How Long Will My Migraine Attack Last?
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There are several different medication options for treating a migraine attack once it has begun. The type of migraine you have as well as the frequency and severity of your attacks is something you should discuss with your doctor when developing a treatment plan.
For people with mild to moderate symptoms, over-the-counter medications are often sufficient to relieve them, according to the American Migraine Foundation. These drugs include:
Your doctor may also prescribe any of a number of drugs for acute treatment of migraine. Generally speaking, acute migraine treatments work better the earlier in the attack you take them, before your pain has gotten severe. Triptans are the most commonly used acute migraine medications, and gepants and ditans are two new classes of migraine drugs that may be helpful if you can’t take triptans or are not helped by them.
Triptans
There are seven different triptan drugs, of which sumatriptan (sold as Alsuma, Imitrex, Onzetra, Zembrace, and Treximet, which is a combination of sumatriptan and naproxen) is probably the best known. All the triptans are available as pills, two come as nasal sprays or powders, and one is sold as a self-administered injection.
Most triptans taken as pills start relieving pain in 30 to 60 minutes, although two longer-acting triptans, Amerge (naratriptan) and Frova (frovatriptan), take one to three hours and about two hours, respectively, to start working. Triptan injections start relieving pain in about 10 minutes, and nasal sprays start working in 10 to 15 minutes.
If migraine pain recurs within 24 hours after you take a triptan, a second dose may be needed. But migraine recurrence may be an indication that a different triptan or a different dose of the one you’re taking may work better for you, according to Eric Baron, DO, a neurologist at the Cleveland Clinic in Ohio, writing for Virtual Headache Specialist.
Because one of the effects of triptans is to narrow blood vessels in the brain, these medications should not be taken by people with coronary artery disease, a history of stroke, peripheral vascular disease, or uncontrolled high blood pressure. Women who are pregnant or planning to become pregnant should discuss the relative risks and benefits of using triptans during pregnancy.
Gepants
A newer class of migraine drugs called calcitonin gene-related peptide (CGRP) receptor antagonists, or “gepants,” may be an alternative for people who can’t use triptans because of vascular disease, since they don’t narrow your blood vessels. CGRP receptor antagonists include:
According to Spears, “These medications target a different neurotransmitter pathway than triptans.”
Both rimegepant and ubrogepant are taken as pills, both begin reducing migraine pain within 60 minutes, and both can cause nausea or sleepiness as a side effect.
Zavegepant is taken as a nasal spray and can relieve pain in as little as 15 minutes.
Ditans
Lasmiditan (Reyvow) belongs to a newer class of migraine medication called selective 5-HT(1F) receptor agonists, or ditans for short. It does not constrict blood vessels and may therefore be another alternative for people who can’t use triptans because of vascular disease.
Lasmiditan is available as a tablet in three dose sizes. No more than one dose of lasmiditan should be taken within 24 hours, and people should not drive or operate machinery for eight hours after taking the drug. Common side effects include dizziness, fatigue, drowsiness, and abnormal skin sensations such as tingling or numbness.
Other Acute Migraine Treatment Options
In addition to the drugs mentioned above, other options for acute migraine relief include the prescription NSAID diclofenac (Cambia); a class of drugs called ergots, which are sometimes used in people who don’t respond to triptans; and a variety of neurostimulation devices that deliver magnetic or electric pulses to specific nerves involved in migraine.
If the combination of drugs and home remedies you’re using to stop migraine attacks isn’t working, talk to your doctor about other treatment possibilities.
RELATED: How to Get Rid of a Headache or Migraine Attack Fast
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