Not all headaches are created equal. In contrast to the standard tension headache, migraines — which affect 38 million Americans — can cause severe pain, in some cases interfering with day-to-day activities.

While migraines can be debilitating, there are a variety of treatment options to help alleviate acute pain and prevent or reduce the severity of future episodes. Here’s more on the difference between migraines and other types of headaches as well as common treatment options.

What is a migraine?

Migraines are recurring, often severe headaches caused by nerve activity and the release of chemicals in the brain. They vary in both duration and frequency, lasting anywhere from hours to days and occurring from once a year to once a week. (The average migraine lasts four hours and occurs about two to four times a month.) Preventative medications can help lessen the frequency and intensity of migraines.

A migraine’s defining symptom is a throbbing, pulsing headache on one side of the head. Other common symptoms include:

• Sensitivity to light, noise, and sound

• Nausea and vomiting

• Dizziness and blurred vision

• Tender scalp

• Abdominal pain

• Loss of appetite

• Fatigue

• Sweating or chills

• Pale skin

Migraines consist of the following four phases, though not everyone experiences all of them.

1. Prodrome

This pre-headache phase may last from hours to days. Common symptoms include difficulty concentrating, irritability and/or depression, nausea, fatigue, and sensitivity to light and sound.

2. Aura

15-20% of individuals affected by migraines experience auras, or sensory, motor, and speech symptoms that indicate the onset of a migraine. They typically occur before the headache but can also happen during or after.

Common symptoms of an aura include:

• Visual disturbances such as seeing bright flashing dots, lights, or wavy lines; blind spots; and/or temporary vision loss

• Numbness or a tingling of the skin

• Ringing in your ears

• Changes in speech

• Changes in smell or taste

3. Headache

The headache that we commonly associate with migraines is the third stage in the progression. For those who do not experience auras, it may occur suddenly without warning. It can last from four to 72 hours.

Individual experiences of a migraine headache can vary. While some people feel only mild pain, many experience a throbbing sensation. It often starts on one side of the head before spreading to the other. It can also affect the front or back of your head — or even the whole head — and may cause pain around the eyes and temple and, less commonly, in the face, sinuses, jaw, or neck.

4. Postdrome

80% of those affected by migraines experience the postdrome phase after the headache. Typically lasting a day or two, this migraine “hangover” can cause concentration issues, fatigue, and shifts in mood (depressed or euphoric).

Migraine risk factors and triggers

While migraines can affect anyone, some individuals are more prone to them. Key risk factors include:

• Genetics: Migraines often run in families. According to Cleveland Clinic, up to 80% of those affected by migraines have a first-degree relative with the condition.

• Sex: 3 in 4 migraine sufferers are women, and the condition is especially common in women between the ages of 15-55. This is likely because of female hormones related to menstruation and menopause.

There are also manageable risk factors such as chronic stress and smoking.

Individual migraine episodes can be triggered by factors such as the following:

• Emotional stress

• Skipped or delayed meals

• Consumption of certain foods and beverages including aged cheese; fermented or pickled foods; alcoholic drinks; chocolate; and food additives like nitrates (pepperoni, hot dogs, and deli meats)

• Changes in sleep patterns

• Exposure to loud noises or specific sources of light (flashing or fluorescent lights; light from TV, computer, and other electronics; and sunlight)

• Caffeine consumption

• Hormonal changes

Migraine treatment options

Migraines can be managed with medication. Treatment is twofold, consisting of pain relief medications, which treat acute symptoms, and preventative medications, which reduce the frequency and intensity of migraine episodes.

Acute treatment options

• Over-the-counter (OTC) pain relief medications including acetaminophen (Excedrin®, Tylenol®) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil®, Motrin®), and naproxen (Aleve®) help alleviate migraine pain. There are also OTC medications specifically formulated for the treatment of migraines: Excedrin Migraine, and Motrin Migraine.

Overuse of OTC pain relief can lead to rebound headaches or dependency. Tell your provider if you are taking OTC medications more than two to three times a week so that they can recommend more effective options.

• Triptans such as sumatriptan (Imitrex®, Tosymra®), and rizatriptan (Maxalt®) reduce migraine symptoms by blocking pain pathways in the brain. They may be administered as pills, injections, or nasal sprays and are only available by prescription. They may not be an appropriate option for individuals at risk of stroke or heart attack.

• Dihydroergotamine (D.H.E. 45®, Migranal®) may also be used to reduce migraine-related pain. It is often used to treat symptoms that last beyond 24 hours and is most effective when taken at the beginning of an episode. It is available as a nasal spray or injection. In some cases, it may cause side effects like nausea or vomiting.

• Lasmiditan (Reyvow®) is a newer oral medication for migraine pain. It may bring a feeling of sedation or dizziness so it’s important to avoid driving for at least eight hours after taking this medication.

• CGRP antagonists such as ubrogepant (Ubrelvy®) and rimegepant (Nurtec® ODT) are oral medications that can relieve a variety of migraine symptoms including pain, nausea, and sensitivity to light and sound. Common side effects include dry mouth and excessive sleepiness. In some cases, these medications may cause or worsen nausea.

• Anti-nausea medications such as chlorpromazine, metoclopramide (Reglan®), and prochlorperazine (Compro®) are commonly used to address nausea and vomiting. They are typically taken in tandem with pain relief medications.

Opioids are reserved for severe, treatment-resistant cases due to their potential for dependency.

Some of these medications are unsafe to take during pregnancy. If you are pregnant or planning to conceive, speak with your doctor about medication options.

Preventative treatment options

The following medications can reduce the frequency, severity, and duration of migraines.

• Blood pressure-lowering medications including beta blockers such as propranolol (Inderal®, InnoPran® XL) and metoprolol tartrate (Lopressor®) and calcium channel blockers such as verapamil (Verelan®)

• Tricyclic antidepressants such as amitriptyline

• Anti-seizure medications including valproate and topiramate (Topamax®, Qudexy® XR) — potential side effects include dizziness, weight changes, and nausea. These medications are not recommended for those who are pregnant or trying to conceive.

• CGRP monoclonal antibodies — a more recently approved treatment option administered as monthly or quarterly injections

Your partner in health

Managing migraines is easier with a reliable pharmacy partner by your side. We offer free, same-day delivery and medication management tools like reminders and auto refills in our app to help you stay on track with your treatment. And our pharmacists are available to answer any questions you may have about medications or side effects.

To learn more, reach out any time through secure in-app messaging or by phone at 1-800-874-5881.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

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