Migraine treatment divides into acute relief for active attacks and preventive strategies to reduce frequency, with options like medications, devices, and lifestyle adjustments tailored to severity and patient response. Neuromodulation devices offer noninvasive alternatives by targeting nerve activity without systemic side effects. Combining therapies often yields the best outcomes for chronic or frequent migraines.
Acute Medications
Triptans such as eletriptan, rizatriptan, sumatriptan, and zolmitriptan provide rapid pain freedom at 2 hours post-dose, outperforming newer agents like lasmiditan or rimegepant in head-to-head studies, with odds ratios up to 5.19 versus placebo. NSAIDs like ibuprofen (400-800 mg) or acetaminophen/aspirin/caffeine combinations serve as first-line for mild attacks, often achieving sustained relief without vasoconstriction risks. Antiemetics such as metoclopramide address nausea, enhancing oral drug absorption during attacks.
Preventive Options
Beta-blockers like propranolol (80-240 mg daily), antidepressants such as amitriptyline (10-150 mg), and anticonvulsants like topiramate (50-200 mg) cut monthly headache days by 50% in responders, ideal for 4+ attacks per month. CGRP monoclonal antibodies (e.g., erenumab) or gepants like atogepant offer monthly dosing for episodic/chronic cases with fewer side effects. Lifestyle changes—consistent sleep, hydration, trigger avoidance (caffeine, stress), and aerobic exercise—amplify drug efficacy.
Neuromodulation Devices
Cefaly delivers transcutaneous electrical stimulation to the supraorbital nerve, reducing attack severity in 50-70% of users with 20-minute daily sessions. SAVI Dual employs single-pulse transcranial magnetic stimulation, sending low-frequency pulses to calm cortical hyperactivity; preventive use involves 4 pulses twice daily for under 2 minutes. Noninvasive vagus nerve stimulation (e.g., gammaCore) or remote electrical neuromodulation (Nerivio) further decrease frequency by modulating trigeminal pathways.
