Having a plan before an attack begins helps you act early, which is one of the most important principles of acute migraine care ¹.

At home, at the first sign

• Treat early. Take your prescribed acute medication as directed at the first sign of an attack, not after the pain is severe ¹.
• Ice on the back and front of the neck. This is part of Dr. Harcourt’s migraine-day protocol.
• Rest in a dark, quiet, cool room.
• Hydrate and eat something with protein if you can tolerate it.
• Ginger has been studied for acute migraine ². Ask your clinician first.
• Use your device if one has been prescribed (for example, vagus or trigeminal nerve stimulation) ^3,4.

In-clinic migraine-day care

For established patients, Harcourt Brain Center may offer care during an attack based on what has helped you before. Depending on your history, this can include gentle nerve stimulation, low-level laser therapy ⁵, vagus nerve stimulation, gentle adjustments if they have helped in previous attacks, and, in appropriate settings, intravenous magnesium.

Avoid the rebound trap

Limit acute pain medications to the amounts your doctor recommends, generally fewer than 10 to 15 days a month depending on the type, to avoid medication overuse headache ⁶.

When to seek emergency care

If the attack is different from your usual pattern or you have any warning signs, get help right away. See When a headache needs urgent care.

Write it down

Print the migraine-day checklist and keep it somewhere easy to reach.

Research cited on this page

1. 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
2. Maghbooli M, Golipour F, Moghimi Esfandabadi A, et al. Comparison between the efficacy of ginger and sumatriptan in the ablative treatment of the common migraine. Phytother Res. 2014;28(3):412-5. PubMed 23657930 · DOI
3. Tassorelli C, Grazzi L, de Tommaso M, et al. Noninvasive vagus nerve stimulation as acute therapy for migraine: The randomized PRESTO study. Neurology. 2018;91(4):e364-e373. PubMed 29907608 · DOI
4. Chou DE, Shnayderman Yugrakh M, Winegarner D, et al. Acute migraine therapy with external trigeminal neurostimulation (ACME): A randomized controlled trial. Cephalalgia. 2019;39(1):3-14. PubMed 30449151 · DOI
5. Loeb LM, Amorim RP, Mazzacoratti MDGN, et al. Botulinum toxin A (BT-A) versus low-level laser therapy (LLLT) in chronic migraine treatment: a comparison. Arq Neuropsiquiatr. 2018;76(10):663-667. PubMed 30427505 · DOI
6. Diener HC, Holle D, Dresler T, et al. Chronic Headache Due to Overuse of Analgesics and Anti-Migraine Agents. Dtsch Arztebl Int. 2018;115(22):365-370. PubMed 29932046 · DOI