Chapter 4, Episode 4: What You Need to Know About Acute & Preventive Migraine Treatments

This content has been medically reviewed by Andrea D. Murphy, MSN, APRN, ANP-BC, NEA-BC, AQH

Learning about acute and preventive treatments can help you manage your migraine disease. First, let’s break down what acute treatments are and when you may need to use them.

Acute treatments are used during a migraine attack and typically work best if used as soon as symptoms start. The goal of acute treatment is to reduce or eliminate the symptoms and level of disability experienced during an attack.

People who have less frequent attacks may only need acute treatments while people with frequent or debilitating attacks may require both acute and preventive treatments.

Acute treatments include over-the-counter or prescription medications, nerve blocks and neuromodulation devices. Every person diagnosed with migraine should be offered an acute treatment, whether pharmacological, non-pharmacological, or both.1

Acute treatments come in various forms such as pills, injections, nasal sprays and devices. The way the treatment is administered can impact the effectiveness and possible side effects. For example, a nasal spray, injection or device may be a better option than oral medication for someone experiencing nausea or vomiting. 

Acute treatments approved by the FDA have been shown to substantially reduce or eliminate the symptoms of a migraine attack within two hours in some individuals compared to placebo. 

Prescription medications called triptans are the current gold-standard for acute migraine treatment, but they are not safe or effective for every person. If one kind of acute treatment doesn’t work well it’s possible that you will have a better result from another, even if it’s in the same class of medication. 

An anti-nausea medication may be prescribed to relieve the nausea and vomiting that can come with a migraine attack, and it may also help relieve head pain.

People with migraine disease should have at least one acute treatment they can count on to reduce or stop the symptoms of an attack. If you need to use acute medications more than 2 days per week then your provider may consider starting preventive treatment. 

Preventive treatments are used regularly to reduce the frequency, severity, and duration of migraine attacks…to reduce the level of disability experienced from migraine…and to improve responsiveness to acute treatments.

Preventive treatment for migraine should be considered for people who have an average of four or more headache days per month. It may also be used for people that experience two or more severe and disabling headache days per month. Preventive therapies include prescription medications, nerve blocks, onabotulinumtoxinA, vitamins and/or supplements, neuromodulation devices, lifestyle changes and more.

Many of the medications FDA-approved for migraine prevention were originally created for other medical conditions such as angina, epilepsy and eye muscle disorders.

Now there are several new treatments designed specifically for migraine prevention.

Many preventives are available as oral medications, but some are available only as injections or intravenous treatments. Your healthcare provider will consider your health history, comorbid conditions, and other factors to choose a preventive treatment that is best for you. Some treatments may make a difference quickly, but they often take at least 8 to 12 weeks before reaching full effectiveness. Preventive treatments can have side effects, but they vary widely among patients. Some people will notice that side effects fade as they adjust to a treatment, while others may find the side effects intolerable at any dose. Your clinician may need to adjust the dosage to help you find the best result.  

A preventive treatment is considered a success if it reduces both the number of migraine days you have and the severity of your attacks by at least 50 percent, without intolerable side effects. 

Finding helpful acute and preventive treatments may take trial and error, but together, you and your healthcare provider can find a treatment regimen that works best for you.

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This video is sponsored in part by AbbVie and Pfizer.



*The contents of this video are intended for general informational purposes only and does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. AMD does not recommend or endorse any treatment, products, or procedures mentioned. Reliance on any information provided by this content is solely at your own risk.