Migraine Medication: Types, Treatment & Prevention Guide

What Medications Are Used During a Migraine Attack?

Acute migraine treatment includes pain relievers (NSAIDs, paracetamol), triptans, and anti-nausea medications. The key to effective treatment is taking medication early in the attack, ideally when the headache is still mild. Triptans are the most effective migraine-specific medications and should be taken once headache begins, not during the aura phase.

When a migraine attack strikes, the goal of treatment is to relieve symptoms quickly and restore normal function. The approach to acute treatment has evolved significantly, with modern medicine offering several effective options that target different aspects of the migraine process. Understanding which medications to use and when to use them can make a substantial difference in treatment outcomes.

The foundation of acute migraine treatment rests on the principle of early intervention. Research consistently shows that medications work more effectively when taken at the onset of symptoms, before pain becomes severe. This is because migraine involves a cascade of neurological events that become increasingly difficult to interrupt as the attack progresses. Delayed treatment often results in incomplete relief and may necessitate additional doses or rescue medications.

For mild to moderate migraine attacks, over-the-counter pain relievers often provide adequate relief when taken promptly. However, for moderate to severe attacks, or when simple analgesics fail, migraine-specific medications like triptans become necessary. The choice of medication depends on several factors, including attack severity, presence of nausea, previous treatment response, and individual patient characteristics.

The Step-Care Approach

Many healthcare providers recommend a stepped approach to acute migraine treatment. This strategy begins with simple analgesics for mild attacks and progresses to more potent medications if initial treatment fails. However, some patients with consistently severe attacks may benefit from starting with triptans to achieve faster, more complete relief.

The stepped approach typically works as follows: at the first sign of a migraine, take an NSAID or paracetamol. If the headache persists or worsens after one hour, a triptan can be added. This combination approach often provides better relief than either medication alone and is supported by clinical evidence. Some patients learn through experience which attacks require immediate triptan use versus those that respond to simple analgesics.

Timing Is Critical

The effectiveness of acute migraine treatment depends heavily on timing. Studies show that patients who treat within the first hour of headache onset have significantly better outcomes than those who delay. This phenomenon, sometimes called the "therapeutic window," reflects the progressive nature of migraine pathophysiology.

During the early stages of a migraine, blood vessels and neural pathways are more responsive to medication. As the attack progresses, inflammatory mediators accumulate, pain pathways become sensitized, and the migraine becomes more resistant to treatment. This explains why the same medication may work brilliantly when taken early but fail completely when taken late in an attack.

How Does Paracetamol Work for Migraine?

Paracetamol (acetaminophen) is a first-line treatment for mild to moderate migraine. It works through mechanisms not fully understood but effectively reduces pain without the gastrointestinal risks of NSAIDs. The standard adult dose is 1000mg at the onset of symptoms. Paracetamol is safe during pregnancy and breastfeeding but should not be used more than 9 days per month to avoid medication overuse headache.

Paracetamol remains one of the most widely used medications for headache disorders worldwide, including migraine. While its exact mechanism of action is not completely understood, research suggests it works through central nervous system pathways to reduce pain perception. Unlike NSAIDs, paracetamol has minimal anti-inflammatory effects, yet it can be remarkably effective for many migraine sufferers, particularly when used early in an attack.

The appeal of paracetamol lies in its favorable safety profile. Unlike NSAIDs, it does not irritate the stomach lining or increase the risk of ulcers, making it suitable for patients with gastrointestinal sensitivities. It also lacks the cardiovascular concerns associated with some NSAIDs, making it a safer choice for patients with heart disease or hypertension. These characteristics make paracetamol a practical first-line option for many patients.

For migraine treatment, a higher dose of paracetamol is typically more effective. Most guidelines recommend 1000mg for adults, which is higher than the standard dose used for general pain relief. This dose should be taken as early as possible during an attack. Some patients find that combining paracetamol with caffeine enhances its effectiveness, though commercial preparations with this combination are available.

Pregnancy and Breastfeeding

Paracetamol is considered the safest pain reliever during pregnancy and breastfeeding. While no medication is completely without risk during pregnancy, paracetamol has a long track record of safe use and is recommended by major medical organizations when pain relief is necessary. It passes into breast milk in small amounts but is not known to harm nursing infants when used at recommended doses.

How Do NSAIDs Treat Migraine Pain?

Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, and aspirin are effective for mild to moderate migraine. They work by inhibiting prostaglandin production, reducing both pain and inflammation. Common options include ibuprofen (400-600mg), naproxen (500-550mg), or aspirin (900-1000mg). Aspirin combined with caffeine may be particularly effective.

NSAIDs represent one of the cornerstones of acute migraine treatment, offering a combination of analgesic and anti-inflammatory effects that address multiple aspects of migraine pathophysiology. These medications work by inhibiting cyclooxygenase (COX) enzymes, which reduces the production of prostaglandins—chemicals that contribute to inflammation and pain signaling. This mechanism makes NSAIDs particularly effective for migraine, where inflammatory processes play a significant role.

Among the NSAIDs, several have demonstrated particular efficacy for migraine. Ibuprofen is widely available and well-studied, with doses of 400-600mg providing effective relief for many patients. Naproxen offers a longer duration of action, which may be advantageous for attacks that tend to recur or persist. Aspirin, especially at higher doses (900-1000mg), has shown comparable efficacy to some triptans in clinical trials.

An interesting finding from migraine research is the enhanced effectiveness of aspirin when combined with caffeine. Caffeine appears to improve gastrointestinal absorption and may have independent effects on migraine through its influence on adenosine receptors and blood vessel tone. Commercial preparations combining aspirin with caffeine are available and may provide superior relief to aspirin alone for some patients.

The choice of NSAID often comes down to individual patient factors and previous treatment responses. Some patients respond better to one NSAID than another, and it may be worth trying different options to find the most effective medication. Factors such as onset speed, duration of action, and side effect profile all play into this decision.

Common NSAIDs for Migraine

• Aspirin (acetylsalicylic acid): 900-1000mg, often combined with caffeine for enhanced effect
• Ibuprofen: 400-600mg, widely available and well-tolerated
• Naproxen: 500-550mg, longer-acting option
• Diclofenac: 50-100mg, available in various formulations

Pregnancy and Breastfeeding Considerations

NSAIDs require careful consideration during pregnancy. While occasionally used in the first and second trimesters under medical supervision, they should be completely avoided during the third trimester due to risks of premature closure of the ductus arteriosus and other complications. Women trying to conceive should also discuss NSAID use with their healthcare provider, as these medications may interfere with ovulation.

During breastfeeding, NSAIDs pass into breast milk in small amounts. Ibuprofen is generally considered compatible with breastfeeding due to its short half-life and low milk transfer. However, it's always advisable to discuss any medication use with a healthcare provider when nursing.

Gastrointestinal Precautions

The most significant limitation of NSAIDs is their potential to cause gastrointestinal side effects, ranging from mild dyspepsia to serious complications like ulcers and bleeding. These risks increase with higher doses, longer duration of use, advanced age, and concurrent use of other medications such as corticosteroids or anticoagulants. Patients with a history of ulcers or gastrointestinal bleeding should use NSAIDs with caution or consider alternative treatments.

What Are Triptans and How Do They Work?

Triptans are a class of migraine-specific medications that work by activating serotonin (5-HT1B/1D) receptors, causing blood vessel constriction in the brain and blocking pain signals. Available as tablets, nasal sprays, and injections, triptans are the gold standard for moderate to severe migraine. Take them when headache begins (not during aura), and a second dose can be taken after 2 hours if needed.

The development of triptans in the 1990s marked a revolutionary advance in migraine treatment. For the first time, patients had access to medications specifically designed to target the underlying mechanisms of migraine rather than simply masking pain. Triptans work by activating serotonin 5-HT1B/1D receptors, which produces three key effects: constriction of dilated blood vessels in the meninges, inhibition of inflammatory neuropeptide release from trigeminal nerve endings, and blockade of pain signal transmission in the brainstem.

This mechanism of action explains why triptans are so effective for migraine but not for other types of headache. The blood vessel constriction counteracts the vasodilation that occurs during migraine, while the neural effects interrupt the pain signaling cascade. The result is not just pain relief but often complete resolution of associated symptoms like nausea, light sensitivity, and sound sensitivity.

Several different triptans are available, each with slightly different properties. While they all work through the same mechanism, they differ in factors such as how quickly they're absorbed, how long they last, and their side effect profiles. This variety allows for individualization of treatment—patients who don't respond to one triptan may find success with another.

The timing of triptan use is crucial for optimal effectiveness. Triptans should be taken once headache begins, not during the aura phase. Taking a triptan during aura is generally ineffective because the medication targets headache mechanisms that aren't yet activated. However, once headache starts, earlier treatment produces better results. Studies show that taking a triptan within the first hour of headache provides the highest rates of pain freedom.

Different Triptan Formulations

Triptans come in various formulations to address different patient needs. Oral tablets are the most common form and work well for most patients. However, when nausea or vomiting is a prominent feature of attacks, oral absorption may be impaired. In these cases, nasal sprays or subcutaneous injections offer advantages.

Nasal sprays provide faster onset than tablets and bypass the gastrointestinal tract. Some of the drug is absorbed through the nasal mucosa, while some is swallowed and absorbed from the gut. Injectable sumatriptan provides the fastest relief—often within 10-15 minutes—but requires patients to self-inject, which some find challenging.

Orally disintegrating tablets (ODTs) dissolve on the tongue and don't require water, making them convenient when water isn't available. However, they're still absorbed from the gastrointestinal tract and don't work faster than regular tablets.

Combining Triptans with Other Medications

Combining a triptan with an NSAID can provide better relief than either medication alone. This combination addresses multiple migraine mechanisms and may reduce the risk of headache recurrence. Metoclopramide, an anti-nausea medication, can also be combined with triptans to address nausea and may enhance triptan absorption by improving gastric emptying.

Triptan Dosing Rules

If the first dose of a triptan doesn't provide relief, taking a second dose is generally not helpful—it won't work if the first dose didn't. However, if the first dose provides relief but the headache returns, a second dose can be effective. Wait at least 2 hours before taking a second dose. Don't use triptans on more than 10 days per month to avoid medication overuse headache.

Side Effects of Triptans

Common triptan side effects include tingling sensations, feelings of warmth, chest tightness or pressure, fatigue, and muscle weakness. These are generally mild and transient. The chest sensations, often called "triptan sensations," are usually not cardiac in origin but can be concerning for patients. If chest pain is severe or prolonged, seek medical attention.

Smoking and Triptans

Both triptans and nicotine cause blood vessel constriction, which may have additive effects. While smoking is not an absolute contraindication to triptan use, it increases cardiovascular risk. Patients who smoke should discuss this with their healthcare provider and consider smoking cessation.

How Does Metoclopramide Help During Migraine?

Metoclopramide is an anti-nausea medication that treats migraine-associated nausea and vomiting while also improving absorption of oral migraine medications. By enhancing gastric motility, it helps pain relievers and triptans work more effectively. Available as tablets and injections, it's particularly useful when nausea is a prominent feature of attacks.

Nausea is one of the most troublesome symptoms of migraine, affecting up to 90% of patients during attacks. Beyond causing misery on its own, nausea creates a practical treatment problem: it's difficult to take oral medications when feeling nauseated, and during a migraine attack, the stomach essentially stops working normally. This gastric stasis delays absorption of oral medications, reducing their effectiveness precisely when they're needed most.

Metoclopramide addresses both of these problems. As a dopamine receptor antagonist, it directly suppresses the nausea and vomiting center in the brain. Additionally, it increases gastric motility—essentially restarting the stomach's normal function—which helps oral medications get absorbed properly. This dual action makes metoclopramide a valuable adjunct to migraine treatment.

Clinical studies have shown that adding metoclopramide to pain relievers or triptans improves treatment outcomes compared to analgesics alone. The effect is most pronounced in patients with significant nausea or those who have noticed inconsistent responses to oral migraine medications. Some patients find that metoclopramide transforms an unreliable treatment into a consistently effective one.

Metoclopramide is available in tablet form for home use and as an injection for emergency department treatment. When taken orally, it should be given 15-30 minutes before the pain reliever to allow time for its prokinetic effects to develop. In severe attacks with vomiting, the injection form may be necessary.

What Are the Options for Preventive Migraine Treatment?

Preventive (prophylactic) migraine medications are recommended for patients with 3 or more attacks per month, significant disability, or inadequate response to acute treatment. Options include beta-blockers (metoprolol, propranolol), antidepressants (amitriptyline), antiepileptic drugs (topiramate, valproate), angiotensin receptor blockers (candesartan), and newer CGRP monoclonal antibodies. Treatment typically continues for 6-12 months before assessing the need for continuation.

While acute medications treat individual migraine attacks, preventive medications aim to reduce the frequency, severity, and duration of attacks over time. This approach is particularly valuable for patients whose quality of life is significantly impacted by frequent migraines. The decision to start preventive treatment considers not just attack frequency but also disability level, response to acute treatment, and patient preferences.

The goal of preventive treatment is typically a 50% or greater reduction in monthly migraine days—a meaningful improvement that can transform daily life for many patients. Most preventive medications take several weeks to show their full effect, and treatment should be continued for at least 2-3 months before being judged ineffective. If successful, treatment is typically continued for 6-12 months before attempting gradual discontinuation.

The landscape of migraine prevention has expanded considerably in recent years. Traditional options include medications originally developed for other conditions—beta-blockers, antidepressants, and antiepileptic drugs—that were found to have migraine-preventive effects. These remain effective first-line options for many patients. More recently, medications specifically designed for migraine prevention, particularly CGRP inhibitors, have provided new options for those who don't respond to traditional treatments.

Beta-Blockers for Migraine Prevention

Beta-blockers have been used for migraine prevention since the 1970s and remain among the best-studied preventive options. Propranolol and metoprolol have the strongest evidence, though other beta-blockers may also be effective. The exact mechanism by which beta-blockers prevent migraine is not fully understood, but they're thought to affect blood vessel reactivity and possibly central nervous system serotonin pathways.

Treatment typically starts at a low dose that's gradually increased over several weeks. This slow titration helps minimize side effects, which can include fatigue, dizziness, cold extremities, and exercise intolerance. Beta-blockers are particularly useful in patients who also have high blood pressure, anxiety, or certain heart conditions. They should be avoided in patients with asthma, as they can trigger bronchospasm.

Amitriptyline and Antidepressants

Amitriptyline, a tricyclic antidepressant, is one of the most effective migraine preventives available. Interestingly, the doses used for migraine prevention are typically much lower than those used to treat depression, and the migraine benefit appears to be independent of any antidepressant effect. Amitriptyline is particularly useful for patients who also have tension-type headache, insomnia, or depression.

The medication is typically taken at bedtime because drowsiness is a common side effect—one that can be beneficial for patients with sleep difficulties. Other common side effects include dry mouth, constipation, and weight gain. These often improve over time or can be managed with dose adjustment. Amitriptyline should be avoided in patients with certain heart rhythm abnormalities.

Antiepileptic Medications

Topiramate and valproate are antiepileptic medications with well-documented migraine-preventive effects. They're thought to work by reducing neuronal excitability—essentially making the brain less susceptible to the electrical storms that initiate migraine attacks. These medications are particularly useful for patients with frequent or chronic migraine.

Topiramate is notable for its association with weight loss—unusual among migraine preventives and potentially beneficial for overweight patients. However, it can cause cognitive side effects (word-finding difficulty, concentration problems), paresthesias, and kidney stones. Valproate is effective but has significant concerns regarding pregnancy and should be avoided by women of childbearing potential due to teratogenic risks.

Angiotensin Receptor Blockers

Candesartan, a medication primarily used for high blood pressure, has emerged as an effective migraine preventive. Studies have shown it to be comparable to propranolol in efficacy. It may be particularly attractive for patients who also have hypertension or for those who cannot tolerate beta-blockers. The mechanism of action in migraine is not completely understood but may involve effects on nitric oxide and CGRP pathways.

What Are CGRP Antibodies and How Do They Work?

CGRP (calcitonin gene-related peptide) monoclonal antibodies represent a breakthrough in migraine prevention. These biologic medications specifically target the CGRP pathway, which plays a central role in migraine. Options include erenumab, fremanezumab, and galcanezumab, administered as monthly or quarterly self-injections. They reduce migraine frequency by approximately 50% in half of patients with chronic migraine, with relatively few side effects.

The development of CGRP-targeting medications represents the most significant advance in migraine treatment since triptans. Unlike previous preventives that were discovered serendipitously while treating other conditions, CGRP antibodies were specifically designed for migraine based on our understanding of migraine biology. This represents the emergence of precision medicine in headache treatment.

Calcitonin gene-related peptide (CGRP) is a neuropeptide that plays a central role in migraine pathophysiology. During a migraine attack, CGRP levels rise dramatically. This peptide causes blood vessel dilation and transmits pain signals. It also plays a role in the sensitization that makes migraine attacks progressively worse if untreated. By blocking CGRP or its receptor, these medications prevent the cascade of events that leads to migraine attacks.

Several CGRP monoclonal antibodies are now available. Erenumab blocks the CGRP receptor, while fremanezumab and galcanezumab bind directly to CGRP itself. All three have shown efficacy in clinical trials for both episodic and chronic migraine. Patients who haven't responded to multiple previous preventives have shown good response rates, making these medications particularly valuable for difficult-to-treat patients.

The medications are administered as subcutaneous injections, typically once monthly or once every three months depending on the specific medication and dose. Patients learn to self-inject using prefilled syringes or auto-injectors, similar to medications used for other conditions like rheumatoid arthritis or diabetes. The injection process is straightforward and can be done at home.

Effectiveness of CGRP Antibodies

Clinical trials have consistently shown that approximately 50% of patients with chronic migraine achieve a 50% or greater reduction in monthly migraine days with CGRP antibodies. For episodic migraine, response rates may be even higher. Many patients notice improvement within the first month of treatment, though some take longer to respond. Unlike many traditional preventives, CGRP antibodies can be started at full dose without titration.

Side Effects and Considerations

CGRP antibodies have a favorable side effect profile compared to traditional preventives. The most common side effects are injection site reactions (pain, redness, swelling) and constipation. Unlike beta-blockers, they don't cause fatigue or exercise intolerance. Unlike topiramate, they don't cause cognitive side effects. This tolerability is a major advantage, as many patients discontinue traditional preventives due to side effects.

However, CGRP has roles beyond migraine, including wound healing and cardiovascular protection. Long-term effects of CGRP blockade are still being studied. These medications should be used with caution in patients with cardiovascular disease. Women should also discuss pregnancy and breastfeeding considerations with their healthcare provider, as data in these populations is limited.

When Is Botulinum Toxin Used for Migraine?

Botulinum toxin (Botox) is approved for chronic migraine—defined as 15 or more headache days per month, with at least 8 having migraine features. Treatment involves multiple injections around the head and neck every 12 weeks. It's typically reserved for patients who haven't responded to other preventives and may take 2-3 treatment cycles to show full effect.

Botulinum toxin type A, commonly known by the brand name Botox, has become an important treatment option for chronic migraine. The discovery of its migraine-preventive properties was serendipitous—physicians noticed that patients receiving cosmetic Botox injections reported improvement in their headaches. Subsequent clinical trials confirmed the effect and led to regulatory approval for chronic migraine.

The exact mechanism by which botulinum toxin prevents migraine is not completely understood. While its cosmetic effects work through muscle relaxation, the migraine benefit appears to involve different pathways. Current theory suggests it reduces pain signaling by blocking the release of pain-transmitting substances from sensory nerve endings and may reduce peripheral sensitization that contributes to chronic migraine.

Treatment involves multiple injections across specific sites on the head and neck—typically 31 injection sites covering the forehead, temples, back of the head, neck, and shoulders. The procedure takes about 15-20 minutes and is performed in a healthcare provider's office. While the injections can be uncomfortable, serious side effects are rare. Neck weakness and pain at injection sites are the most common complaints.

Botulinum toxin is given every 12 weeks. Some patients notice improvement after the first treatment, but it often takes 2-3 treatment cycles to achieve the full benefit. If there's no improvement after three treatments, the therapy is usually discontinued. For responders, treatment typically continues long-term, though some patients find they can eventually reduce frequency or stop treatment.

What Medications Can Children Use for Migraine?

Migraine treatment in children differs from adults. First-line treatments include paracetamol and ibuprofen, taken early in the attack. Aspirin can be used in children over 7 years but never during fever (risk of Reye's syndrome). Triptan nasal sprays are approved for adolescents, but triptan tablets are generally not recommended under 18. Overusing any acute medication can worsen headaches in children, so limiting use to 1-2 times per week is important.

Migraine is common in children, affecting about 10% of school-age children. The approach to treatment differs from adults in several important ways. Children's migraines are often shorter in duration but may have more prominent gastrointestinal symptoms like abdominal pain and vomiting. The developing brain and body also require careful consideration when selecting medications.

As with adults, early treatment is key to effective migraine management in children. Parents should help children recognize the early signs of an attack and ensure medication is taken promptly. Having medication available at school is important, as migraines often strike during the school day. A written action plan from the healthcare provider can help school staff understand when and how to administer medication.

First-Line Treatments for Children

Paracetamol and ibuprofen are the first-line treatments for pediatric migraine. Both are safe and effective when used appropriately. Dosing is based on weight, and formulations designed for children (liquids, chewable tablets) are available. These should be taken at the very first sign of a migraine—waiting until pain becomes severe reduces effectiveness.

Aspirin can be used in children over 7 years of age for migraine, but it must never be given during fever or viral illness due to the risk of Reye's syndrome, a rare but serious condition affecting the brain and liver. This restriction makes aspirin less practical for children, who may have difficulty distinguishing migraine from illness-related headache.

Triptans in Children

Among the triptans, nasal spray formulations (sumatriptan, zolmitriptan) have the best evidence in children and adolescents and are approved for use in this age group. They offer the advantage of not requiring swallowing during nausea. Triptan tablets are generally not recommended for children under 18 years, as efficacy data in this population is less robust.

Preventing Medication Overuse in Children

Children are just as susceptible to medication overuse headache as adults—perhaps more so. Limiting acute medication use to no more than 1-2 times per week helps prevent this problem. If a child needs medication more frequently, preventive treatment should be discussed with the healthcare provider. Non-medication approaches like regular sleep, hydration, and stress management are particularly important in children.

What Is Medication Overuse Headache and How Can It Be Avoided?

Medication overuse headache (MOH) occurs when frequent use of acute headache medications paradoxically causes more headaches. To prevent MOH, limit pain relievers to no more than 9 days per month and triptans to no more than 10 days per month. If you find yourself needing medication this often, speak with your healthcare provider about preventive treatment. Treatment of established MOH requires medication withdrawal under medical supervision.

One of the most important concepts in migraine management is medication overuse headache, also known as rebound headache. This condition develops when acute headache medications are used too frequently, leading to a cycle of increasingly frequent headaches that require more medication, which in turn causes more headaches. Understanding and preventing MOH is essential for successful long-term migraine management.

The exact mechanism of MOH is not fully understood, but it appears to involve changes in pain processing pathways in the brain. Regular exposure to pain medications may alter the sensitivity of these pathways, lowering the threshold for headache and making the brain more prone to pain. Different medications have different thresholds for causing MOH, with opioids and combination analgesics carrying the highest risk.

The key to preventing MOH is tracking medication use. Keep a record of every time you take acute headache medication—this simple practice makes it easy to recognize when you're approaching the danger zone. As a general rule, limit pain relievers and triptans to no more than 2-3 days per week. If you consistently need medication more than 9-10 days per month, this is a signal that preventive treatment should be considered.

If MOH has already developed, treatment requires withdrawal of the overused medication. This is challenging because headaches typically worsen before they improve. Most patients experience 2-10 days of increased headache during the withdrawal period. Working with a healthcare provider is important—they can provide supportive medications to ease the transition and can prescribe preventive treatment to reduce headache frequency once the cycle is broken.

What Migraine Medications Are Safe During Pregnancy?

Paracetamol is the safest pain reliever during pregnancy and the first choice for pregnant migraine patients. NSAIDs should be avoided, especially in the third trimester. Triptans require discussion with your healthcare provider—sumatriptan has the most safety data. Always use your emergency medication if you have a severe attack, as uncontrolled migraine may also carry risks. Some preventive medications are absolutely contraindicated during pregnancy.

Managing migraine during pregnancy presents unique challenges. Fortunately, many women experience improvement in their migraines during pregnancy, particularly during the second and third trimesters. This improvement is thought to be related to stable estrogen levels. However, some women continue to have migraines, and others experience worsening, particularly in the first trimester.

The good news for pregnant migraine sufferers is that non-medication approaches often become more effective during pregnancy. Regular sleep, adequate hydration, stress reduction, and avoidance of triggers can help reduce migraine frequency. When medication is needed, paracetamol remains the safest option throughout pregnancy. It has decades of use and a reassuring safety profile.

Medications to Avoid During Pregnancy

NSAIDs should be used cautiously in early pregnancy and avoided completely in the third trimester due to risks to fetal circulation. Valproate and topiramate are absolutely contraindicated due to high rates of birth defects. Ergotamine should never be used during pregnancy. Even medications considered relatively safe should be used at the lowest effective dose for the shortest duration.

Triptans During Pregnancy

The safety of triptans during pregnancy has been a topic of concern, but accumulating data, particularly for sumatriptan, is reassuring. Pregnancy registries have not shown an increased risk of birth defects with sumatriptan use. Most guidelines suggest that triptans can be used if needed, particularly when severe migraines would otherwise require emergency care. However, this decision should be made in consultation with a healthcare provider.

Breastfeeding Considerations

Paracetamol is safe during breastfeeding. Ibuprofen is also considered compatible with breastfeeding due to minimal transfer into breast milk. Sumatriptan passes into breast milk but is generally considered acceptable—expressing and discarding milk for 8-12 hours after a dose can further minimize infant exposure. Discuss any medication use with your healthcare provider when breastfeeding.

When Should You Seek Medical Care for Migraine?

Seek immediate medical attention for sudden severe headache ("thunderclap" headache), headache with fever and stiff neck, headache after head injury, or headache with confusion, weakness, vision changes, or difficulty speaking. Contact your healthcare provider if your migraines become more frequent, current medications stop working, or you're using acute medications more than 2-3 times per week. Finding your local emergency number is important for severe episodes.

While most migraine attacks can be managed at home with appropriate medication, certain situations require prompt medical attention. Knowing the warning signs helps ensure that serious conditions aren't missed and that you receive appropriate care when needed.

The most critical warning sign is a sudden, severe headache that reaches maximum intensity within seconds or minutes—often described as a "thunderclap" headache. This pattern is different from typical migraine, which usually builds gradually, and can indicate a serious condition like subarachnoid hemorrhage. If you experience this type of headache, seek emergency care immediately.

When to Contact Your Healthcare Provider

Even without emergency symptoms, you should contact your healthcare provider if your headache pattern changes significantly. This includes migraines becoming more frequent, more severe, or lasting longer than usual. New symptoms accompanying your migraines, like aura if you've never had aura before, also warrant evaluation.

If your current medications stop working or you find yourself needing to use acute medications more than 2-3 times per week, it's time to discuss treatment optimization with your provider. This situation often indicates the need for preventive medication or suggests that medication overuse headache may be developing.