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Exactly What to Do During a Migraine Attack, According to a Neurologist

The earlier you take action, the better.

The internet is peppered with advice on how to prevent migraines, but how do you find relief once you’re in the middle of one? If you’re prone to migraines, you know that they’re a complicated syndrome that can be seriously debilitating, and during a migraine attack you’d do just about anything to feel better.

That’s why we asked Mark Green, MD, a neurologist at Mount Sinai Hospital what you should do as soon as a migraine hits, so you can soothe your symptoms and feel like yourself again as soon as possible.

Responding to the First Signs of a Migraine

“When you first have an attack, the worst thing you can do is ignore it and think it’s going to go away,” says Mark Green, MD, neurologist at Mount Sinai Hospital.

For other types of headaches, many people will wait it out and see if the pain goes away on its own. They might not want to prematurely take a pain reliever in case it turns out to be a brief and mild episode. That’s OK for your standard tension headache, but doctors recommend a different approach for migraine.

“When you first develop a migraine, and you have an acute medication, we want you to take it. Take it right away,” says Dr. Green.

Once you’ve had a couple migraine attacks, you quickly learn the early warning signs of a migraine. The prodrome and aura stages of an attack precede the migraine headache itself, and you can become pretty skilled at recognizing the telltale signs.

“The false alarm rate in early migraine is very low,” says Dr. Green. “In other words, when people think, ‘I think I’m going to get a migraine,’ guess what? They’re going to get a migraine.” The longer you wait to treat the migraine, the more resistant it will be to treatment methods.

Early Treatment Options That Work

Migraine treatment has come a long way: Some particularly morbid methods throughout history include hot irons, sticking garlic into an incision in the head, and even drilling a hole in the skull to let out evil spirits, according to the American Migraine Foundation (AMF).

Not surprisingly, none of those methods helped patients in any way, shape, or form. Thankfully, today’s migraine sufferers have safe and effective options to choose from.

“The most common of the acute medications that we use are called triptans,” says Dr. Green.

Triptans were the first class of prescription drugs designed specifically for migraines, and didn’t appear until the 1990s. This medication interacts with receptors in the brain to help turn off the trigeminal nerve, which is the largest of the 12 cranial nerves that supplies sensation to the face, mucous membranes, and other structures of the head. Triptans come in the forms of pills, nasal sprays, and injections.

Another acute medication for migraines is ergotamines (a.k.a. ergots). Ergots constrict the blood vessels and are not designed specifically for migraines, but doctors have used them for migraines since the 1930s. These are used less commonly now, but they may be prescribed to people who have not found relief using triptans.

The final acute medication commonly used for migraines are nonsteroidal anti-inflammatory medications, often called NSAIDs. These nonspecific pain relievers—such as aspirin and ibuprofen—are often found over-the-counter.

These NSAIDs are affordable and readily available, but they’re not the perfect solution: “You often need a decent dose in order to stop a migraine,” says Dr. Green. Using NSAIDs for migraines on a daily or regular basis could lead to medication overuse, and may even make your headaches worse.

The Natural Treatments You Shouldn’t Overlook

One of the best ways to treat your early migraine needs no prescription or trip to the pharmacy at all: Napping.

In addition to taking an acute medication that works best for you, simply sleeping may help treat your migraine. “Lie down and see if you can possibly fall asleep,” says Dr. Green. “Sleep is often very effective to abort an individual attack.”

Another natural treatment that can supplement your acute medications is caffeine. This one’s tricky, since caffeine can either trigger or treat migraines, depending on the person. (Consider that caffeine is actually an active ingredient in several pain relievers, including Excedrin and Midol.) Caffeine tends to be more effective at reducing migraine pain in people who are not already active caffeine consumers.

For more tips, learn more about natural home remedies that help treat migraines.

Mark Green, MD

This video features information from Mark Green, MD. Dr. Green is a neurologist at the Mount Sinai Hospital in New York City.

Duration: 1:45. Last Updated On: Sept. 14, 2018, 4:01 p.m.
Reviewed by: Preeti Parikh, MD . Review date: Aug. 22, 2018
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