Learn / The Mastering Migraine Approach
The Mastering Migraine Approach
Working with your medical team
An overview of migraine medications and procedures, and how they fit with the framework.
5 min read · 8 research sources · Based on the Mastering Migraine courses by Dr. Adam Harcourt
Medications can be an important part of migraine care. The Mastering Migraine framework is designed to work alongside them, and many patients find they need less medication as the other pillars improve. Any medication change should be made with your prescribing physician.
Acute (rescue) medications
Used at the start of an attack:
- Pain relievers and NSAIDs such as ibuprofen or naproxen
- Triptans, which have been used for decades 1
- Gepants, a newer class that blocks CGRP, such as ubrogepant 2
- Anti-nausea medicines
The goal is to treat early and avoid overuse 3.
Preventive medications
Used daily or monthly to reduce how often attacks happen:
- Traditional options including certain blood pressure medicines, antidepressants and anti-seizure medicines 1,4
- CGRP monoclonal antibodies, monthly or quarterly injections or infusions 5
- OnabotulinumtoxinA (Botox) for chronic migraine 6
The American Headache Society advises starting preventive medicines at a low dose, increasing slowly, giving them an adequate trial, setting clear expectations and maximizing adherence 3. Many people stop preventive medicines early, often because of side effects 7.
Procedures
- Nerve blocks, such as greater occipital nerve blocks, can reduce headache for some patients 8.
- Surgical approaches exist for carefully selected patients.
How the pieces fit
Medications act on specific pathways. The four pillars address the factors filling your bucket. Combined, they give you the best chance of fewer, milder attacks. Bring your full medication and supplement list to every visit, and share your progress reports with all your clinicians.
This article is educational and does not replace a personal evaluation. Talk with your clinician before making changes to medications, supplements or diet.
Research cited on this page
- Ong JJY, De Felice M. Migraine Treatment: Current Acute Medications and Their Potential Mechanisms of Action. Neurotherapeutics. 2018;15(2):274-290. PubMed 29235068 · DOI
- Dodick DW, Lipton RB, Ailani J, et al. Ubrogepant for the Treatment of Migraine. N Engl J Med. 2019;381(23):2230-2241. PubMed 31800988 · DOI
- American Headache Society. The American Headache Society Position Statement On Integrating New Migraine Treatments Into Clinical Practice. Headache. 2019;59(1):1-18. PubMed 30536394 · DOI
- Kish T. Emerging Therapies for Patients With Difficult-to-Treat Migraine. P T. 2018;43(10):616-621. PubMed 30271106
- Vikelis M, Spingos KC, Rapoport AM. A new era in headache treatment. Neurol Sci. 2018;39(Suppl 1):47-58. PubMed 29904827 · DOI
- Blumenfeld AM, Stark RJ, Freeman MC, et al. Long-term study of the efficacy and safety of OnabotulinumtoxinA for the prevention of chronic migraine: COMPEL study. J Headache Pain. 2018;19(1):13. PubMed 29404713 · DOI
- Hepp Z, Dodick DW, Varon SF, et al. Persistence and switching patterns of oral migraine prophylactic medications among patients with chronic migraine: A retrospective claims analysis. Cephalalgia. 2017;37(5):470-485. PubMed 27837173 · DOI
- Allen SM, Mookadam F, Cha SS, et al. Greater Occipital Nerve Block for Acute Treatment of Migraine Headache: A Large Retrospective Cohort Study. J Am Board Fam Med. 2018;31(2):211-218. PubMed 29535237 · DOI
Mastering Migraine is an educational resource and is not a substitute for individualized medical care. Always talk with your own doctor before changing medications, starting supplements, or beginning a new treatment.
