is not limited to Chinese food and has many aliases, making it difficult to detect on packaged foods ingredient listings. |
| Eliminating nitrates/nitrites | Preventive | Free | Lifestyle | Nitrates are converted into nitrites once they are digested. Foods high in artificially added nitrates have been linked to migraine as well as a potentially higher risk of cancer. Processed meats such as bacon, hot dogs, sausages, cured ham, cold cuts, and related products commonly have artificially added nitrates as a preservative. |
| Eliminating soy | Preventive | Free | Lifestyle | Soy has been linked to migraine in some people. In addition to soy beans, soy products are often included in breads, crackers, cakes, rolls, processed cereals, canned soups, ice cream, frozen desserts, margarines, butters, salad dressings, sauces, breakfast bars, and other products, as well as soy sauce, soy lattes, tofu, and miso. |
| Eliminating sulfates/sulfites | Preventive | Free | Lifestyle | Sulfates are found commonly in wine as a preservative, though some preservative-free wines are now available. Sulfates are thought to be a reason why wine is a significant migraine trigger. Sulfate is also used as a preservative in dried fruit and many dried-fruit products. |
| Eliminating tyramine | Preventive | Free | Lifestyle | Tyramine has been recognized as a common migraine trigger, though experts are still trying to understand why. One explanation might be that tyramine can cause nerve cells in the brain to release a chemical called norepinephrine, and the norepinephrine may cause changes in the brain that lead to migraine. Tyramine is found in red or balsamic vinegar, aged cheeses, chocolate, smoked fish, bacon, sausages, hot dogs, avocado, red plums, bananas, citrus fruits, olives, processed meats, and some types of alcohol. |
| Emotional freedom technique (EFT) | Acute | Free | Behavioral therapy | Emotional freedom technique (EFT), also referred to as "tapping", is an alternative treatment for physical pain and emotional distress. EFT involves fingertap tapping on the meridian points (like the ones used in acupuncture) to restore the body's energy, which can lead to relieving symptoms of a negative experience or emotion. |
| Epsom salt baths | Acute & Preventive | Paid | Vitamin/ Supplement | Magnesium sulfate is the scientific name for Epsom salt. The magnesium and sulfates in Epsom salt are apparently absorbed through the skin and may increase the magnesium levels in your body. Epsom salt baths are popular for softening and exfoliating skin, relaxation, drawing impurities out of skin and relieving migraine and cold or flu symptoms. Consult with your physician before taking Epsom salt baths if you are pregnant or have a medical condition. |
| Essential oils | Preventive | Paid | Product/device | See Aromatherapy. |
| Evening primrose oil | Acute | Paid | Vitamin/Supplement | Evening primrose oil contains “fatty acids” which are thought to help decrease inflammation related to conditions like arthritis or migraine. Evening primrose oil has been used for a range of disorders, including skin complaints such as eczema, psoriasis, and acne. It is also used for other conditions including rheumatoid arthritis, multiple sclerosis, high cholesterol, and heart disease. |
| Exercise | Preventive | Free | Lifestyle | Exercise helps with rest and relaxation and it also helps release stress, a common trigger for migraine. Most experts recommend at least 30 minutes of moderate exercise daily to get the best results for stress reduction. If you can find things you enjoy doing, you’re more likely to be consistent. Anything is better than nothing. If exercise triggers migraine, however, start small. If you’re outside, wear polarized sunglasses. Ensure that you’ve eaten enough and stay hydrated. Starting small and building upwards is a much more successful approach than trying to jump in without preparation. Many people with migraine find yoga, Pilates, or t’ai chi to be great low-impact options. |
| Feverfew | Preventive | Paid | Vitamin/Supplement | Feverfew is an herb with leaves containing natural anti-inflammatory qualities. It may prevent the release of blood-vessel dilating substances in the brain and may reduce inflammatory substances from developing, both of which can increase pain levels. It does provide relief for some sufferers and, given its low side effects, it is a relatively low-risk option. |
| Folate | Preventive | Paid | Vitamin/Supplement | Folate is also known as folic acid or vitamin B9. This vitamin is important for cell growth and metabolism. Folate is the natural version found in foods, and folic acid is the man-made version found in supplements and added to foods. See Folic Acid for more details. |
| Folic acid / Vitamin B9 | Preventive | Paid | Vitamin/Supplement | Folic acid is a type of B vitamin that is normally found in foods such as dried beans, peas, lentils, oranges, whole-wheat products, liver, asparagus, beets, broccoli, Brussels sprouts, and spinach. Folic acid helps your body produce and maintain new cells, and also helps prevent changes to DNA that may lead to cancer. As a medication, folic acid is used to treat folic acid deficiency and certain types of anemia (lack of red blood cells) caused by folic acid deficiency. |
| Forest bathing | Preventive | Free | Lifestyle | Forest bathing is a Japanese technique that involves sitting in the forest and being surrounded by greenery. In Traditional Chinese Medicine this is one of the treatments for issues relating to the Wood element, which includes migraine. |
| Ginger | Acute & Preventive | Paid | Vitamin/Supplement | Ginger is an herb known for its antinausea, antidiarrhea, and digestion-aiding properties. It can be consumed in many forms including raw, as powders, in supplements and in ginger ale. Ginger is used in migraine to alleviate the symptoms of nausea and vomiting. Ginger root can also be used in the treatment of migraine. Ginger contains more than 200 substances in its oils that help facilitate its many roles. For migraine, it is thought that ginger may block prostaglandins, which stimulate muscle contractions and control inflammation and some hormones. |
| Glucosamine | Preventive | Paid | Vitamin/Supplement | Glucosamine is a natural chemical compound found in the body. As a supplement, glucosamine is most often used to try to ease the joint pain caused by arthritis. |
| Green-Light Lamp, The Allay Lamp | Acute | Paid | Product/Device | Therapeutic light device designed to reduce anxiety and migraine intensity during an attack. It is based on scientific evidence from seven years of research at Harvard Medical School. The studies show that light made up of all the colors of light (red, blue, yellow, etc.) generates large electrical signals in the eye and brain, which tend to hurt people with light sensitivity. A very specific narrow band - which is the only light emitted by the Allay Lamp - generates smaller electrical signals in the eye and brain. |
| Heat therapy | Acute | Free | Lifestyle | Heat therapy can increase blood flow to muscles and help relax them. Heat therapy can also stimulate nerve endings, which may block pain signals from the affected area to the brain. Examples of heat therapy include heating pads, heat lamps, hot packs, and hot water bottles. If the temperature of the heat therapy becomes too high, discomfort or even burns may occur. |
| Herbal teas | Acute & Preventive | Paid | Vitamin/Supplement | Herbal teas contain vitamins and nutrients. Drinking hot herbal tea can also be a calming and relaxing activity that helps with hydration. Commonly used teas to help with migraine related symptoms include Dandelion, Chamomile, Ginger, and Mint. |
| Homeopathy | Preventive | Paid | Lifestyle | Homeopathy is a form of alternative medicine that claims to stimulate the body’s own healing response to disease using highly diluted preparations (potentizing). There are no effective homeopathic vaccines, and homeopathic treatments should not be used to replace conventional medical treatment of serious diseases or infections. The effectiveness of homeopathy has not been proven by medical science. |
| Hydration | Acute & Preventive | Free | Lifestyle | Dehydration is a common migraine trigger. Keeping water on hand throughout the day helps ensure you get the recommended eight glasses per day. In hospital settings, hydration is often provided via IV fluids. |
| Hydrotherapy | Acute & Preventive | Free | Lifestyle | Hydrotherapy involves the use of water for pain relief and treatment. Using ice packs on the head or splashing the face with cold water can help provide relief. Having hot and cold showers dilates then constricts blood vessels, which stimulates circulation. Exercise in water, such as water aerobics, is another form of hydrotherapy. |
| Hyperbaric oxygen therapy | Preventive | Paid | Lifestyle | Hyperbaric oxygen therapy (HBOT) is an immersive, enclosed chamber where 100 percent oxygen flows with no mask or cannulae. It does not require a prescription. Hyperbaric oxygen therapy hasn’t been shown to be as effective for migraine as it is for cluster headache. See Oxygen in Medical Treatments. |
| Hypnotherapy/ Hypnosis | Preventive | Paid | Behavioral Therapy | Hypnosis is the induction of a state of consciousness in which a person apparently is highly responsive to suggestion or direction. Its use in therapy to recover suppressed memories or to allow modification of behavior is controversial. |
| Ice/cold therapy | Acute | Free | Lifestyle | Cold slows down blood flow to an injury, thereby reducing pain and swelling. Cold therapy slows circulation, reduces inflammation, muscle spasms, and pain. It is often found to be helpful for people wanting to take the edge off” a migraine attack by applying ice or cooling gel sheets to painful areas on the head. Wearable ice packs permit sleeping and movement while worn. |
| Improving posture | Preventive | Free | Lifestyle | Poor posture can result in tightening muscles in the neck or scalp, which may lead to headache and migraine. Extended reading looking down at a mobile phone or hunching over a computer, laptop, or gaming console can lead to neck and back pain and can trigger an attack. Modern laptops encourage poor posture. Correcting postural issues may help relieve migraine and reduce the frequency of attacks. |
| Iron supplements | Preventive | Paid | Vitamin/Supplement | Iron is a mineral found naturally in foods as well as a vitamin supplement. Iron is required for growth, development, normal cellular functioning, and synthesis of some hormones and connective tissue. |
| Isoflavones | Preventive | Paid | Vitamin/Supplement | Isoflavones (e.g. Promensil) are polyphenolic compounds that are capable of exerting estrogen-like effects. For this reason, they are classified as phytoestrogens – plant-derived compounds with estrogenic activity. Legumes, particularly soybeans, are the richest sources of isoflavones in the human diet. |
| Juva Health App | Preventive | Paid | Digital therapeutics, behavioral therapy | The Juva app provides clinician-developed biofeedback coaching that helps you control your nervous system. The 20-minute sessions occur five times per week, and the app monitors your vital signs and provides real-time feedback using your phone's camera. Calming the nervous system and relaxation training have been shown to reduce migraine frequency and severity. |
| Krill oil | Preventive | Paid | Vitamin/Supplement | Krill oil capsules are a more highly concentrated form of omega-3 fats than fish oil capsules, with similar benefits. The omega-3 fats EPA and DHA play an important role in emotional health, and deficiencies have been linked to mood disorders. Krill oil helps reduce inflammation, which causes pain. (See Omega-3). |
| Lavender oil | Acute & Preventive | Paid | Vitamin/Supplement | Lavender oil may help reduce nervous tension and pain, and enhance blood circulation. Its calming scent makes it a popular choice for anxiety issues. It is also used as a natural alternative to help with insomnia. |
| L-carnitine | Preventive | Paid | Vitamin/Supplement | L-carnitine is an amino acid naturally produced by the body. It can be used as a supplement when natural levels are low or for those on a vegetarian diet. Not FDA approved for migraine. |
| L-methylfolate / Levomefolic acid | Preventive | Paid | Vitamin/Supplement | L-methylfolate is a particular type of folic acid supplement that provides the body with folate. It can assist in the management of low plasma or low red blood cell folate in patients. |
| Magnesium (including variants i.e., citrate, glycinate, threonate oxide) | Preventive | Paid | Vitamin/Supplement | During a migraine attack, low levels of magnesium have been shown in the brain. It’s thought that magnesium deficiency and migraine may be related since magnesium is required for proper nerve function. Magnesium as a preventive may be especially helpful for those with hormonal migraine. Sources of magnesium include legumes, nuts, whole grains, seeds, leafy green vegetables, soy products, bananas, dried apricots, avocados, and supplements. Dr. Mark Hyman recommends a high dose of magnesium citrate or glycinate at 300-600 mg twice per day to help prevent migraine attacks. Magnesium threonate may be used to improve sleep if one has trouble falling asleep. |
| Magnotherapy | Preventive | Paid | Lifestyle | Also known as magnet therapy or magnetic therapy. It is an alternative practice involving the use of static magnetic fields. Practitioners of magnotherapy claim that subjecting certain parts of the body to magnetostatic fields produced by permanent magnets has beneficial health effects. These physical and biological claims are unproven and no effects on health or healing have been established. |
| Manage stress | Preventive | Free | Lifestyle | Stress in its many forms is one of the most significant factors for people with migraine. Stress can come from strong emotions, both negative and positive. But it can also descend into anxiety, panic attacks, and depression. Stress can easily creep up on you. You get used to it. It can feel familiar or even normal without any realization of the heavy toll it takes. Stress can be beneficial at a mild level, but beyond a certain point it starts causing major damage to your health, particularly in relation to migraine conditions. |
| Meditation | Acute & Preventive | Free | Behavioral therapy | Meditation is a practice in which an individual uses a technique to train attention, awareness and achieve a mentally clear and emotionally calm state. Techniques include focusing the mind on a particular object, thought, or activity (mindfulness) or being gently guided by an expert into a meditative state (guided meditation). Research has shown promising results for meditation, with participants reporting less severe migraines as well as other benefits including lower stress, less anxiety, better sleep, and better general health, concentration, self-awareness, and self-control. |
| Melatonin | Preventive | Paid | Vitamin/Supplement | Melatonin acts on the receptors for many pain-relieving molecules in the brain (e.g. opioid receptors), leading to a decrease in pain sensations when melatonin levels are high. Melatonin supplements have been shown to lower pain intensity, and a clinical trial found that 3 mg of melatonin 30 minutes before bedtime helped to reduce the overall frequency, intensity, and duration of migraine headaches for the subjects in the study. |
| Menthol/Mint, Camphor | Acute | Paid | Vitamin/Supplement | Peppermint and menthol are numbing and calming, making them useful to soothe the overactive nervous system during a migraine attack. It can be inhaled, applied topically, or ingested. There’s growing evidence that menthol for migraine is just as effective as over-the-counter medications to treat an attack in the early stages. Camphor is a waxy terpene commonly used in creams ointments, and lotions. It has a wide variety of topical uses, including as an anti-inflammatory. Can be used to treat mild to moderate pain. |
| Mescaline or Peyote | Preventive | Paid | Psychedelics | Mescaline is a hallucinogenic substance found within the Peyote cactus. Mescaline can be taken from the Peyote cactus or created synthetically. Throughout history, Peyote and mescaline have been used by some Native American communitites for traditional religious rites.There have been anecdotal reports of people with cluster headaches using mescaline as a treatment. |
| Migraine Buddy | Preventive | Free & Paid | Digital Therapeutics | Using a migraine app means being able to go to your doctor with proper documentation to answer questions such as, How many migraine days do you have? How many types of treatments are you taking? It also assists with identifying potential triggers, showing how migraine evolved with the treatment provided and the level of relief with those treatments. |
| Migraine Support Formula | Preventive | Paid | Vitamin/Supplement | This is a multivitamin product designed specifically for people with migraine, which combines several well-known vitamins and supplements to help relieve migraine into one pill. Vitamins included are riboflavin, niacin, vitamin B6, magnesium, ginger, CoQ10, white willow, feverfew, butterbur & black pepper. |
| Mindfulness | Acute & Preventive | Free & Paid | Lifestyle | A form of meditation based on a moment-by-moment awareness of thoughts, feelings, bodily sensations, and surrounding environment. It means tuning in to the present moment, paying attention to thoughts and feelings without judgment. Though it has its roots in Buddhist meditation, mindfulness has entered the mainstream in part through the work of Jon Kabat-Zinn and his Mindfulness Based Stress Reduction (MBSR) program. Thousands of studies have documented the mental and physical benefits of MBSR, often used in pain reduction. |
| Mindfulness-Based Cognitive Therapy (MBCT) | Preventive | Paid | Behavioral Therapy | Mindfulness-based cognitive therapy (MBCT) is a modified form of cognitive behavioral therapy (CBT). MBCT incorporates mindfulness practices that include present moment awareness, meditation, and breathing exercises. Using these tools, MBCT teaches one how to be in the here-and-now as well as how to break away from negative thought patterns. |
| Mini-prevention | Acute & Preventive | Paid & Free | Behavioral therapy, Diagnostics | Mini-prevention involves keeping a diary or journal to track days of migraine attacks to identify the days at risk in advance and then treat in anticipation of those days. Treating in anticipation of risk involves starting treatment a day before the attack onset (or the morning of) and then continuing treatment twice daily for five to seven days. A person would continue this regimen regardless of whether an attack is occurring because the likelihood of an attack in that time period is high. Mini-prevention is especially helpful for the treatment of menstrually-related migraine. |
| Movement | Preventive | Free | Lifestyle | Movement involves moving your body in any way that feels good -- be it stretching, strength training, cardio, or anything else. Movement can release certain neurotransmitters called endorphins. Endorphins interact with the receptors in the brain that reduce perception of pain and can also trigger a positive feeling in the body similar to that of morphine. |
| Myofascial release | Preventive | Paid | Physical therapy | Myofascial release (MFR) is a soft-tissue therapy for the treatment of skeletal muscle immobility and pain. This alternative medicine therapy aims to relax contracted muscles, improve blood and lymphatic circulation, and stimulate the stretch reflex in muscles. |
| N1-Headache app | Preventive | Paid | Digital Therapeutics | N1-Headache is a smartphone app that allows users to track migraine symptoms, triggers, and medications for 90 days and then produces an individualized report. N1 can identify triggers and protectors and is able to eliminate nonrelevant factors. This approach can help untangle the interactions between triggers and protectors that govern attacks. |
| Naturopathy | Preventive | Paid | Lifestyle | Naturopathy is a holistic approach to wellness based on the principle that the body has the inherent ability to heal itself. Using gentle therapeutic techniques, the body, mind, and emotions are supported during the healing process. Naturopathic medicine has been criticized for its lack of scientific evidence and conflicts with evidence-based medicine. For example, many naturopaths oppose vaccination. |
| Neura Health | Acute & Preventive | Paid | Diagnostics, Digital therapeutics | Neura Health is a virtual headache and migraine clinic which aims to provide quality care to anyone, anywhere. Membership with Neura Health includes same or next-day headache neurologist video visits; unlimited 24/7 in-app chat with headache care team; headache tracker & insights into triggers and trends; and personalized treatment plan and dedicated care coach. |
| Niacin / Vitamin B3 | Preventive | Paid | Vitamin/Supplement | Vitamin B3 helps release energy from carbohydrates, fats, and cholesterol while regulating blood sugar levels. Supplemental vitamin B3 causes the face and skin to flush, which is thought to help release the pressure of a migraine headache. |
| Night or Mouth guard | Preventive | Paid | Product/Device | A dental guard (occlusal splint, mouth guard, night guard, or bite plate) is a custom-fitted dental device meant to prevent teeth grinding and jaw clenching, either while awake or asleep. Mouth guards not only protect the teeth but can also alleviate jaw and head pain that occurs from bruxism, or clenching and grinding of the teeth. |
| Noise-cancelling headphones | Acute & Preventive | Paid | Product/Device | Noise-canceling headphones block out ambient sound and background noise. Reduction in noise can be helpful for those with sound sensitivity during a migraine attack and in preventing migraine if noise is a trigger. Noise-canceling headphones are widely available by most major brands including Bose, Sony, Apple, Beats, Bang & Olufsen, and JBL, etc. |
| Nutraceuticals | Preventive | Paid | Vitamin/supplement | Nutraceuticals are products derived from food sources that provide nutrition and medicinal benefits. Examples of nutraceuticals include dietary supplements, diets, herbal products, and vitamins. |
| Occipital lift technique | Acute & Preventive | Paid | Physical therapy | Typically performed by a manual therapist, for example a physiotherapist or chiropractor, the occipital lift technique is where the therapist gently lifts the head away from the neck to allow for a release in tension and muscle relaxation. Practitioners believe that this practice may facilitate an increase in venous and lymphatic drainage from the skull, improve circulation, promote relaxation, and reduce blood pressure, all of which can relieve headaches. |
| Omega-3 | Preventive | Paid | Vitamin/Supplement | Omega-3 fatty acids are found mostly in fish and fish oils but also in nuts, seeds, and vegetable oils. According to the American Heart Association, the omega-3 in fish oil may reduce inflammation, aid in preventing blood clotting, improve blood pressure, and steady the heart rhythm. This may be useful in the reduction of migraine as it may reduce inflammation in the head. Sources of fish oil can be obtained from taking supplements or by eating fish including mackerel, tuna and salmon, among others. |
| Osteopathy | Preventive | Paid | Physical therapy | Osteopathy is a type of alternative medicine physical therapy that emphasizes physical manipulation of the body's muscle tissue and bone. It can be used to correct misalignments that may trigger migraine attacks in some people. |
| Pain Reprocessing Theory (PRT) | Preventive | Free & Paid | Behavioral therapy | Pain Reprocessing Therapy (PRT) is a system of psychological techniques that retrains the brain to interpret and respond to signals from the body properly, subsequently breaking the cycle of chronic pain. A randomized controlled study at the University of Colorado Boulder validated PRT as the most effective current treatment for chronic pain. |
| Passage of time | Acute | Free | Lifestyle | While not technically considered a treatment, the passage of time is one of the most common tactics people with migraine employ to get over the worst part of their attacks. Resorting to “waiting it out” may be due to a lack of effective acute treatment, lack of knowledge about available treatments, or a lack of willingness to try new options with the help of a doctor. |
| Pedialyte | Acute & Preventive | Paid | Vitamin/Supplement | Pedialyte is designed to promote rehydration and electrolyte replacement in ill children. Compared to Gatorade, Pedialyte contains more sodium and potassium, and does not contain sucrose, but may contain synthetic sweeteners. |
| Peppermint | Preventive | Paid | Vitamin/Supplement | Peppermint is used for a variety of health conditions and can be taken orally in dietary supplements or as a tea, or topically as a skin cream or ointment. Some evidence suggests that peppermint oil may help relieve symptoms of irritable bowel syndrome and indigestion. Despite promising findings, there is no clear-cut evidence to support its use for other health conditions. Its use is not advisable for pregnant women. |
| PERMA™ Theory of Well-Being | Preventive | Free | Behavioral therapy | PERMA™ Theory of Well-Being focuses on five building blocks that enable an individual's flourishing: Positive Emotion, Engagement, Relationship, Meaning, and Accomplishment. There are techniques to increase each building block and the process will vary from person to person. Having a greater sense of well-being can help with having fewer sleep problems, lower levels of burnout, and better self-control and coping abilities. |
| Petadolex (butterbur extract) | Preventive | Paid | Vitamin/Supplement | Butterbur is an herbal supplement that has been reported to be effective in reducing the frequency and severity of migraine in some people with migraine. However, caution should be exercised with butterbur, as it contains components called pyrrolizidine alkaloids (PAs), which are toxic to the liver and may cause cancer. The concentrations of this toxin vary depending on which part of the plant is harvested and where the plant is grown. Petadolex is a brand name of the vitamin producer whose makers claim that it doesn’t contain the harmful chemicals (PAs) within butterbur. |
| Physiotherapy / Physical Therapy | Preventive | Paid | Physical therapy | Physical therapy or physiotherapy has the potential to release pressure, tension, strain, or injury that may lead to headaches. It is also a medically respected approach to treat physical ailments. People with migraine are known to have a number of trigger points in the shoulders, back, and neck. Releasing these areas may be particularly useful to help desensitize nerves, which may be leading to migraine, particularly if you feel your migraine attacks are caused by neck issues. |
| Pilates | Preventive | Free & Paid | Lifestyle | Pilates is a system of exercise with or without special apparatus, designed to improve physical strength, flexibility, and posture, and enhance mental awareness. The two primary types are Mat Pilates, which can be done for free or in a paid class; and Reformer Pilates, which requires the use of a specially designed table and is usually done with a paid instructor at a studio or physical therapy office. |
| Pillow (Shaped or Cooling) | Acute & Preventive | Paid | Lifestyle | A pillow that supports the natural curve of the neck can help to reduce neck pain and improve sleep quality. A pillow with a cooling segment can be comforting during a migraine attack. |
| Placebo response | Acute & Preventive | Paid | Behavioral Therapy | Occurs when a person perceives an improvement in symptoms or overall health after receiving a treatment or medication. This is from the psychological effect of receiving this treatment/medication, rather than the treatment/medication itself. Sometimes a sugar pill is enough to improve a person’s condition because of this effect. This is a powerful effect and could be even more so if harnessed into a treatment. |
| Prayer | Acute & Preventive | Free | Lifestyle | Prayer can provide comfort, strength, and reassurance for those who practice it as part of their faith. It offers hope for those who are dealing with chronic pain and health issues. |
| Probiotics | Preventive | Paid | Vitamin/Supplement | Probiotics are live bacteria and yeasts that are good for your health, especially your digestive system. Increasing evidence considers the gut to be the “second brain,” and the gut-brain connection to be a significant factor in our well-being. They can be consumed through supplments or naturally in many fermented foods including certain yogurts, pickles, sauerkraut, miso, tempeh, kombucha, sourdough bread, and some cheeses. |
| Progressive muscle relaxation therapy | Acute & Preventive | Free & Paid | Behavioral therapy | Progressive muscle relaxation, also known as Jacobson's relaxation technique, involves tensing a group of muscles while breathing in, then relaxing them while breathing out. Muscle groups are tensed and relaxed in sequence until the entire body is relaxed. This strategy is helpful for migraine, anxiety, and general stress management. |
| Psilocybin | Acute | Paid | Psychedelics | Psilocybin is a naturally occurring psychedelic prodrug compound produced by various species of mushrooms. The prodrug is converted by the body to psilocin, which has mind-altering effects similar to LSD and mescaline. Psilocybin has been reported to abort cluster headache attacks. |
| Psychotherapy | Preventive | Paid | Behavioral therapy | Psychotherapy is a general term for treating mental health problems or emotional difficulties by talking with a psychiatrist, psychologist, or other mental health provider. Psychotherapy can help a person to take control of their life and respond to challenging situations with healthy coping skills. For persons with chronic conditions, psychotherapy can help with accepting the diagnosis and condition, making adjustments to everyday life, and managing related emotions and stresses. |
| Qigong | Acute & Preventive | Free & Paid | Lifestyle | Qigong practice involves posture or movements, breathing techniques, and mental focus, which aim to integrate and cleanse the body and mind. Qigong is a type of mind-body training; regular practice helps physical relaxation and mental calm. |
| Reflexology | Preventive | Free & Paid | Physical therapy | Reflexology is an alternative medicine involving the application of pressure to the feet and hands with specific thumb, finger, and hand techniques without the use of oil or lotion. It is based on a system of zones and reflex areas that purportedly reflect an image of the body on the feet and hands, with the premise that such work affects a physical change to the body. |
| Reiki | Preventive | Paid | Physical therapy | Reiki is a technique commonly called palm healing or hands-on healing. Through the use of this technique, practitioners believe that they are transferring "universal energy" through the palms of the practitioner, which they believe encourages healing. It is based on “qi,” which practitioners say is a universal life force, although there is no empirical evidence that this life force exists. Global cancer societies state that Reiki should not be a replacement for conventional treatment of diseases such as cancer, but that it may be used a supplement to standard medical treatment. |
| Relaxation techniques | Acute & Preventive | Free & Paid | Behavioral therapy | Relaxation techniques help control stress. They can also help you fall asleep faster. Common relaxation techniques include meditation, t’ai chi, massage, and deep breathing. |
| Remedial massage | Preventive | Paid | Physical therapy | Remedial massage, also known as medical masssage or sports massage, is a type of massage that focuses on relieving muscle tension and treating chronic pain. It can can reduce headaches by relieving muscle tension throughout the body. |
| Resilience | Preventive | Free | Lifestyle | Resilience is the process of adapting well (or "bouncing back") in the face of adversity, trauma, tragedy, threats, or significant sources of stress. Resilience helps people get through difficult circumstances and also empowers them to grow and improve their life along the way. |
| Rub/pressure temples | Acute | Free | Lifestyle | Rubbing or placing pressure on the temples can be a self-massage technique that is sometimes known as "the temple rub.” It’s simple to apply. Take deep breaths and rub your temples in gentle circles. Rubbing your temples in forward circles toward your ears and nose is generally the direction suggested. Do so for at least 10 circles and 10 deep breaths. It is claimed to help relieve headache and neck aches. |
| Saffron | Preventive | Paid | Vitamin/Supplement | Saffron contains several plant-derived chemical compounds that are known to be antioxidant, disease preventing, and health promoting. It is also an excellent source of vitamins and minerals including vitamin A, folic acid, riboflavin, niacin, vitamin C, copper, potassium, calcium, manganese, iron, selenium, zinc, and magnesium. |
| Salt Crystals/Salt lamps | Acute | Paid | Vitamin/Supplement | Natural salts such as Himalayan salt contain numerous minerals and electrolytes. Taking 2 teaspoons mixed with lemon juice in a cup of water may help a migraine attack. Salt lamps — which are thought to help purify the air by attracting moisture, humidity, and other airborne water molecules — may also be used. |
| SEEDS | Preventive | Free | Lifestyle | SEEDS is an acronym for a lifestyle management technique. It stands for regular Sleep, regular Eating, regular Exercise, Drinking water (staying well-hydrated and avoiding caffeine and alcohol), and Stress reduction. |
| Self-acupressure | Acute & Preventive | Free | Physical therapy | Acupressure is an ancient practice of using the fingers to gradually press key healing points, which stimulate the body's natural self-curative abilities. Self-acupressure is the practice of pressing on these certain points yourself, rather than by an acupressure practitioner. There are many different points, but the Hoku Point (LI4), just behind the webbing between your thumb and index finger, is considered helpful in relieving headaches. |
| Shiatsu | Preventive | Paid | Physical therapy | Shiatsu is a Japanese form of massage therapy that involves targeted hand pressure to certain body points to help restore the “energy balance” and promote relaxation. |
| Sleep | Acute & Preventive | Free | Lifestyle | Sleep is a restorative brain function that affects many other aspects of bodily function. It is a vital and often neglected area for people with migraine. Sleep helps the body to heal itself. It powers down areas of the body so that recovery and repair can be performed. As a preventive measure, good sleep hygiene is a practice that ensures at least 7-8 hours per night on a consistent sleep/wake cycle. As an acute treatment, many people list sleep as one of the most effective acute treatments for migraine. |
| Sleeping mask | Acute & Preventive | Paid | Product/Device | A sleeping mask is a simple tool used to cover the eyes to facilitate sleep in an area with distracting lights. If you are woken by light early in the morning, wearing a sleeping mask may facilitate more sleep after the sun has risen. |
| Smartphone and computer-screen filters | Acute & Preventive | Paid | Product/Device | Smartphone filters, such as Apple's Dark Mode, in which users can choose a dark palette for all screens, views, menus and controls. Contrast and transparency can be adjusted for comfort and legibility. For computer screens, f.lux is a free software that changes a user's computer dispay to adapt to the time of day: warm at night, and like sunlight during the day. Such filters are said to promote better sleep. |
| Smell retraining therapy | Preventive | Free | Physical | Smell retraining therapy is typically used as a treatment for loss of smell. It helps to rebuild the connection between the nose and the brain to recover the sense of smell. It involves sniffing several potent scents for 10-15 seconds each time, 2-4 times/day, for 10-16 weeks. The most recommended scents are rose, lemon, cloves, and eucalyptus. |
| Social connection | Preventive | Free | Lifestyle | Social connection is the feeling of belonging to a group and feeling close to other people. The support one receives from their social connections can add to the feelings of meaning and purpose in life, which then contributes to resilience. |
| Social support | Acute & Preventive | Free | Lifestyle | Social support can be broken down into four forms. Emotional: people who offer the proverbial shoulder to cry on. Informational: people you can go to for advice and information. Belonging: people who give you the sense that you're not alone, you're part of a family or a community. Esteem: people who make you feel like you have value and worth. |
| Somatic Tracking | Acute & Preventive | Free | Behavioral therapy | A technique for attending to painful sensations by using non-judgmental mindfulness, safety reappraisal, and an objective lens to help deactivate the pain signal |
| St. John’s Wort | Preventive | Paid | Vitamin/Supplement | St. John’s Wort is most used for depression and conditions that sometimes go along with depression, such as anxiety, tiredness, loss of appetite, and trouble sleeping. There is scientific evidence supporting its effectiveness for mild to moderate depression. It can also be used to treat menopause symptoms. The evidence for migraine is inconclusive. Consult your Doctor before taking it as many contraindications exist for St. John's Wort. |
| Stretching | Preventive | Free | Lifestyle | Stretching can be beneficial in relieving muscle tension that can lead to stiffness and pain. Neck exercises and shoulder shrugs can be helpful in keeping the area around the neck and head limber. It also helps settle trigger points. Next time you feel an oncoming attack, try a few gentle stretches and see if it helps alleviate the attack. |
| T’ai Chi | Preventive | Free & Paid | Lifestyle | T’ai chi is a form of traditional Chinese exercise that purports to improve health by changes in mental focus, breathing, coordination, and relaxation. The goal of t’ai chi is to “rebalance” the body's own healing capacity. It has been practiced in China for hundreds of years. A 15-week intervention of t’ai chi practice was effective in reducing headache impact and also effective in improving perceptions of some aspects of physical and mental health. |
| THC | Acute & Preventive | Paid | Vitamin/supplement | THC is a psychoactive compound of marijuana used by some for preventive or acute migraine treatment. THC and marijuana are controlled substances in the U.S., prohibited by federal law. |
| Tinted migraine glasses and contacts | Preventive | Paid | Product/Device | Migraine glasses or contacts fitted with an FL-41 tint, offered in indoor and outdoor tints, reduce glare and blue light from digital screens. People with photophobia and light sensitivity as a trigger may find benefit with these products. Yellow-tinted and amber-tinted lenses are popular choices for managing light sensitivity. |
| Trigger point injections | Acute & Preventive | Paid | Physical therapy | Trigger points are knotted or tightly banded areas of a muscle; when pressed, it can produce pain within the muscle and even pain in other areas (called "referred pain"). Trigger points within the muscles of the head, neck, and shoulders can cause migraine attacks by themselves — or they can be a result of migraine attacks. Trigger point injections involve the inserting of numbing medication into the trigger point to relieve pain in the affected areas. They are typically performed by doctors in an outpatient setting. |
| Triphala | Preventive | Paid | Vitamin/Supplement | Triphala means “three fruits.” Triphala is a traditional Ayurvedic herbal formulation consisting of Amalaki (Emblica officinalis), Bibhitaki (Terminalia belerica), and Haritaki (Terminalia chebula). Triphala is most commonly known for its use as a gentle bowel tonic, being helpful in digestion, and assisting natural internal cleansing. |
| Turmeric | Preventive | Paid | Vitamin/Supplement | Turmeric is an herb that contains curcumin, a substance with powerful anti-inflammatory and antioxidant properties. |
| Valerian | Preventive | Paid | Vitamin/Supplement | Valerian is an herb. The roots are used as a muscle relaxer. Outside of migraine treatment, valerian is most commonly used as a sleep aid. It can also be helpful for stress and anxiety. You can find valerian as a supplement as it is not easily found in food. |
| Vapor inhaler stick | Acute & Preventive | Paid | Product/Device | Often using menthol as the active ingredient, inhaler sticks may be used to treat nasal congestion and help clear the sinuses, which may be adding pressure or contributing to a migraine attack. |
| Vestibular rehabilitation | Preventive | Paid | Physical therapy | For people who experience severe dizziness or vertigo with migraine, vestibular rehabilitation offers an exercise-based program to help restore vestibular function and balance. Depending on the problems identified, three principal methods of exercise can be prescribed: 1) Habituation, 2) Gaze Stabilization, and/or 3) Balance Training. |
| Visceral manipulation | Preventive | Paid | Physical therapy | Visceral manipulation is a gentle manual technique involving specific placement of soft manual forces to encourage the normal mobility, tone, and motion of the viscera (internal organs) and the connective tissue and ligaments that support each organ onto our skeleton. Specific techniques are used to evaluate how abnormal forces might be affecting your normal body functions or affecting your skeleton, soft tissues, and organs. Techniques are then used to gently assist releasing the tension lines and improve visceral mobility. These manipulations are believed to improve the functioning of individual organs, the systems the organs function within, and the structural integrity of the entire body. There is not conclusive evidence to support visceral manipulation. |
| Vision Therapy / Eye Exercises | Preventive | Paid | Physical therapy | Eye exercises are thought to help improve vision and strengthen the muscles surrounding the eye that assist with normal function. Scientific evidence for eye exercise regimes are controversial with little evidence to support some of the claims made by practitioners. It is thought that with better vision comes less visual strain, which may contribute to migraine attacks. |
| Vitamin B complex | Preventive | Paid | Vitamin/Supplement | This is a multivitamin that includes a range of B vitamins. Some of the benefits from a B-complex multivitamin may include energy production, a healthy function of the nervous system and assisting in the conversion of food to energy. |
| Vitamin B12/Cobalamin | Preventive | Paid | Vitamin/Supplement | The key role of vitamin B12 is the normal functioning of the brain, the nervous system, and the formation of blood. It is involved in the metabolism of every cell of the human body. Vitamin B12 is found in most animal-derived foods including fish, shellfish, meat (especially liver), poultry, eggs and milk. |
| Vitamin B2/Riboflavin | Preventive | Paid | Vitamin/Supplement | Riboflavin/vitamin B2 has been reported as useful in migraine treatment due to its role in helping heal and strengthen brain cells. This can be taken as a supplement or by consuming foods high in vitamin B such as milk, cheese, leafy vegetables, liver, kidneys, legumes, yeast, mushrooms, almonds, soybeans, wheat bran, salmon, and sun-dried tomatoes. |
| Vitamin B6/Pyridoxine | Preventive | Paid | Vitamin/Supplement | Vitamin B6 is involved in the process of making serotonin and norepinephrine, which are chemicals that send signals to the brain. Vitamin B6 is also involved in the formation of a protein layer around the nerve cells called myelin. Deficiencies in this vitamin may cause health issues affecting the nerves, skin, and circulatory system. Mild deficiency of vitamin B6 is common. Sources of B6 include cereal, grains, legumes, vegetables (carrots, spinach, peas, potatoes), milk, cheese, eggs, fish, liver, meat, and flour. |
| Vitamin D3 / Cholecalciferol | Preventive | Paid | Vitamin/Supplement | A significant correlation exists between low levels of blood serum cholecalciferol and higher rates of various cancers, multiple sclerosis, tuberculosis, heart disease, and diabetes. Supplementation may serve a preventive role for migraine. |
| Vitex agnus-castus | Preventive | Paid | Vitamin/Supplement | Vitex agnus-castus, also called vitex, chaste tree, or chasteberry, is a shrub. It's fruit and seed are used as a herbal supplement, often to balance hormones, including during perimenopause for premenstrual syndrome (the dosage used in clinical trials for premenstrual syndrome is 20 mg, equivalent to 400mg of the dried product). |
| Walking in nature | Preventive | Free | Lifestyle | A recent Stanford study has demonstrated 30 minutes of walking in nature to be as effective as an SSRI antidepressant for mild or moderate depression. As it combines exercise and stress relief, it is certainly worth trying as part of a migraine prevention strategy. |
| Wearing sunglasses | Acute & Preventive | Free | Lifestyle | Glare from the sun may contribute to migraine. Ensuring you have sunglasses with sufficient UV protection and polarization to reduce glare may provide significant relief. Wear polarized sunglasses even when there is the smallest amount of sunshine if you are sensitive to sunlight. |
| Weight loss | Preventive | Free | Lifestyle | Obesity is associated with an increased risk of progression from episodic to chronic migraine. For overweight individuals, weight loss may contribute to a reduction in the frequency, severity, and duration of their migraine attacks. |
| White willow | Preventive | Paid | Vitamin/Supplement | White willow bark is an anti-inflammatory supplement that is thought to restrict prostaglandins and reduce pain. |
| Yoga | Preventive | Free & Paid | Lifestyle | Yoga is a form of exercise that involves stretching, maintaining poses, and breathing control to strengthen muscles and increase blood flow. It can promote calmness and is often used in combination with meditation and breathing exercises. Yoga can be done independently or in a class with minimal equipment. There are various forms of yoga including restorative, Hatha, Vinyasa, Yin, Iyengar, Nidra, chair, and hot yoga. |
| Zinc | Preventive | Paid | Vitamin/Supplement | Zinc is needed for the proper growth and maintenance of the human body. It is found in several systems and biological reactions and it is needed for immune function, wound healing, blood clotting, thyroid function, and much more. Meat, seafood, dairy products, nuts, legumes, and whole grains offer relatively high levels of zinc. Low zinc levels have been associated with depression and diabetes among other conditions. |
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| Generic Name (Active Ingredient List) | Brand Names | Treatment Class | RX | Format | Treatment Type | Description |
|---|---|---|---|---|---|---|
| Acetaminophen & Codeine | Tylenol 3 or 4, Panadeine | Combination - Opioid | X | Liquid, Pill | Acute | Acetaminophen/paracetamol with codeine is an opioid and analgesic/antipyretic combination. It works in the brain and nervous system to decrease mild to moderately severe pain. |
| Acetaminophen & Oxycodone | Percocet | Combination - Opioid | X | Liquid, Tablets | Acute | Percocet is used to relieve moderate to severe pain. It contains a combination of oxycodone (an opioid pain medication that works in the brain to change how your body feels and responds to pain) and acetaminophen (a less powerful pain reliever that increases the effects of oxycodone). |
| Acetaminophen (Paracetamol) | Little Fevers, Panadol, Tylenol & others | Analgesic (painkiller) | Liquid, Pill, Suppository | Acute | Acetaminophen is also known as paracetamol depending on where you live. A pain reliever and fever reducer, the exact mechanism of action of acetaminophen is unclear. Many common pain conditions including headache, muscle aches, arthritis, backache, toothaches, colds, and fevers are treated with acetaminophen. It relieves pain in mild arthritis but does not affect the underlying inflammation and swelling of the joint. | |
| Acetaminophen, Butalbital & Caffeine | Anolor 300, Dolgic LQ, Esgic, Fioricet, Margesic, Orbivan, Repan, Zebutal & others | Combination - Barbiturate | X | Pill | Acute | Acetaminophen is a pain reliever and fever reducer. Butalbital is a barbiturate, known to relax muscle contractions involved in a tension headache. Caffeine is a stimulant that can relax muscle contractions in blood vessels to improve blood flow. The combination is used to treat tension headaches caused by muscle contractions. Butalbital has a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment. Butalbital is not available in some countries and restricted in others due to its dangerous side effects. |
| Acetaminophen, Dichloralphenazone & Isometheptene | Duradrin, Midrin | Analgesic (painkiller) | X | Pill | Acute | Acetaminophen, dichloralphenazone, and isometheptene is a combination analgesic, sedative, and sympathomimetic. It works by decreasing pain, providing sedation, and narrowing the blood vessels in the head and brain. It is used to treat migraine, certain other types of headaches (tension, neurovascular), among other conditions. |
| Acetazolamide | Diamox, Diamox Sequels | Diuretic | X | Pill | Acute & Preventive | Acetazolamide medications are used to treat glaucoma, epilepsy, altitude sickness, periodic paralysis, idiopathic intracranial hypertension, and heart failure. It is sometimes used to treat high-pressure headaches by lowering the production of spinal fluid. Acetazolamide is not well-studied as a preventive treatment for migraine in general, and there is no solid evidence for its effectiveness outside the context of familial hemiplegic migraine. |
| Acetylsalicylic acid (ASA) | Aspirin, Baby aspirin | Nonsteroidal anti-inflammatory drugs (NSAIDs) | Orally-dissolving tablet, Pill | Acute & Preventive | Regular low-dose aspirin or "baby" aspirin may be one of the most effective ways to help prevent migraine with aura. When tested against topiramate, a common migraine preventive, Italian researchers found that low doses of aspirin daily may be up to six times more effective than topiramate. Up to 1,000 mg of aspirin may also be used in the acute treatment of migraine. | |
| Acetylsalicylic acid (ASA) or Aspirin & Combinations | AsproClear, Bayer Aspirin, Bufferin, Easprin, Ecotrin, Ecpirin, Excedrin, Fasprin & others | Combination – NSAID | Pill, Powder, and others | Acute | Aspirin/ASA is an NSAID that works by reducing substances in the body that cause pain, fever, and inflammation. It is used to treat pain and reduce fever or inflammation. Sometimes aspirin is used to treat or prevent heart attacks, strokes, and chest pain (angina) but it should be used for cardiovascular conditions only under the supervision of a doctor. Some aspirin combination drugs, like Excedrin, also contain acetaminophen and caffeine. Check the label to be sure. Overuse of combination treatments containing caffeine may lead to medication overuse headache. | |
| Acyclovir | Zovirax | Antiviral | X | Pill, Topical ointment | Preventive | Acyclovir is an antiviral drug that is used to treat infections caused by certain types of viruses. It treats shingles caused by herpes zoster and outbreaks of herpes simplex. In people with frequent outbreaks of genital herpes, acyclovir is used to help reduce the number of future episodes. Acyclovir can also be useful in the treatment of fibromyalgia and allodynia, often in conjunction with other medications. |
| Agomelatine | Valdoxan | Antidepressant | X | Pill | Preventive | Agomelatine is primarily used to treat depression. It acts on brain receptors for melatonin, a hormone that is important for regulating sleep, as well as serotonin receptors. It is the only antidepressant that acts on melatonin receptors. |
| Air pressure modulation device | Nocira | Neuromodulation | X | Device | Acute | Nocira is a new device that delivers controlled puffs of air into the ear (Automated Variable Pulse Insufflation), which stimulates pressure-activated sensory neurons to reset the brain's pain response. It was designated by the FDA as a "Breakthough Device" in April of 2022 for the acute treatment of migraine, which can help speed up FDA-approval. As of March 2023, it is not yet FDA-approved or available for use. |
| Almotriptan | Almogran, Axert | Serotonin 5-HT1 agonists or Triptans | X | Pill | Acute | Almotriptan is a second-generation serotonin 5-HT1 receptor agonist, also known as a triptan. An agonist mimics the effects of the neurotransmitter found naturally in the brain. It works by narrowing the blood vessels around the brain, blocking pain signals and the release of substances that cause other migraine symptoms. A person with migraine is thought to be hypersensitive to widened blood vessels exerting pressure on the brain. |
| Alprazolam | Niravam, Xanax | Benzodiazepines | X | Pill | Preventive | Alprazolam belongs to a group of drugs called benzodiazepines. It works by slowing down the movement of chemicals in the brain that may become unbalanced. This results in a reduction in nervous tension or anxiety. Alprazolam is used to treat anxiety disorders, panic disorders, and anxiety caused by depression. |
| Amitriptyline | Elavil, Endep | Antidepressant | X | Pill | Preventive | Amitriptyline is a tricyclic antidepressant. It affects brain chemicals that may become unbalanced. Amitriptyline is used to treat symptoms of depression. |
| Amphetamine | Adzenys XR-ODT, Dyanavel XR, Evekeo | Stimulant | X | Pill | Preventive | Amphetamine is a stimulant used to treat attention-deficit hyperactivity disorder (ADHD), narcolepsy, and obesity. Stimulants increase the level of dopamine, a neurotransmitter associated with pleasure, movement, and attention. Use of this medication should be closely monitored, as it carries a high risk for addiction. In the context of migraine, amphetamine can contribute to medication overuse headache (MOH). |
| Angiotensin-converting enzyme (ACE) inhibitors | Altace, Epanded, Prinivil, Qbrelis, Vasotec, Zestril | Hypertension | x | Pill | Preventive | Angiotensin-converting enzyme (ACE) inhibitors are commonly prescribed to treat high blood pressure, heart problems, and other conditions by helping to relax veins and arteries. A 2019 study concluded that ACE inhibitors could be used as a preventive treatment for migraine in persons with high blood pressure or high risk of side effects, but the evidence did not support use of it as a preventive otherwise. |
| Aprepitant | Emend | Neurokinin-1 receptor antagonist (antiemetic) | X | Pill | Acute | Used to prevent chemotherapy-induced or postoperative nausea and vomiting, and for CVS (Cyclic Vomiting Syndrome, a migraine variant). Also used to control nausea and vomiting related to intravenous DHE (dihydroergotamine). |
| Asenapine | Saphris | Other - schizophrenic & bipolar | X | Pill | Preventive | Asenapine treats schizophrenia. It is used alone or along with lithium or valproate to treat acute manic or mixed episodes associated with bipolar disorder or manic-depression. Asenapine is an atypical antipsychotic. Exactly how it works is not known. It may work by blocking certain substances in the brain. |
| Aspirin & Codeine | Aspalgin, Disprin Forte | Analgesic (painkiller) | X | Pill | Acute | Aspirin with codeine is an analgesic combination. It works to relieve pain by dulling pain perception in the brain and blocking certain chemicals in the body that cause pain, swelling, and inflammation. It helps relieve mild to severe pain. Codeine is an opioid and opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment. |
| Aspirin, Butalbital & Caffeine | Fiorinal, Fortabs, Farbital, Fiormor, Fiortal, Idenal, Isollyl, Lanorinal & others | Combination - Barbiturate | X | Pill | Acute | Aspirin is a pain reliever, anti-inflammatory, and fever reducer. Butalbital is part of a group of drugs called barbiturates, which have high risk for addiction and medication overuse headache (MOH). They are known to relax muscle contractions involved in tension headache. Caffeine is a stimulant that can relax muscle contractions in blood vessels to improve blood flow. The combination of aspirin, butalbital, and caffeine is used to treat tension headaches caused by muscle contractions. |
| Aspirin, Caffeine & Orphenadrine | Norgesic | Combination - NSAID | X | Pill | Acute | Orphenadrine, aspirin, and caffeine is a muscle relaxant and stimulant combination. It works by decreasing pain and inflammation, which helps muscles to relax. This combination relieves mild to moderate pain from certain muscle problems. |
| Atenolol | Tenormin | Beta blocker | X | Pill | Preventive | Atenolol is part of a group of drugs called beta blockers. Beta blockers affect the heart and the circulation of blood flow through arteries and veins. Atenolol is used to treat angina (chest pain) and hypertension. It may also be used to treat or prevent heart attack. |
| Atogepant | Qulipta | Small molecule CGRP receptor antagonist (Gepant) | X | Pill | Preventive | Atogepant is an oral CGRP receptor antagonist used for the preventive treatment of episodic migraine. Atogepant has a longer half-life than another similar gepant (ubrogepant), making it suitable for preventive treatment. It was approved by the FDA in September 2021 for episodic migraine prevention, and awaiting approval for chronic migraine as of March 2023. |
| Baclofen | Lioresal, Gablofen | Muscle Relaxant | X | Pill | Acute | Baclofen is a muscle relaxer and an antispastic agent. Baclofen is used to treat muscle symptoms caused by multiple sclerosis including spasm, pain, and stiffness. |
| Barbital/Barbitone | Medinal, Veronal | Barbiturate | X | Cachets, Pill | Preventive | As barbital is a controlled substance, other substances have largely replaced barbital-based medications. When barbitone was first introduced, it was considered a great improvement over the existing hypnotics. It was used as a sleeping aid (hypnotic) from 1903 until the mid-1950s. Barbiturates have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment. |
| Bariatric surgery | - | - | X | Procedure | Preventive | Bariatic surgery, including gastric bypass, is a weight-loss surgical procedure. Weight reduction, by means of bariatric surgery, for obese individuals may contribute to a reduction in the frequency, severity, and duration of migraine attacks. The beneficial impact of weight loss on migraine has been noted to a comparable degree for both bariatric surgery and weight lost through lifestyle modification. Obesity is associated with an increased risk of progression from episodic to chronic migraine. |
| Behavioral Health Device | Click Therapeutics | Device | TBD | Device | Preventive | Click Therapeutics has a device in development as a clinically-validated digital program for migraine that combines multiple mechanisms of actions with Click's adaptive patient engagement platform. In late 2022, this device received a Breakthrough Device designation from the FDA, which helps speed up the FDA clearance process for devices. |
| Budesonide | Entocort, Pulmicort, Rhinocort Aqua | Steroid | X | Nasal Spray, Pill | Preventive | Budesonide is a steroid that reduces inflammation in the body. Budesonide is primarily used to treat mild to moderate Crohn's disease. |
| Buprenorphine | Buprenex, Temgesic | Opioid | X | Injection, Pill | Acute | Buprenorphine is an opioid analgesic. It works on the brain and nervous system to decrease pain. It can help relieve moderate to severe pain. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment. |
| Butalbital | - | Barbiturate | X | - | Acute | Butalbital has been discontinued as a single agent and is not recommended as a single agent or in combination drugs, due to high risk for addiction and medication overuse headache (MOH). It is known to relax muscle contractions involved in a tension headache. Butalbital is often combined with other medications, such as acetaminophen, aspirin, and codeine for the treatment of headache. |
| Candesartan | Atacand, Amias, Blopress, Ratacand | Hypertension | X | Pill | Preventive | Candesartan is an angiotensin II receptor blocker (ARB). It works by relaxing blood vessels. This helps to lower blood pressure. Candesartan is used to treat high blood pressure alone or with other medicines. It is used in certain patients to treat heart failure. It may also be used for other conditions as determined by your doctor. |
| Cannabidiol oil (CBD) | Various | Phytocannabidiol | Edibles, Oils, Topicals, Sublingual, & Vapors | Acute & Preventive | CBD is the nonpsychoactive part of the cannabis, or marijuana plant. CBD oil is made by extracting CBD from the cannabis plant then diluting it with a carrier oil. It has quickly become popular in the health and wellness community, with several research-backed studies suggesting it may be helpful in alleviating such conditions as anxiety, depression, and chronic pain, including migraine. It comes in many formats including edibles such as gummies and baked goods, topical creams and gels, among others. Epidiolex is the first FDA-approved prescription for highly purified CBD oil which is used in some forms of epilepsy. | |
| Carbamazepine | Carbatrol, Epitol, Equetro, TEGretol, TEGretol XR | Anticonvulsant | X | Pill | Preventive | Carbamazepine is an anticonvulsant. It works by decreasing nerve impulses that cause seizures and pain. Carbamazepine is used to treat seizures and nerve pain such as trigeminal neuralgia and diabetic neuropathy. It is also used to treat bipolar disorder. |
| Carvedilol | Coreg | Beta blocker | X | Pill | Preventive | Carvedilol is a beta blocker. Beta blockers affect the heart and blood circulation. Carvedilol is used to treat heart failure and hypertension. It is also used after a heart attack that has compromised your heart’s ability to function effectively. |
| Celecoxib | Bextra, Celebrex, Elyxyb, Vioxx | Nonsteroidal anti-inflammatory drugs (NSAIDs) | X | Liquid, Pill | Acute & Preventive | Celecoxib is an NSAID. It works by reducing hormones that cause inflammation and pain in the body. Celecoxib is used to treat pain or inflammation caused by many conditions such as arthritis, ankylosing spondylitis, and menstrual pain. Celecoxib is also used in the treatment of hereditary polyps in the colon. Vioxx and Bextra are no longer available due to increased risk of heart attack and stroke. It is sometimes recommended before exercise to prevent a migraine attack. Celebrex is the only brand available in the U.S. Vioxx and Bextra are no longer available due to increased risk of heart attack and stroke. Elyxcyb is an oral liquid format. |
| Celecoxib | Celebrex, Vioxx, Bextra | COX inhibitor | X | Pill | Acute & Preventive | A subclass of NSAIDs that work by reducing the production of prostaglandins, the chemicals that promote inflammation, pain, and fever. The enzymes that produce prostaglandins are called cyclooxygenase (COX). There are two types: COX-1 and COX-2. Unlike older NSAIDs that block both inhibitors, the newer COX-2 inhibitors only block the COX-2 enzyme. Sometimes recommended before exercise to prevent a migraine attack. Celebrex is the only brand available in the U.S. Vioxx and Bextra are no longer available due to increased risk of heart attack and stroke. |
| Cetirizine | Zyrtec | Antihistamine | Pill | Acute | Cetirizine is an antihistamine that reduces the natural chemical histamine in the body. Histamine can produce symptoms of sneezing, itching, watery eyes, and runny nose. Cetirizine is used to treat cold or allergy symptoms such as sneezing, itching, watery eyes, or runny nose. It is also used to treat itching and swelling caused by hives. | |
| Chlorpromazine | Largactil, Thorazine | Other - schizophrenic & bipolar | X | Injection, Pill, Suppository | Preventive | Chlorpromazine is a phenothiazine. The exact way chlorpromazine works is not known. It is used to treat certain mental or mood disorders (e.g. schizophrenia), the manic phase of manic-depressive disorder, anxiety and restlessness before surgery, the blood disease porphyria, severe behavioral and conduct disorders in children, nausea and vomiting, and severe hiccups. It is also used with other medicines to treat symptoms associated with tetanus. |
| Citalopram | Cipramil, Celexa | Antidepressant | X | Pill | Preventive | Citalopram is a selective serotonin reuptake inhibitor (SSRI). This medication works by helping to restore the balance of serotonin in the brain. Citalopram is used to treat depression. It may improve your energy level and feelings of well-being. Leading neurologist Dr. Andrew Charles has flagged SSRI medications as having the potential to make migraine worse. If you take an SSRI and have migraine, consider discussing with your doctor whether an alternative medication might be right for you. |
| Clonazepam | Klonopin | Benzodiazepines | X | Pill | Acute | Clonazepam belongs to a group of drugs called benzodiazepines and is known as an anticonvulsant drug. It is used as a treatment to prevent and control seizures and also for panic attacks, insomnia, and anxiety disorders. Clonazepam works by calming down the brain and nerves. |
| Clonidine | Catapres, Dixarit, Kapvay | Hypertension | X | Pill | Preventive | Clonidine lowers blood pressure by decreasing the levels of certain chemicals in your blood. This allows your blood vessels to relax and your heart to beat more slowly and easily. Clonidine is used to treat hypertension. The Kapvay brand of clonidine is used to treat attention deficit hyperactivity disorder (ADHD). |
| Codeine | Migraleve | Opioid | X | Pill, Suppository | Acute | Codeine is used to treat mild to moderately severe pain. Codeine or 3-methylmorphine (a naturally occurring methylated morphine) is an opiate used for its analgesic, antitussive, antidiarrheal, antihypertensive, anxiolytic, antidepressant, sedative, and hypnotic properties. It is also used to suppress premature labor contractions, myocardial infarction, and for many other uses. It is often sold as a salt in the form of either codeine sulfate or codeine phosphate in the United States and Australia. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment. |
| Combination therapy | - | - | X | Various | Preventive | Combination therapy uses more than one method of treatment for a condition. An example of combination therapy for migraine prevention is using both Botox and a CGRP monoclonal antibody. An example of combination therapy for a migraine attack is using both a neuromodulation device and a triptan. |
| CPAP machine | Fisher & Paykel, Philips, RESmart, ResMed | Ventilator | X | Device | Preventive | Continuous Positive Airway Pressure (CPAP) therapy is a common treatment for obstructive sleep apnea. It includes a small machine that supplies a constant and steady air pressure, a hose, and a mask or nose cannula. |
| Cyclobenzaprine | Amrix, Fexmid, Flexeril | Muscle relaxant | X | Pill | Acute | Cyclobenzaprine is a muscle relaxant. It works by blocking nerve impulses or pain sensations that are sent to your brain. It is used together with rest and physical therapy to treat skeletal muscle conditions such as pain or injury. |
| Cyproheptadine | Periactin | Antihistamine | X | Pill | Preventive | Cyproheptadine is an antihistamine. It works by blocking the action of histamine to reduce allergy symptoms. Cyproheptadine is used to treat symptoms of allergic reactions caused by seasonal allergies, food, blood, or plasma. It is also used to treat mild, uncomplicated hives. |
| Desvenlafaxine | Khedezla, Pristiq | Antidepressant | X | Pill | Preventive | Desvenlafaxine is in the class of antidepressant drugs called selective serotonin and norepinephrine reuptake inhibitors (SNRI). SNRIs block or delay the reuptake of the neurotransmitters, serotonin and norepinephrine by the presynaptic nerves. This increases the levels of these two neurotransmitters in the synapse and tends to elevate mood. Serotonin-norepinephrine reuptake inhibitors (SNRIs) are used to treat depression, anxiety disorder, panic disorder and other mood disorders. |
| Diazepam | Valium | Other - psychoactive benzodiazepine | X | Injection, Pill, Suppository | Acute | Diazepam is a benzodiazepine. It affects chemicals in the brain that may become unbalanced and cause anxiety. Diazepam is used to treat anxiety disorders, alcohol withdrawal symptoms, or muscle spasms. Diazepam is sometimes used with other medications to treat seizures. |
| Diclofenac | Cambia, Cataflam, Voltaren, Voltaren-XR, Zipsor, Zorvolex | Nonsteroidal anti-inflammatory drugs (NSAIDs) | Injection, Gel, Pill Suppository | Acute | Diclofenac is an NSAID. It is used to treat mild to moderate pain, or signs and symptoms of osteoarthritis or rheumatoid arthritis. The Cataflam brand of this medicine is also used to treat menstrual cramps. Diclofenac oral powder (Cambia) is used to treat migraine attacks acutely. | |
| Dihydroergotamine mesylate (DHE) | Dihydergot, DHE 45, Migranal, Trudhesa | Ergot alkaloid - derivative | X | Injection, IV, Nasal Spray | Acute | Dihydroergotamine (DHE) is used to treat acute migraine with or without aura, and cluster headaches. DHE is an ergot derivative. It works by constricting blood vessels in the brain, which can help to relieve migraine. Trudhesa, a DHE nasal spray targeting the upper nasal space, was approved by the FDA in September 2021; it is thought that the nasal spray allows the medication to work faster and more effectively. |
| Diltiazem | Cardizem, Cartia XT, Dilacor XR, Dilt-CD, Diltzac, Flunarizine, Matzim LA, Tiazac & others | Calcium channel blockers | X | Pill | Preventive | Diltiazem is part of a group of drugs called calcium channel blockers. These work by relaxing the muscles of your heart and blood vessels. Diltiazem is used to treat hypertension, angina (chest pain), and certain heart rhythm disorders. |
| Dimenhydrinate | Gravol, Dramamine & others | Antihistamine, antiemetic | Injection, Liquid, Pill, Suppository | Acute | Used to prevent and treat nausea, vomiting, and dizziness due to motion sickness. Gravol is used to control vomiting associated with migraine but it has largely been replaced by Zofran (ondansetron). | |
| Diphenhydramine | Benadryl, Nytol, Simply Sleep & others | Antihistamine | Pill | Acute | Used to control high levels of histamine. May speed relief of migraine when taken with migraine medications. | |
| Divalproex sodium | Depakote, Depakote ER, Depakote Sprinkles | Anticonvulsant | X | Pill | Preventive | Divalproex sodium affects chemicals in the body that may be involved in causing seizures. It is used to treat various types of seizure disorders. It is sometimes used together with other seizure medications. Divalproex sodium is also used to treat manic episodes related to bipolar disorder and to prevent migraine headaches. |
| Domperidone | Molax, Motilium, Motinorm Costi, Nomit | Antiemetic | X | Injection, Pill, Suppository | Acute | Antiemetics help relieve the nausea associated with migraine attacks. Domperidone helps increase the transit of food through the stomach which helps facilitate its antinausea properties. |
| Dosulepin/Dothiepin | Dopress, Dothep, Prothiaden, Thaden | Antidepressant | X | Pill | Preventive | Dosulepin is a tricyclic antidepressant. This class of antidepressants is named after its chemical structure, which contains three rings of atoms. Today they have largely been replaced in clinical use by newer classes of antidepressants. |
| Doxylamine | Dozile, Restavit | Antihistamine | Pill | Acute | Doxylamine is an antihistamine. It works by depressing the central nervous system to produce drowsiness. Doxylamine is used to treat occasional sleeplessness and reduce difficulty falling asleep. | |
| Doxylamine, Paracetamol & Codeine | Mersyndol | Antihistamine | Pill | Acute | Mersyndol is an analgesic intended for short-term use to relieve moderate pain and fever. Paracetamol and codeine are both active ingredients designed to help reduce pain. See Codeine & Paracetamol. Doxylamine is a type of antihistamine that can cause drowisness and/or have a calming effect. | |
| Duloxetine | Cymbalta | Antidepressant | X | Pill | Preventive | Duloxetine is a selective serotonin and norepinephrine reuptake inhibitor (SNRI). SNRIs block or delay the reuptake of the neurotransmitters, serotonin and norepinephrine, by the presynaptic nerves. This increases the levels of these two neurotransmitters in the synapse and tends to elevate mood. SNRIs are used to treat depression, anxiety disorder, panic disorder, and other mood disorders. Duloxetine can also be useful in the treatment of fibromyalgia and allodynia. |
| Ear insufflation therapy | - | Neuromodulation | X | Procedure | Acute | Ear insufflation therapy is the administration of small bursts of air or ozone gas to the ear drum via a tool called a pneumatic otoscope. Researchers believe these controlled puffs of air stimulate pressure-activated nerve receptors found in the ears, resetting the pain centers in the brain. This in-office procedure is not currently FDA approved but rather a new and developing concept being investigated. |
| Eletriptan | Relpax | Serotonin 5-HT1 agonists or Triptans | X | Pill | Acute | Eletriptan is a second-generation triptan drug intended for the treatment of migraine. It is used as an abortive treatment to help block a migraine attack that is already in progress. |
| Epidural blood patch | - | - | X | Patch | Acute | An epidural blood patch is an injection of one's own blood into the epidural space (i.e., the area outside of the sack that contains cerebrospinal fluid, or CSF). It is used to treat headaches resulting from a CSF leak, also known as persistent or spinal headaches. |
| Eptinezumab | Vyepti | CGRP monoclonal antibody | X | IV Infusion | Preventive | Eptinezumab is a preventive CGRP monoclonal antibody approved by the FDA in February 2020, and also approved for prevention in other countries including Australia, Canada, and England. CGRP monoclonal antibodies attach to the calcitonin gene-related peptide (CGRP) and inactivate it. Eptinezumab is given as an IV infusion four times a year with few sideeffects for most people. |
| Erenumab | Aimovig | CGRP monoclonal antibody | X | Injection | Preventive | Erenumab is a preventive CGRP monoclonal antibody approved by the FDA in May 2018. This CGRP monoclonal antibody attaches to CGRP receptors to inhibit its function. Erenumab is self administered monthly. An FDA warning was added for erenumab about high blood pressure after the first dose. If you are on erenumab or start it, you should monitor your blood pressure. |
| Ergotamine tartrate | Cafergot, Ergomar, Migril | Ergot alkaloid - derivative | X | Pill, Suppository | Acute | Ergotamine is an ergot derivative. It works by narrowing blood vessels in the brain, which can help to relieve migraine. Some brands, like Cafergot, also contain caffeine. |
| Escitalopram | Lexapro | Antidepressant | X | Pill | Preventive | Escitalopram is a selective serotonin reuptake inhibitor (SSRI). It works by restoring the balance of serotonin which helps to improve certain mood problems. It is used to treat depression or generalized anxiety disorder. Leading neurologist Dr. Andrew Charles has flagged SSRI medications as having the potential to make migraine worse. If you take an SSRI and have migraine, consider discussing with your Doctor whether an alternative medication might be right for you. |
| Estrogen patch | Alora, Estraderm, EstroGel, Vivelle & others | Other - hormones | X | Transdermal patch | Preventive | An estrogen patch, using estradiol hormone, used for 7 to 10 days during the tail end of the menstrual cycle before a menstrual period may blunt the cyclic fall in estrogen and prevent a menstrual migraine. |
| Eszopiclone | Lunesta | Hypnotic | X | Pill | Acute | Eszopiclone is a sedative, also called a hynoptic. It affects chemicals in one's brain that may be unbalanced in people with insomnia. Eszopiclone causes relaxation to help one fall asleep and stay asleep. |
| External combined occipital and trigeminal neurostimulation (COT-NS) device | Relivion MG | Neuromodulation | X | Device | Acute | Relivion is a smartphone-controlled, cloud-connected neuromodulation device. It delivers stimulation to six branches of the occipital and trigeminal nerves via three adaptive output channels. This releases neurotransmitters in the brain stem and modulates brain networks associated with control of pain and mood. Cleared by FDA in March 2021 and is available with a prescription in the U.S. for acute treatment. It is being studied for the prevention of migraine. |
| Eye Drops – Dry Eyes | Artificial Tears, Cyclosporine, Restasis | Immunosuppressant | X | Eye drops | Preventive | Because dry-eye symptoms are prevalent in people with migraine, doctors may prescribe artificial tears. Nonprescription eye drops contain preservatives, while prescription formulas like Cyclosporine or Restasis do not. Both decrease inflammation that can cause dry eyes and discomfort for people with migraine. |
| Eye drops – Glaucoma | Levobunolol, Timolol | Beta blocker | X | Eye drops | Acute & Preventive | Beta blocker eye drops, used to treat glaucoma, have been shown in a series of patients to provide almost complete pain relief from acute migraine over years of use. The mechanism of action of the drops is believed to be the passage of the beta blockers into the nasal cavity, which is then rapidly absorbed into the blood vessels. |
| Famciclovir | Famvir | Antiviral | X | Pill | Preventive | Famciclovir is an antiviral drug that is used to treat infections caused by certain types of viruses. It treats shingles caused by herpes zoster and outbreaks of herpes simplex. In people with frequent outbreaks of genital herpes, famciclovir is used to help reduce the number of future episodes. It can also be useful in the treatment of fibromyalgia and allodynia, often in conjunction with other medications. |
| Fludrocortisone | Florinef Acetate | Steroid | X | Pill | Preventive | Fludrocortisone is a corticosteroid. It works by causing the kidneys to retain sodium and acting as a replacement for cortisone when the body does not produce enough. It is used to treat adrenocortical insufficiency in Addison’s disease and for treating salt-losing adrenogenital syndrome. |
| Flunarizine | Sibelium | Calcium channel blockers | X | Pill | Preventive | Flunarizine is part of a group of drugs called calcium channel blockers. These work by relaxing the muscles of your heart and blood vessels. Flunarizine reduces calcium entry into neurons making them less “excitable.” |
| Fluoxetine | Lovan, Prozac, Sarafem | Antidepressant | X | Pill | Preventive | Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) antidepressant used to treat major depressive disorder, bulimia nervosa, obsessive-compulsive disorder, panic disorder, and premenstrual dysphoric disorder (PMDD). Leading neurologist Dr. Andrew Charles has flagged SSRI medications as having the potential to make migraine worse. If you take an SSRI and have migraine, consider discussing with your Doctor whether an alternative medication might be right for you. |
| Fluvoxamine | Luvox | Antidepressant | X | Pill | Preventive | Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI). It works by restoring the balance of serotonin, a natural substance in the brain, which helps to decrease obsessive or compulsive behavior. It is used to treat obsessive-compulsive disorder (OCD) and other conditions. Leading neurologist Dr. Andrew Charles has flagged SSRI medications as having the potential to make migraine worse. If you take an SSRI and have migraine, consider discussing with your doctor whether an alternative medication might be right for you. |
| Fosaprepitant | Emend for Injection | Neurokinin 1 receptor antagonist (antiemetic) | X | Injection | Acute | Used to prevent chemotherapy-induced or postoperative nausea and vomiting and for CVS (Cyclic Vomiting Syndrome, a migraine variant). Also used to control nausea and vomiting related to intravenous DHE (dihydroergotamine). |
| Fremanezumab | Ajovy | CGRP monoclonal antibody | X | Injection | Preventive | Fremanezumab is a preventive monoclonal antibody approved by the FDA in September 2018 for the prevention of migraine. This CGRP monoclonal antibody attaches to CGRP and inactivates it. Ajovy is self administered monthly or quarterly, as your physician advises. |
| Frovatriptan | Frova, Migard | Serotonin 5-HT1 agonists or Triptans | X | Pill | Acute | Frovatriptan is a triptan. It works by narrowing the blood vessels in the brain, which helps to relieve migraine. It is used to treat acute migraine with or without aura in adults. It should not be used as a migraine preventive. |
| Gabapentin | Gabarone, Gralise, Horizant, Neurontin | Anticonvulsant | X | Pill | Preventive | Gabapentin is an anticonvulsant medication. It affects chemicals and nerves in the body that are involved in the cause of seizures and some types of pain. Gabapentin is used in adults to treat nerve pain caused by herpes virus or shingles. The Horizant brand is also used to treat restless legs syndrome (RLS). The Neurontin brand is also used to treat seizures in adults and children who are at least 3 years old. |
| Galcanezumab | Emgality | CGRP monoclonal antibody | X | Injection | Preventive | Galcanezumab is a CGRP monoclonal antibody approved by the FDA in September 2018 for prevention of migraine, and for treatment of episodic cluster headache in June 2019. This CGRP monoclonal antibody attaches to CGRP and inactivates it. Emgality is self administered monthly for migraine. For cluster, it is self administered initially at a loading dose at the start of a cluster period and then monthly until the end of the cluster period. |
| Greater occipital nerve (GON) block | Decadron, Dexamethasone Intensol, Dexasone, Solurex, Baycadron / Xylocaine, XTLido & others | Other - steroid & anesthetic | X | Injection | Preventive | This treatment injects a steroid and lidocaine into the greater occipital nerve (GON) to block pain messages to the brain from the GON. The occipital nerves are two pairs of nerves originating in the upper cervical vertebrae. The GON is located beneath the scalp in the back of the head. This region of the brain deals with vision including color recognition, spatial awareness, and word recognition. Most people who have migraine and headache also have tenderness in the suboccipital region of the skull. In cases where migraine is resistant to medication, or treatment is hindered by adverse effects, a GON block may be explored. |
| Hormonal Contraceptives | Various | Other - Hormones | X | Intradermal, Intrauterine Device, Patch, Pill, Vaginal Ring | Preventive | Hormonal contraceptives are birth control that use hormones to prevent pregnancy. They contain estrogen and progesterone, or progesterone only. They prevent pregnancy by blocking the release of eggs from the ovaries, thinning the lining of the uterus, or thickening the mucus in the cervix to help keep sperm from reaching the egg. Hormonal contraceptives may be taken by mouth, injected or inserted under the skin, placed on the skin as a patch, or placed in the vagina or uterus. Dips in estrogen are most commonly associated with migraine onset, which may lead menstruating persons to seek out hormonal balancing methods as a form of treatment. |
| Hormone replacement therapy (HRT) | - | Other - hormones | X | Cream, Patch, Pill | Preventive | Hormone replacement therapy (HRT), also known as hormone therapy, or menopausal hormone therapy (MHT), depending on the country you are in, is typically prescribed for those experiencing natural or surgically-induced menopause. Hormones commonly involved are estrogens, progesterone or progestins, and sometimes testosterone. These hormones can either be bioidentical or synthetic. Hormones, and major changes in them, can be a trigger for many people so HRT can help balance hormones in an aim to reduce migraine. |
| Hydrocodone | Hysingla ER, Zohydro ER | Opioid | X | Nasal Spray, Pill, Suppository | Acute | Hydrocodone is an opioid pain medication. Zohydro ER and Hysingla ER are extended-release forms of hydrocodone that are used for around-the-clock treatment of severe pain. Extended-release hydrocodone is not for use on an as-needed basis for pain. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment. |
| Hydromorphone | Dilaudid-HP, Jurnista | Opioid | X | Pill | Acute | Hydromorphone is an opioid analgesic. It works in the brain and nervous system to reduce pain. It is used to treat moderate to severe pain in opioid-tolerant patients who require larger than usual doses to provide adequate pain relief. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment. |
| Hydroxyzine | Atarax, Alamon, Equipose, Hyzine, Rezine, Vistaril IM, Vistazine & others | Antihistamine | X | Injection, Pill | Acute | Hydroxyzine reduces activity in the central nervous system. It also acts as an antihistamine that reduces natural chemical histamine in the body. Histamine can produce symptoms of sneezing and runny nose, or hives on the skin. Hydroxyzine is used as a sedative to treat anxiety and tension. It is also used with other medications for anesthesia. Hydroxyzine may also be used to control nausea and vomiting, and to treat allergic skin reactions such as hives or contact dermatitis. |
| Ibuprofen | Advil, Genpril, IBU, Midol, Motrin, Nuprin, Nurofen & others | Nonsteroidal anti-inflammatory drugs (NSAIDs) | Injection, Pill, Suppository, Topical | Acute | Ibuprofen is an NSAID that works by reducing hormones that cause inflammation and pain in the body. Ibuprofen is used to reduce fever and treat pain or inflammation caused by many conditions such as headache, toothache, back pain, arthritis, menstrual cramps, or minor injury. | |
| Ibuprofen & Codeine | ProVen Plus, Panafen Plus, Nurofen Plus, Rafen Plus | Nonsteroidal anti-inflammatory drugs (NSAIDs) | Pill | Acute | Ibuprofen, an NSAID, combined with codeine, an opioid, is used to reduce pain and inflammation. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment. See ibuprofen and codeine for their separate descriptions. | |
| Indomethacin | Indocid, Indocin | Nonsteroidal anti-inflammatory drugs (NSAIDs) | X | Pill | Acute | Indomethacin is used to treat patent ductus arteriosus (PDA) in certain premature infants. It is thought to work by blocking the action of a certain chemical in the body called prostaglandin. |
| Intrauterine Device (IUD) | Kyleena, Liletta, Mirena, ParaGard, Skyla | Other - hormones | X | Device | Preventive | An IUD is a T-shaped device that is inserted into the uterus as a birth control method. There are five types, four of which are hormonal (Liletta, Kyleena, Mirena, and Skyla) and one that is made of copper and is hormone free (ParaGard). For some women with menstrual migraine, continuous hormone treatment may be helpful in preventing attacks linked to falling estrogen levels. |
| Irbesartan | Abisart, Avapro | Hypertension | X | Pill | Preventive | Irbesartan is an angiotensin II receptor blocker (ARB), which relaxes blood vessels. This helps to lower blood pressure. It is also used in certain patients to treat kidney problems caused by diabetes. |
| Isometheptene mucate | Duradrin, Midrin | Other | Pill | Acute | Isometheptene works by causing the blood vessels in the brain to narrow. By decreasing the width of blood vessels, isometheptene helps relieve the pain from migraine attacks. It is often used in combination with other active ingredients. The British National Formulary states that, as more effective preparations are now available, this is no longer widely used. | |
| Ketamine | Ketalar | Anesthetic | X | Injection, IV | Acute | Ketamine is an anesthetic. It works in the brain to inhibit painful sensations. Because it has powerful psychogenic side effects and can produce adverse reactions in some patients, it is frequently administered under careful supervision by an anesthesiologist. |
| Ketoprofen | Actron, Orudis, Oruvail | Nonsteroidal anti-inflammatory drugs (NSAIDs) | X | Injection, Pill, Topical | Acute | Ketoprofen is an NSAID. Exactly how it works is not known. It may block certain substances in the body that are linked to inflammation. NSAIDs treat the symptoms of pain and inflammation. They do not treat the disease that causes those symptoms. Ketoprofen is used to treat rheumatoid arthritis or osteoarthritis, menstrual cramps and pain, and other conditions as determined by your doctor. |
| Ketorolac | Toradol | Nonsteroidal anti-inflammatory drugs (NSAIDs) | X | Injection, IV, Pill | Acute | Ketorolac is an NSAID indicated for short-term management of moderate to severe pain. Concerns about the high incidence of side effects has led to restriction in its dosage and maximum duration of use. In the U.K., treatment should be initiated only in a hospital. Maximum duration of treatment should not exceed five days for tablets, or two days for continuous daily dosing with intravenous or intramuscular formulations. May be used intravenously in hospital or emergency settings. Ketorolac is used in the short-term treatment of moderately severe pain (usually after surgery), alone or in combination with other medicines. |
| Lasmiditan | Reyvow | 5-HT1F receptor agonist (Ditan) | X | Pill | Acute | Like triptans, ditans work on serotonin receptors, but they work on the receptors that are not found on the blood vessels. Ditans are a potential acute therapy option for people with migraine who have heart conditions, as they avoid the blood vessels while working on similar mechanisms as triptans. Lasmiditan has been shown to work when migraine pain has progressed to moderate or severe. |
| Levetiracetam | Keppra | Anticonvulsant | X | Pill | Preventive | Levetiracetam is an anticonvulsant. Exactly how it works is not known, but it may work by slowing abnormal nerve impulses in the brain. Levetiracetam is used to treat partial-onset, myoclonic, or other types of seizures in patients with epilepsy. It may be used in combination with other medicines. |
| Lidocaine | Burn-O-Jel, LMX4, LMX5 | Analgesic (painkiller) | x | Topical | Acute | Lidocaine is commonly used for numbing an area of the body to reduce pain or discomfort. Some topical lidocaine prescriptions can also be used to relieve nerve pain — these come in forms of gel or skin patches that can be worn on the neck, shoulders and forehead for migraine. Over-the-counter creams are also available to help relieve joint and muscle pain. |
| Lithium | Eskalith, Lithobid | Antimanic agent | X | Pill, Solution | Preventive | Lithium can be used to prevent hypnic headache, a type of headache that occurs exclusively during sleep and awakens the patient. Taken at bedtime, lithium has been shown to be effective in preventing a hypnic headache attack from occurring. Lithium is also indicated for use as a mood stabilizer to treat manic episodes associated with bipolar disorder. Lithium should be used with caution in cases of kidney or thyroid disease, dehydration, or in conjunction with diuretics. |
| Loratadine | Alavert, Alavert Allergy, Claritin, Clear-Atadine Children's, Dimetapp ND, Tavist ND, Wal-itin & others | Antihistamine | Pill | Acute | Loratadine is an antihistamine that reduces the effects of natural chemical histamine in the body. Histamine can produce symptoms of sneezing, itching, watery eyes, and runny nose. Loratadine is used to treat the symptoms of allergies, such as sneezing, watery eyes, and runny nose. It is also used to treat skin hives and itching in people with chronic skin reactions. | |
| Lorazepam | Ativan | Benzodiazepines | X | Injection, Pill | Acute | Lorazepam belongs to a group of drugs called benzodiazepines and is used to treat the symptoms of anxiety disorders. It is thought lorazepam works by enhancing the activity of certain neurotransmitters in the brain. |
| Lysergic Acid Diethylamide (LSD) | N/A | Psychedelics | TBD | Oral | Acute & Preventive | Lysergic acid diethylamide (LSD) is a type of psychedelic--a type of drug that can alter perception, emotion, and cognition without impairing memory or inducing delirium. LSD, and other psychedelics, have been reported to abort attacks and to decrease frequency and intensity of attacks in people suffering from cluster headaches. LSD is in clinical trials and not yet available outside trials. |
| Marijuana/Medical cannabis | - | - | X | Edibles, Oils, Pill, Tea | Acute | The use of medical marijuana for the management of chemotherapy-induced nausea, glaucoma, spasticity in multiple sclerosis, and neuropathic pain has been clinically demonstrated to some extent. The likelihood of undesirable adverse reactions limits its applications, and therapeutic use may be limited to either concomitant therapy or when conventional therapy has failed. |
| Meclizine | Antivert, Bonine, Dramamine Less Drowsy | Antiemetics | Pill | Acute & Preventive | Meclizine is an antiemetic with less associated drowsiness than some other antiemetics. It is used to help prevent motion sickness and treat dizziness (vertigo), both of which can be symptoms of migraine. | |
| Mefenamic acid | Ponstan, Ponstel | Nonsteroidal anti-inflammatory drugs (NSAIDs) | Pill | Acute | Mefenamic acid is an NSAID. Exactly how it works is not known. It may block certain substances in the body that are linked to inflammation. NSAIDs treat the symptoms of pain and inflammation. Mefenamic acid is used for menstrual pain. It may be used for short term (no more than 7 days) treatment of mild to moderate pain. | |
| Meloxicam | Mobic, Movalis | Nonsteroidal anti-inflammatory drugs (NSAIDs) | X | Pill | Acute | Meloxicam is an NSAID that works by reducing hormones that cause inflammation and pain in the body. Meloxicam is used to treat pain or inflammation caused by osteoarthritis or rheumatoid arthritis in adults and children who are at least 2 years old. |
| Memantine | Abixa, Akatinol, Axura, Ebixa, Memox, Namenda | Other - central nervous system agent | X | Pill | Preventive | Memantine is an N-methyl-D-aspartate (NMDA) receptor antagonist. It works by blocking excess activity of a substance in the brain called glutamate, which may reduce the symptoms associated with Alzheimer disease. Memantine is not a cure for Alzheimer disease. It is used to help treat moderate to severe Alzheimer-type dementia. |
| Menopausal Replacement Therapy (MHT) | Various | Other - Hormones | X | Cream, Patch, Pill | Preventive | Menopausal hormone therapy (MHT), also known as hormone therapy, or hormone replacement therapy (HRT), depending on the country you are in, is typically prescribed for those experiencing either natural or surgically induced menopause. Hormones commonly involved are estrogens, progesterone or progestins, and sometimes testosterone. These hormones can either be bioidentical or synthetic. Hormones, and major changes in them, can be a trigger for many people so MHT can help balance hormones in an aim to reduce migraine. |
| Meperidine | Demerol | Opioid | X | Injection, Pill | Acute | Meperidine is an opioid analgesic. It works in the brain and nervous system to decrease pain. Meperidine is used in the short-term treatment of moderate to severe pain. It may also be used before or during surgery (e.g. to support anesthesia), for pain relief during labor and delivery, or for other conditions as determined by your doctor. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment. |
| Metaxalone | Skelaxin | Muscle relaxant | X | Pill | Acute | Metaxalone is a muscle relaxant used to relax muscles and relieve pain caused by strains, sprains, and other musculoskeletal conditions. Its exact mechanism of action is not known, but it may be due to general central nervous system depression. |
| Methazolamide | GlaucTabs, Neptazane | Diuretic | X | Pill | Acute & Preventive | These medications are used to treat glaucoma, epilepsy, altitude sickness, periodic paralysis, idiopathic intracranial hypertension, and heart failure. Sometimes used to treat high-pressure headaches by lowering the production of spinal fluid. |
| Methocarbamol & Acetaminophen | Robaxin, Robaxacet | Muscle relaxant | Injection, Pill | Acute | Methocarbamol is a central muscle relaxant used to treat skeletal muscle spasms. It is used in conjunction with acetaminophen. See acetaminophen for a separate description of this medication. | |
| Methyl salicylate | Menthoderm, Thera-Gesic Plus, Salonpas Pain Patch | Other - topical rubefacient | Topical | Acute | Methyl salicylate, or menthol cream, is a topical analgesic. It works by temporarily relieving minor pain. Topical rubefacients cause irritation and reddening of the skin, due to increased blood flow. They are used in the treatment of pain in various musculoskeletal conditions and in the temporary relief of minor aches and pains caused by arthritis, simple backache, strains, sprains, and bruises. | |
| Methysergide | Deseril, Sansert | Anti-serotonergic (Anti 5-HT) | X | Pill | Preventive | The exact way that methysergide works is unknown. It is believed to be involved in narrowing the veins and arteries that supply blood to your head. Serotonin 5-HT is a chemical occurring in the body, and is thought to play a key role in migraine. These drugs block 5-HT2 receptors to stop the effects of 5-HT. Methysergide is a semi-synthetic ergot alkaloid. It should only be administered under hospital supervision because of potential side effects including retroperitoneal fibrosis and fibrosis of heart values and pleura. |
| Metoclopramide | Maxolon, Metozolv ODT, Pramin, Reglan | Antiemetic | X | Injection, Pill | Acute | Metoclopramide increases muscle contractions in the upper digestive tract which speeds up the rate at which the stomach empties into the intestines. It is used short term to treat heartburn caused by gastroesophageal reflux when other medications have not relieved symptoms. Metoclopramide is also used to treat slow gastric emptying in people with diabetes (also called diabetic gastroparesis) which can cause nausea, vomiting, heartburn, loss of appetite, and a feeling of fullness after meals. |
| Metoclopramide & Paracetamol | Anagrain, Metomax, Paramax | Combination - Analgesic & antiemetic | Pill | Acute | The combination of metoclopramide and paracetamol is used to treat the symptoms of migraine, both to relieve headache (the paracetamol) and to treat associated nausea and vomiting (the antiemetic). In addition to its direct antiemetic effect, metoclopramide also stimulates gastric emptying (prokinetic), which is often delayed during migraine attacks, and accelerates the absorption of paracetamol. | |
| Metoprolol | Dutoprol, Betaloc, Lopressor | Beta blocker | X | Pill | Preventive | Metoprolol is a beta blocker that affects the heart and circulation. Metoprolol is used to treat angina (chest pain) and hypertension. It is also used to treat or prevent heart attack. |
| Migraine and Headache Telehealth | Cove, Neura Health | Diagnostics | - | Digital Therapeutics | Acute & Preventive | Migraine and headache telehealth-services allows people who are not easily able to see migraine specialists (whether due to location or health reasons) the ability to get migraine specific care from the comfort of their home. Diagnosing migraine, prescription renewals, diary tracking, referrals, and behavior and lifestyle coaching can all be done with telehealth services. |
| Migraine Cocktail | - | X | Intramuscular, Intraveneous, Pill | Acute | Combinations of medications and treatments for severe migraine attacks are informally referred to as a “migraine cocktail.” Treatment can occur at an urgent care, in an outpatient infusion center, in an emergency department, or when someone is admitted to hospital for treatment of migraine. The exact combination could be different for every patient, but the treatment often includes nonsteroidal anti-inflammatory drugs (NSAIDs) such as ketorolac. A person may also receive magnesium, certain medications to reduce nausea or vomiting, diphenhydramine (Benadryl®), dihydroergotamine (DHE), steroids, and/or IV fluids. | |
| Mini-prevention | - | - | X | Various | Preventive & Acute | Mini-prevention involves keeping a diary or journal to track days of migraine attacks to identify the days at risk in advance and then treat in anticipation of those days. Treating in anticipation of risk involves starting treatment a day before the attack onset (or the morning of) and then continuing treatment twice daily for five to seven days. A person would continue this regimen regardless of whether an attack is occurring because the likelihood of an attack in that time period is high. Mini-prevention is especially helpful for the treatment of menstrually-related migraine. |
| Mirtazapine | Remeron | Antidepressant | X | Pill | Preventive | Mirtazapine is an antidepressant. It affects chemicals in the brain that may become unbalanced and cause depression. Mirtazapine is used to treat major depressive disorder. |
| Mometasone | Elocon, Nasonex | Steroid | Nasal Spray, Topical | Acute | Mometasone is a corticosteroid that works by reducing inflammatory reactions and modifying immune reactions in the body. The topical format is used for treating and preventing allergic nasal symptoms including congestion, sneezing, itching, and runny nose. It is also used for treatment of growths in the nose (nasal polyps). As a spray, it reduces inflammatory reactions in the nasal airway in response to allergens and irritants in the air. It is used to treat itching, redness, and swelling in many skin conditions. | |
| Morphine | AVINza, Kadian, MS Contin | Opioid | X | Inhalation, Injection, Pill, Suppository | Acute | Morphine is an opioid pain medication. Morphine is used to treat moderate to severe pain. Short-acting formulations are taken as needed for pain. The extended-release form of this medicine is for around-the-clock treatment of pain and is not for use on an as-needed basis for pain. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment. |
| Moxonidine | Physiotens | Hypertension | X | Pill | Preventive | Moxonidine is a blood pressure treatment that works by relaxing the muscles in the walls of your blood vessels. This means that your blood vessels widen, which reduces your blood pressure and allows blood and oxygen to circulate more freely around your body. |
| Nadolol | Corgard | Beta blocker | X | Pill | Preventive | Nadolol is a beta blocker. It works by slowing down the heart and decreasing the amount of blood it pumps out. This helps to decrease blood pressure, helps the heart pump more efficiently, and reduces the workload on the heart. Nadolol is used in the long-term management of angina (chest pain). It is also used alone or with other medicines to treat high blood pressure. |
| Naproxen | Aleve, Anaprox, Midol Extended Relief, Naprelan 375, Naprosyn, Synflex & others | Nonsteroidal anti-inflammatory drugs (NSAIDs) | Pill | Acute | Naproxen is an NSAID that works by reducing hormones that cause inflammation and pain in the body. Naproxen is used to treat pain or inflammation caused by conditions such as arthritis, ankylosing spondylitis, tendinitis, bursitis, gout, or menstrual cramps. Naproxen is the preferred NSAID for long-term use in people with a high risk of cardiovascular complications, due to its relatively low risk of causing such complications. | |
| Naratriptan | Amerge, Naramig | Serotonin 5-HT1 agonists or Triptans | X | Pill | Acute | Naratriptan is a serotonin 5-HT1 receptor agonist. It works by narrowing blood vessels in the brain. It is used to relieve certain types of migraine. |
| Nimodipine | Nimotop | Calcium channel blockers | X | Injection, Pill | Preventive | Nimodipine is a calcium channel-blocking agent. Exactly how nimodipine works is unknown. It is used to help reduce problems from a lack of oxygen caused by bleeding from a blood vessel in the brain. |
| Nitrazepam | Alodorm, Insoma, Mogadon, Nitrosun, Ormodon, Paxadorm, Somnite & others | Hypnotic | X | Pill | Acute | Nitrazepam is a hypnotic drug of the benzodiazepine class, indicated for the short-term relief of severe, disabling anxiety and insomnia. It also has sedative and motor-impairing properties, as well as amnestic, anticonvulsant, and skeletal muscle relaxant effects. |
| Nonsteroidal anti-inflammatory drugs (NSAIDs) | Advil, Aleve, Bayer Aspirin, Celebrex, Miniprin, Motrin, Ponstel, Voltaren & others | Nonsteroidal anti-inflammatory drugs (NSAIDs) | Pill | Acute & Preventive | Nonsteroidal anti-inflammatory drugs (NSAIDs) are a group of medicines that reduce inflammation and relieve pain and fever. There are many different kinds of NSAIDs which can be grouped according to their preference for COX-1 and COX-2 enxymes. NSAIDs are used to treat mild-to-moderate pain from a wide range of conditions including headaches, migraine attacks, arthritis, toothache and fevers. | |
| Nortriptyline | Allegron, Pamelor | Antidepressant | X | Pill | Preventive | Nortriptyline belongs to a group of medicines called tricyclic antidepressants (TCAs). It is used to treat depression and some other conditions. It affects chemicals in the brain that may become unbalanced. |
| Omega Procedure (see also Reed Procedure®) | - | Neuromodulation | X | Surgically implanted neuromodulation | Preventive | The Omega Procedure is a trademarked surgical procedure for patients diagnosed with chronic migraine that involves implanting an occipital-nerve stimulator beneath the skin while the patient is under general anesthesia. It requires an initial minor surgery for a trial period, and a second surgery for permanent implantation as well as a battery-pack change every 10 years. Removal or repair requires surgery. The Omega Procedure and the Reed Procedure® are the same surgical procedure; the difference is solely in their registered names. From a practical standpoint, the difference comes in the relative experience of the physicians involved. Not FDA approved. |
| OnabotulinumtoxinA | Botox | Muscle relaxant | X | Injection | Preventive | OnabotulinumtoxinA (Botox), is made from the bacteria that causes botulism. Botulinum toxin blocks nerve activity in the muscles, causing a temporary reduction in muscle activity. Botox can be used to prevent chronic migraine in adults but should not be used to treat tension headache. It is an in-office procedure where multiple injections are inserted into the muscles of the forehead, head and neck. Treatment is repeated every 12 weeks if successful; however, there are maximum dose limits to be aware of. Botox is also used for other conditions and for cosmetic purposes. Botox can be combined with many other types of treatment. |
| Ondansetron | Zofran, Zofran ODT, Zuplenz | Antiemetic | X | Injection, Pill | Acute | Ondansetron blocks the actions of chemicals in the body that can trigger nausea and vomiting. It is used to prevent nausea and vomiting that may be caused by surgery or by medicine to treat cancer (chemotherapy or radiation). It can be taken prior to acute migraine medications to increase medication absorption and to decrease nausea and vomiting from migraine. |
| Oxycodone | Endone, Oxecta, OxyContin, Oxyfast, Roxicodone | Opioid | X | Injection, Pill, Suppository | Acute | Oxycodone is an opioid pain medication used to treat moderate to severe pain. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment. |
| Oxygen | - | Inhalant/Device | X | Cannula/Mask | Acute & Preventive | It has been shown that oxygen causes a marked decrease in cerebral blood flow concurrent with a reduced degree of pain in cluster headache. There are two high-flow oxygen delivery methods for migraines: normobaric and hyperbaric, with normobaric more effective for migraine. |
| Oxymetazoline nasal | Allerest, Afrin, Mucinex, Nostrilla, Sinex | Decongestant | Nasal Spray | Acute | Oxymetazoline solution is a decongestant. It works by shrinking swollen and congested nasal tissues (mucous membranes) by constricting blood vessels. This helps relieve congestion, improve drainage of mucus, and improve breathing through the nose. Local application using nose drops or sprays causes more intense and rapid vasoconstriction than oral medicines such as tablets or syrups. | |
| Pantoprazole | Protonix, Protonix IV, Somac | Proton-pump inhibitors | X | Injection, Pill | Acute | Pantoprazole is a proton-pump inhibitor that decreases the amount of acid produced in the stomach. It is used to treat erosive esophagitis and other conditions involving excess stomach acid, such as Zollinger-Ellison syndrome. Pantoprazole is not for immediate relief of heartburn symptoms. Leading neurologist Dr. Andrew Charles has flagged proton-pump inhibitors as having the potential to make migraine worse. If you use one and have migraine, consider discussing with your doctor whether an alternative medication might be right for you. |
| Paracetamol & Codeine | Paracodol | Opioid | X | Pill | Acute | Paracetamol combined with codeine phosphate is used for the relief of moderate to severe pain when milder painkillers are not effective. Paracetamol is an analgesic and also an antipyretic, which helps reduce your body temperature if you have a fever. Codeine phosphate is also an analgesic and acts by blocking pain and emotional response to pain. See codeine for more detail. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment. |
| Paracetamol & Ibuprofen | Maxigesic | Combination - Analgesic & NSAID | Pill | Acute | For the temporary relief of mild to moderate pain associated with migraine, headache, backache, menstrual pain, dental pain, rheumatic and muscular pain, pain of non-serious arthritis, cold and flu symptoms, sore throat and fever. This combination is especially suitable for pain which requires stronger analgesia than ibuprofen or paracetamol alone. | |
| Paracetamol (Acetaminophen) | Little Fevers, Panadol, Tylenol & others | Analgesic (painkiller) | Liquid, Pill, Suppository | Acute | Paracetamol is also known as Acetaminophen depending on where you live. A pain reliever and fever reducer, the exact mechanism of action of paracetamol is unclear. Many common pain conditions including headache, muscle aches, arthritis, backache, toothaches, colds, and fevers are treated with paracetamol. It relieves pain in mild arthritis but does not affect the underlying inflammation and swelling of the joint. | |
| PFO valve closure | - | - | X | Procedure | Preventive | Multiple studies suggest that migraine with aura is more prevalent in subjects with patent foramen ovale (PFO), an open passage between the chambers of the heart. Several studies suggest that PFO closure, a surgical procedure, may be an effective treatment for migraine. However, the grade of evidence from these studies is low. |
| Phenylephrine Hydrochloride & Ibuprofen | Sudafed PE | Combination - Decongestant & NSAID | Pill | Acute | Contains ibuprofen and phenylephrine hydrochloride, which are effective in relieving the symptoms of influenza and cold, including fever, headache, painful sinuses, sore throat, and muscle and joint pain. Moreover, it helps relieve a runny or stuffy nose and nasal sinuses. | |
| Phenylephrine Hydrochloride & Paracetamol | Dimetapp PE Sinus Pain, Lemsip Cold & Flu, Panadol Cold & Flu, Sudafed | Combination - Decongestant & Analgesic | Pill | Acute | This combination medication contains a decongestant & analgesic (paracetamol) and can help ease symptoms such as blocked or runny nose, sore throat, and body aches and headaches. | |
| Pizotifen | Sandomigran | Anti-serotonergic (Anti 5-HT) | X | Pill | Preventive | Pizotifen acts on serotonin 5-HT, a chemical that is thought to play a key role in migraine. It is part of a class of drugs that block 5-HT2 receptors to inhibit the effects of 5-HT. Pizotifen also has antihistamine properties and is related to the tricyclic group of antidepressants. |
| Potassium | Various | Vitamin/Supplement | X | IV Infusiton, Pill, Liquid | Acute & Preventive | A mineral and electrolyte that assists in several body functions, including blood pressure, water balance, muscle contractions, digestion, heart rhythm and pH balance. It is sometimes taken in supplement form to balance electrolytes which are often low due to migraine and nausea. |
| Prednisone | Rayos, Sterapred | Steroid | X | Injection, Nasal Spray, Pill, Suppository, | Acute | Prednisone is a corticosteroid that prevents the release of substances in the body that cause inflammation. It is used as an anti-inflammatory or an immunosuppressant medication. Prednisone treats many different conditions such as allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, and breathing disorders. |
| Pregabalin | Lyrica | Anticonvulsant | X | Pill | Preventive | Pregabalin is an anticonvulsant and neuropathic pain agent. Exactly how pregabalin works is not known. It is thought to bind to certain areas in the brain that help reduce seizures, nerve pain, and anxiety. Pregabalin is used to treat fibromyalgia or nerve pain caused by certain conditions (e.g., shingles, diabetic nerve problems, spinal cord injury). It is also used in combination with other medicines to treat certain types of seizures. Pregabalin can also be useful in the treatment of allodynia. |
| Prochlorperazine | Buccastem, Compazine, Phenotil, Stemzine, Stemetil | Antiemetic & Antipsychotic | X | Injection, Pill, Suppository | Acute | Prochlorperazine is a phenothiazine. It is not known exactly how it works. It is a highly potent typical antipsychotic, 10–20× more potent than chlorpromazine. It is used to help control severe nausea and vomiting, and to treat schizophrenia. It is also used to treat migraine. Intravenous administration can be used to treat status migrainosus. |
| Promethazine | Phernergan, Phenadoz, Promethegan | Antihistamine & antiemetic | X | Injection, Pill, Suppository | Acute | Promethazine works by changing the actions of chemicals in your brain. Promethazine also acts as an antihistamine. It blocks the effects of the naturally occurring chemical histamine in your body. Promethazine is used to treat allergy symptoms such as itching, runny nose, sneezing, itchy or watery eyes, hives, and itchy skin rashes. It also prevents motion sickness, and treats nausea and vomiting or pain after surgery. It is also used as a sedative or sleep aid. |
| Propranolol | Hemangeol, Inderal LA, Inderal XL, InnoPran XL, Inderal | Beta blocker | X | Injection, Pill, Suppository | Preventive | Propranolol is a beta blocker. Beta blockers affect the heart and blood circulation. Propranolol is used to treat tremors, angina (chest pain), hypertension, heart rhythm disorders, and other heart or circulatory conditions. It is also used to treat or prevent heart attack and to reduce the severity and frequency of migraine. |
| Psilocybin | N/A | Psychedelics | TBD | Oral | Preventive | Psilocybin is a naturally occurring psychedelic prodrug compound produced by various species of mushrooms. The prodrug is converted by the body to psilocin, which has mind-altering effects similar to LSD and mescaline. Psilocybin has been reported to abort cluster headache attacks. It is in clinical trials and not yet medically available. |
| Pseudoephedrine | Contac Cold, Elixsure Decongestant, Entex, Genaphed, Sudafed, Suphedrin, Unifed & others | Decongestant | Pill | Acute | Pseudoephedrine is a decongestant that shrinks blood vessels in the nasal passages. Dilated blood vessels can cause nasal congestion or stuffy nose. Pseudoephedrine is used to treat nasal and sinus congestion, or congestion of the tubes that drain fluid from your inner ears, called the Eustachian tubes. | |
| Quetiapine | Seroquel | Anti-psychotic | X | Pill | Preventive | Quetiapine is an atypical antipsychotic. Exactly how it works is not known. It is thought to affect certain substances in the brain. It is used to treat schizophrenia or bipolar disorder. |
| Radiofrequency ablation | - | - | X | Procedure | Preventive | Radiofrequency ablation or neurotomy is an in-office procedure that uses heat generated by radio waves to target specific nerves and temporarily turn off their ability to send pain signals. Due to the proximity to other nerves in the face, a high degree of technical precision is necessary to perform the procedure. Radiofrequency ablation is generally considered for the treatment of chronic headaches that have failed to respond to other treatments or procedures. |
| Reed Procedure® (see also Omega Procedure) | - | Neuromodulation | X | Surgically implanted neuromodulation | Preventive | The Reed Procedure® is a surgical procedure for patients diagnosed with chronic migraine that involves implanting an occipital nerve stimulator beneath the skin while the patient is under general anesthesia. It requires an initial minor surgery for a trial period and a second surgery for permanent implantation as well as a battery pack change every 10 years. Removal or repair requires surgery. The Omega Procedure and the Reed Procedure® are the same surgical procedure; the difference is solely in their registered names. From a practical standpoint, the difference comes in the relative experience of the physicians involved. Not FDA approved. |
| Remote wearable neuromodulation (REN) device | Nerivio | Neuromodulation | X | Device | Acute | Nerivio is a wireless non-invasive remote electrical stimulation wearable device applied to the upper arm at the onset of migraine headache or aura. Nerivio induces an inherent pain inhibition brain mechanism, resulting in clinically significant pain relief. Nerivio is controlled by a smartphone app, which includes a treatment diary. It was FDA cleared for use in adults in October 2020 and for adolescents in January 2021. |
| Rimegepant | Nurtec ODT | Small molecule CGRP receptor antagonist (Gepant) | X | Orally-dissolving tablet | Acute & Preventive | Rimegepant is a gepant that treats acute migraine with or without aura by blocking CGRP receptors. CGRP is a brain chemical that causes vasodilation, inflammation, and pain at sites along the trigeminovascular pathway. Early studies show promise in the lack of association of gepants with medication overuse headache. It was FDA approved for acute treatment in February 2020 and for the preventive treatment of episodic migraine in June 2021. |
| Rizatriptan | Maxalt | Serotonin 5-HT1 agonists or Triptans | X | Pill, Sublingual | Acute | Rizatriptan is a triptan that works by narrowing dilated blood vessels in the brain, relieving migraine. It is used to treat migraine with or without aura. It should not be used to prevent migraine or to treat cluster headache. |
| Sertraline | Zoloft | Antidepressant | X | Pill | Preventive | Sertraline is an selective serotonin reuptake inhibitors (SSRIs) antidepressant. It is used to treat depression, obsessive-compulsive disorder, panic disorder, anxiety disorders, post-traumatic stress disorder (PTSD), and premenstrual dysphoric disorder (PMDD). Leading neurologist Dr. Andrew Charles has flagged SSRI medications as having the potential to make migraine worse. If you take an SSRI and have migraine, consider discussing with your medical practitioner whether an alternative medication might work for you. |
| Sodium valproate | Epilim | Anticonvulsant | X | Injection, Pill | Preventive | Valproate is an anticonvulsant that works by increasing a certain chemical in the brain. The injectable form of sodium valproate is used to control epileptic seizures in patients who are unable to take the oral form. It is also used for the treatment of migraine and bipolar disorder. |
| Sphenopalatine ganglion (SPG) device | Sphenocath, Allevio, & Tx360 | Neuromodulation | X | Device | Preventive | The Sphenopalatine Ganglion (SPG) is a group of nerve cells that is linked to the trigeminal nerve, the main nerve involved in headache. Application of local anesthetics (or numbing medications) to block or partially block the SPG, can be helpful in reducing head and facial pain. Three devices have been approved for performing SPG blocks. A doctor inserts a very thin plastic tube into the nose to insert numbing medication in and around the SPG. |
| Sumatriptan | Imigran, Imitrex, Onzetra XSail, Sumavel DosePro, Tosymra, Treximet, Zembrace Symtouch | Serotonin 5-HT1 agonists or Triptans | X | Needle-less injection, Nasal Spray, Pill | Acute | Sumatriptan is a triptan that works by narrowing blood vessels in the brain, which helps to relieve migraine and cluster headache. Sumatriptan is used to treat migraine with or without aura. It is one of the most common treatments with numerous high-quality studies demonstrating its efficacy for the treatment of acute migraine. It is also used to treat cluster headache. The Treximet brand is a combination of sumatriptan and naproxen sodium, both of which are available as generics. |
| Supraorbital TNS unit or External Trigeminal Nerve Stimulation (eTNS) | Cefaly | Neuromodulation | X | Device | Acute & Preventive | A battery-powered electrical stimulator that's applied to the forehead. The device activates a low-level electrical current intended to stimulate the upper branches of the trigeminal nerve, which transmits some of the pain associated with migraine. The Cefaly I is a headband; Cefaly II is a smaller rechargeable unit with adjustable intensity. |
| Telcagepant | - | Gepant/small molecule CGRP receptor antagonist | - | Acute & Preventive | Early CGRP treatment withdrawn from market by its manufacturer, Merck in 2009. A previous safety study showed patients taking it experienced elevated liver enzymes. | |
| Timolol | Betimol, Betrim, Blocadren, Istalol, Timoptic | Beta blocker | X | Eye drops, Pill | Preventive | Timolol is part of a group of drugs called beta blockers. It is used to treat hypertension. Timolol eye drops are used to treat increased pressure in the eye (ocular hypertension) and open-angle glaucoma. It may also be used for other conditions as determined by your doctor.Timolol is part of a group of drugs called beta blockers. It is used to treat hypertension. Timolol eye drops are used to treat increased pressure in the eye (ocular hypertension) and open-angle glaucoma. It may also be used for other conditions as determined by your doctor. |
| Tizanidine | Zanaflex | Muscle relaxant | X | Injection, Nasal Spray, Pill | Acute | Tizanidine is a short-acting muscle relaxant. It works by blocking nerve impulses or pain sensations that are sent to your brain. Tizanidine is used to treat spasticity by temporarily relaxing muscle tone. |
| Topiramate | Topamax | Anticonvulsant | X | Pill | Preventive | Topiramate is an anticonvulsant that is also helpful to prevent migraine. It works by affecting several chemicals in the brain that help to reduce seizure activity and prevent migraine from occurring. It may be used alone or with other medications. |
| Tramadol | ConZip, Rybix ODT, Ryzolt, Ultram | Opioid | X | Injection, Pill, Suppository | Acute | Tramadol is a centrally-acting, oral opioid-like analgesic and is approved for the treatment of moderate to moderately severe pain in adults. The extended-release form of tramadol is for around-the-clock treatment of pain and not for use on an as-needed basis for pain. |
| Tramadol & Paracetamol (Acetominophen) | Tramacet, Ultracet | Opioid-like & Analgesic (painkiller) | X | Injection, Pill | Acute | This formulation combines individual ingredients for a stronger effect. See individual active ingredients for mode of action. |
| Transcranial Magnetic Stimulation (TMS) device | eNeura SAVI Dual™ | Neuromodulation | X | Device | Acute & Preventive | TMS uses magnets to emit a single pulse of electricity. This pulse has been shown to treat cortical spreading depression (CSD), which is the phsyical change in the brain during aura and migraine. Research shows that daily use of TMS for 3 months or longer can lead to a reduction in acute medication use. eNeura's SAVI DualTM (previously known as eNeura's sTMS device) is a TMS device available via prescription. |
| Transcutaneous electrical nerve stimulation (TENS) device | Cefaly, Icy Hot Smart Relief, Omron, truMedic | Neuromodulation | X | Device | Acute | TENS units are predominately used for nerve-related pain conditions, which may be acute or chronic. TENS machines work by sending stimulating pulses across the surface of the skin and along the nerve strands. The stimulating pulses help prevent pain signals from reaching the brain. TENS devices also help stimulate your body to produce higher levels of endorphins, its natural painkillers. |
| Ubrogepant | Ubrelvy | Small molecule CGRP receptor antagonist (Gepant)Small molecule CGRP receptor antagonist (Gepant) | X | Pill | Acute | Ubrogepant is a gepant designed to treat migraine with or without aura as well as the symptoms of light sensitivity, sound sensitivity, or nausea. Ubrogepant targets CGRP receptors, blocking the CGRP from attaching. CGRP is a brain chemical that causes vasodilation, inflammation and pain at sites along the trigeminovascular pathway. Early studies show promise in the lack of association of gepants with medication overuse headache. It was FDA approved for acute treatment in December 2019. |
| Vagus Nerve Stimulation (VNS) device | gammaCore | Neuromodulation | X | Device | Acute & Preventive | The vagus nerve runs from the brain stem through the chest and abdomen on each side of the body. Vagus nerve stimulation appears to inhibit cortical spreading depression as well as calm the brain’s excitability. A VNS device stimulates the production of inhibitory neurotransmitters in the brain, including GABA, serotonin, and norepinephrine, which affect migraine and cluster headache. gammaCore is a handheld VNS device that stimulates the nerves noninvasively when placed above the vagus nerve in the neck. It is FDA cleared in the United States for adjunctive use for the preventive treatment of cluster headache in adults; acute treatment of pain associated with episodic cluster headache in adults; acute and preventive treatment of migraine in adolescents (age 12+ years) and adults; and treatment of paroxysmal hemicrania and hemicrania continua in adults. |
| Valproic Acid | Depacon, Depakene, Stavzor, Valproate Sodium | Anticonvulsant | X | IV, Liquid, Pill | Preventive | Valproic acid is used to treat various types of seizure disorders, sometimes together with other seizure medications. Valproic acid is also used to treat manic episodes from bipolar disorder and to prevent migraine. |
| Venlafaxine | Effexor | Antidepressant | X | Pill | Preventive | Venlafaxine is an antidepressant in a group of drugs called selective serotonin and norepinephrine reuptake inhibitors (SNRIs). Venlafaxine affects chemicals in the brain that may become unbalanced and cause depression. Venlafaxine is used to treat major depressive disorder, anxiety, and panic disorder. |
| Verapamil | Calan, Isoptin | Calcium channel blockers | X | Injection, Pill | Preventive | Verapamil is a calcium channel blocker. It works by relaxing the muscles of your heart and blood vessels. Verapamil is used to treat hypertension, angina (chest pain), and certain heart rhythm disorders. |
| Zaleplon | Sonata | Hypnotic | X | Pills | Acute | Zaleplon is a sedative, also called a hynoptic. It affects chemicals in one's brain that may be unbalanced in people with insomnia. Zaleplon causes relaxation to help one fall asleep and stay asleep. |
| Zavegepant (formerly Vazegepant) | - | Small molecule CGRP receptor antagonist (Gepant) | X | Nasal Spray, Oral | Acute | Zavegepant (formerly vazegepant) is a gepant currently in development for the treatment of migraine. As of March 2023, Zavegepant, as a nasal spray, is awaiting FDA approval for the acute treatment of migraine. It would provide possible relief in as little as 15 minutes, for up to 48 hours. If approved, it will be the only CGRP medication offered as a nasal spray. In September 2020, zavegepant received the go-ahead from FDA for clinical trials on oral formulations. |
| Zolmitriptan | Zomig | Serotonin 5-HT1 agonists or Triptans | X | Nasal Spray, Pill | Acute | Zolmitriptan is a triptan that works by narrowing blood vessels in the brain, which helps to relieve migraine. It is used to treat migraine with or without aura in adults. It is not intended to prevent migraine attacks. |
| Zolpidem | Ambien, Edluar, Intermezzo, Sanval, Stilnox, Zonadin, Zolpimist Hypnogen | Hypnotic | X | Pill, Suppository | Acute | Zolpidem is a sedative, also called a hypnotic. It affects chemicals in your brain that may become unbalanced and cause sleep problems or insomnia. The immediate-release forms of zolpidem are Ambien, Intermezzo, Edluar, and Zolpimist. The extended-release form of zolpidem is Ambien CR. Ambien, Edluar, and Zolpimist are used to help you fall asleep when you first go to bed. Intermezzo is used to help you fall back asleep if you wake up in the middle of the night. |
| Zonisamide | Zonegran | Anticonvulsant | X | Pill | Preventive | Zonisamide is often used in combination with other medications to treat certain types of seizures. Zonisamide is in a class of medications called anticonvulsants. It works by decreasing abnormal electrical activity in the brain. |
These guidelines were created because we couldn’t find them anywhere else. They were created specifically for the Migraine World Summit (MWS) based on official guidelines published by leading medical societies, including the American Headache Society (AHS), the American Academy of Neurology (AAN), the European Headache Foundation (EHF), the US Headache Consortium, and the WHO Lifting the Burden Campaign. Some of these guidelines have also been interpreted in Headache: The Journal of Headache and Facial Pain and the European Journal of Headache.
If you’re wondering why some treatments are in our Treatment Directory but are not reflected in these Guidelines, it’s often because safety board (e.g., FDA) approval and clinical practice often precede medical society reviews to allow time for additional studies to be completed. Medical societies also review entire classes of treatments every five or ten years, whereas new treatments are approved and enter the market every year.
Specific doses are generally not provided since they vary by country and can be highly individualized. Consult with your healthcare provider to determine the right medication and dose for you. If a certain treatment is not available in your country, check with your healthcare provider for similar medications. The MWS Guidelines and Directory is published annually in March and may be outdated during the year. This summary has not been reviewed by any medical society and it does not constitute medical advice.
Many evaluations of migraine treatments use a scale to evaluate the quantity and quality of evidence supporting the effectiveness of a particular treatment. Studies are undertaken including clinical research trials whereas others may be less scientifically robust. The quality of these studies is considered by dividing them into Classes. For example, a Class I study is more rigorous than a Class III study. If there are more Class I studies for a treatment that demonstrates strong effectiveness, then this results in a higher evidence level for that treatment.
Studies are ranked in terms of “Class” from I to IV, with Class I studies being the highest quality and Class IV studies not meeting any quality controls, consensus, or expert opinion. Class designations are based on the AAN designations. After careful review, the studies are graded, summarized, and then placed into the following “Levels”:
• Level A: established efficacy (at least two Class I trials)
• Level B: probably effective (one Class I or at least two Class II studies)
• Level C: possibly effective (at least one Class II study)
• Level U: inadequate or conflicting data to support or refute the use
• Other: treatments that are established as possibly or probably ineffective
In 2021, AHS updated their guidance on the use of migraine treatments. This section focuses on preventive treatments for adults with migraine, generally available by prescription, for use at home. Other preventives may be available by purchase, or by visiting a healthcare provider. Classification may vary by country.
These may be offered to you by your healthcare provider if you require migraine prevention.
• Behavioral therapy in combination with preventive drug therapy
• Candesartan
• Divalproex sodium
• Eptinezumab
• Erenumab
• Fremanezumab
• Frovatriptan
• Galcanezumab
• Metoprolol
• OnabotulinumtoxinA (for chronic migraine only)
• Propranolol
• Timolol
• Topiramate
• Valproate sodium
These may be considered to you by your healthcare provider if you require migraine prevention.
• Amitriptyline
• Atenolol
• Lisinopril
• Memantine
• Nadolol
• OnabotulinumtoxinA in combination with a CGRP mAB
• Venlafaxine
These biobehavioral therapies have Grade A evidence supporting their use as listed by the 2021 AHS Consensus document:
• Cognitive behavioral therapy
• Biofeedback
• Relaxation training
These biobehavioral therapies have a growing evidence base for use in migraine:
• Mindfulness-based cognitive therapy
• Mindfulness-based stress reduction
• Acceptance and commitment therapy
Five neuromodulation devices have been approved by the FDA:
• eTNS External Trigeminal Nerve Stimulation (Cefaly)
• nVNS Vagus Nerve Stimulation (gammaCore)
• REN Remote wearable neuromodulation (Nerivio)
• sTMS Transcranial Magnetic Stimulation (sTMS mini)
• COT-NS External combined occipital and trigeminal neurostimulation (Relivion)
Notes:
1) All five devices can be used alone or together with pharmacotherapy for acute treatment.
2) Three devices are cleared for use as monotherapy or adjunctive therapy for preventive migraine treatment: eTNS, nVNS, and sTMS.
3) Three devices (nVNS, REN, and sTMS) are also cleared for the acute and preventive treatment of migraine in adolescents between 12 and 17 years of age.
In 2021, AHS updated their guidance on the use of migraine treatments. This section focuses on acute treatments for adults with migraine, generally available by prescription for use at home. Classification may vary by country.
• Almotriptan
• Atogepant
• Eletriptan
• Ergotamine derivatives
• Frovatriptan
• Lasmiditan
• Naratriptan
• Rimegepant
• Rizatriptan
• Sumatriptan (nasal spray, IM, oral)
• Sumatriptan with Naproxen
• Ubrogepant
• Zolmitriptan (oral or nasal spray)
Note: AHS Guidelines recommend considering neuromodulatory devices in patients who prefer nondrug treatments or in whom drug treatment is ineffective, intolerable, or contraindicated.
• Acetaminophen
• Aspirin
• Celecoxib oral solution
• Diclofenac
• Ibuprofen
• Naproxen
• Combination analgesic: Acetaminophen, aspirin, and caffeine
• Dihydroergotamine (nasal spray, injection, and intravenous)
• Ergotamine
• Flurbiprofen
• Isometheptene-containing compounds
• Ketoprofen
• Ketorolac (IV and IM formats)
• Magnesium (IV) (for migraine with aura only)
• Chlorpromazine
• Droperidol
• Metoclopramide
• Prochlorperazine
• Promethazine
In 2013, AAN and AHS updated guidelines on treatment for episodic migraine prevention. The following treatments are appropriate for short-term migraine prevention of migraine associated with menstruation:
• Frovatriptan
Note: a loading dose was used where an initial higher dose is given at the beginning of a course of treatment before dropping to a maintenance dose.
• Naratriptan
• Zolmitriptan
• Estrogen
In 2019, AAN and AHS updated the practice guidelines for acute migraine treatment in children and adolescents. They evaluated the efficacy of acute treatments compared to placebo (i.e., a treatment that has no active medication):
High Confidence (more likely than placebo)
• Sumatriptan/naproxen OT 10/60 mg, 30/180 mg, 85/500 mg
• Zolmitriptan NS 5 mg
Moderate Confidence (probably more likely than placebo)
• Ibuprofen OS 7.5-10 mg/kg
• Sumatriptan NS 20 mg
Low Confidence (probably more likely than placebo)
• Rizatriptan ODT 5 mg, 10 mg
Low Confidence (possibly no more likely than placebo)
• Almotriptan 12.5 mg
Very Low Confidence (insufficient evidence)
• Acetaminophen OS 15 mg/kg
• Almotriptan OT 6.25 mg, 25 mg
• Eletriptan OT 40 mg
• Sumatriptan OT 25 mg, 50 mg
Moderate Confidence (probably no more likely than placebo)
• Sumatriptan NS 5 mg, 20 mg
• Sumatriptan/naproxen OT 85/500 mg
Low Confidence (possibly no more likely than placebo)
• Eletriptan OT 40 mg
Very Low Confidence (insufficient evidence)
• Ibuprofen OS 7.5-10 mg/kg
• Sumatriptan NS 10 mg
• Sumatriptan/naproxen OT 10/60 mg, 30/180 mg
• Rizatriptan 5 mg, 10 mg
In 2016, AHS assessed treatments for acute migraine in the emergency room setting and categorized them by levels of efficacy:
• Metroclopramide IV
• Prochlorperazine IV
• Sumatriptan SC
• Dexamethasone IV, IM
• Acetaminophen IV
• Acetylsalicylic acid IV
• Chlorpromazine IV
• Dexketoprofen IV
• Diclofenac IV
• Dipyrone IV
• Droperidol IM
• Haloperidol IM
• Ketorolac IV
• Valproate IV
• DHE SC
• Ergotamine SC
• Ketamine SC
• Lysine clonixinate SC
• Magnesium IV
• Meperidine IV
• Nalbuphine IV
• Propofol IV
• Promethazine SC
• Tramadol IV
• Trimethobenzamide IM
Ailani, J., Burch, R. C., & Robbins, M. S. (2021). The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache: The Journal of Head and Face Pain, 61(7), 1021–1039. https://doi.org/10.1111/head.14153
Evers, S., Áfra, J., Frese, A., Goadsby, P. J., Linde, M., May, A., & Sándor, P. S. (2009). EFNS guideline on the drug treatment of migraine – revised report of an EFNS task force. European Journal of Neurology, 16(9), 968–981. https://doi.org/10.1111/j.1468-1331.2009.02748.x
Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. (2013). Neurology, 80(9), 871–871. https://doi.org/10.1212/wnl.0b013e318287dc4e
Orr, S. L., Friedman, B. W., Christie, S., Minen, M. T., Bamford, C., Kelley, N. E., & Tepper, D. (2016). Management of Adults With Acute Migraine in the Emergency Department: The American Headache Society Evidence Assessment of Parenteral Pharmacotherapies. Headache: The Journal of Head and Face Pain, 56(6), 911–940. https://doi.org/10.1111/head.12835
Oskoui, M., Pringsheim, T., Holler-Managan, Y., Potrebic, S., Billinghurst, L., Gloss, D., Hershey, A. D., Licking, N., Sowell, M., Victorio, M. C., Gersz, E. M., Leininger, E., Zanitsch, H., Yonker, M., & Mack, K. (2019). Practice guideline update summary: Acute treatment of migraine in children and adolescents. Neurology, 93(11), 487–499. https://doi.org/10.1212/wnl.0000000000008095
Silberstein, S. D., Holland, S., Freitag, F., Dodick, D. W., Argoff, C., & Ashman, E. (2012). Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults: Table 1. Neurology, 78(17), 1337–1345. https://doi.org/10.1212/wnl.0b013e3182535d20
While each healthcare provider has their list of treatments to try for migraine relief, we are all painfully aware that there is no cure. Often, treatments work for a while and then mysteriously stop working. Other times, treatment side effects become intolerable, or our migraine symptoms change. No matter the reason, circumstances may prompt us to search for a new way to find relief. And we don’t ever want to hear that we are “out of options.”
That’s why we bring you more than 350 medical and complementary and nonmedical treatments, reviewed and updated annually in the following Directory. It is not designed to be a comprehensive reference. Instead, the Directory provides a listing of treatments with their basic information and how it relates to treating migraine. Not all listings have been proven to be effective, and some have been ineffective, or are no longer available. However, having a comprehensive list of drugs that may be related to migraine can be a useful tool in our search for relief.
You’ll find that this guide is divided into two major sections:
In this section, you’ll find preventive and acute treatments both prescribed by a healthcare provider and available over the counter.
For preventive treatments, you’ll see more “off-label” drugs. Until recently, most preventive medications were not developed specifically for migraine. For example, you’ll find major drug classes of preventives including anticonvulsants, antidepressants, and calcium channel blockers, among others. In the past few years, the arrival of the new class of CGRP inhibitors and CGRP small-molecule receptor antagonists (gepants) are finally providing migraine-specific preventive medication options.
For acute treatments, healthcare providers may prescribe drugs like analgesics, painkillers, NSAIDs, ergots, triptans, and anti-nausea medications. Recently, CGRP antagonists (called gepants), and selective 5HT1F receptor agonists (called ditans), have been approved for acute migraine relief. You’ll also find neuromodulation devices used for acute treatment in this section.
A variety of effective complementary and nonmedical preventive treatments exist that don’t require a prescription. These can be in the form of behavior and lifestyle changes, and vitamins and supplements, among others. Many can often be used as a complement to your medical options. Doctors generally endorse healthy lifestyle options, most of which are free. Complementary and nonmedical acute treatments are more limited than other categories with fewer options. However, the listings include simple treatment ideas — anecdotally relied upon by many for years — like heat or cold therapy, aromatherapy, and acupressure.
There are many complementary and nonmedical treatments that have been used for migraine relief over centuries. Some have been proven effective in preventing migraine, but most have not yet been proven effective. You may not hear about many of these from your healthcare provider, but many patients use them. Always check with your healthcare provider if you choose to try a complementary and nonmedical treatment as even things labeled as “natural” are not always safe and some vitamins and supplements have contraindications with certain prescription medications, and other medical conditions.
Recently, a new group of complementary and nonmedical acute and preventive treatments has emerged called digital therapeutics. Digital therapeutics include apps and virtual clinics that provide a variety of services including behavioral therapy, biofeedback coaching, and migraine diary tracking, among others. This is a growing and exciting space, especially for people who may be far from headache specialists or psychology services.
There are several ways you can use this guide:
If you find yourself taking more acute medications than you’d like, running out of medications, or ending up in the emergency room too often, it’s a sign you need a better plan. That plan may consist of a different mix of prevention and acute treatments – possibly including a combination of complementary and nonmedical treatment options.
Give each treatment a fair evaluation. For prevention, that generally means at least several months. For acute treatments, that generally means at least three attacks since each attack can be different.
If you are currently taking a medication listed as an opioid or narcotic, these medications can be habit-forming and may also contribute to medication adaptation headache (also called medication overuse headache), which makes migraine attacks less responsive to treatment. Discuss the maximum number of doses per week or month with your healthcare provider and if there are non-narcotic alternatives that may be more appropriate.
This listing does not constitute medical advice. The quality, safety, and appropriateness of these listed treatments must be assessed by your healthcare provider and tailored to your individual health circumstances. Only your healthcare provider can provide you with an informed and safe treatment plan. Many treatments may be used to treat other conditions. We do not endorse any of the brand name treatments herein. The effectiveness of treatments has not been evaluated for this directory.
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