What is the best way to manage a migraine episode at home?

Home Management of Acute Migraine Episodes

Begin treatment immediately at migraine onset with combination therapy: a triptan plus an NSAID (such as ibuprofen or naproxen) or acetaminophen for moderate to severe attacks, or an NSAID alone for mild to moderate attacks. 1

Stratified Treatment Approach by Attack Severity

Mild to Moderate Migraine

• Start with NSAIDs as first-line therapy: ibuprofen (400-800 mg), naproxen sodium (500-550 mg), or aspirin (900-1000 mg) 1, 2
• Alternatively, use combination analgesics containing aspirin, acetaminophen, and caffeine (e.g., Excedrin Migraine) 1, 2
• Take medication as early as possible when headache begins—early treatment significantly improves efficacy 1

Moderate to Severe Migraine

• Use combination therapy immediately: a triptan (sumatriptan 50-100 mg, rizatriptan 10 mg, naratriptan 2.5 mg, or zolmitriptan 2.5-5 mg) combined with an NSAID or acetaminophen 1, 2
• This combination approach provides superior pain freedom and relief compared to monotherapy 1
• If you have severe nausea or vomiting, use non-oral formulations: subcutaneous or intranasal sumatriptan, or intranasal zolmitriptan 1, 2

If First-Line Treatment Fails

• Consider CGRP antagonists (gepants): rimegepant (75 mg), ubrogepant (50-100 mg), or zavegepant nasal spray if you don't tolerate or have inadequate response to triptan-NSAID combinations 1
• Alternatively, use intranasal dihydroergotamine if other options are ineffective 1, 2
• Lasmiditan (50-200 mg) is reserved for patients who fail all other treatments in this guideline 1

Critical Medication Overuse Warning

Do not use acute migraine medications more than 2 days per week to avoid medication overuse headache. 1

• NSAIDs: limit to fewer than 15 days per month 1
• Triptans: limit to fewer than 10 days per month 1
• Medication overuse headache develops when headache occurs ≥15 days per month for at least 3 months due to overuse of acute medications 1, 3
• If you're treating migraines more than twice weekly, you need preventive therapy—contact your physician 1

Medications to Avoid at Home

Never use opioids (such as hydrocodone, oxycodone, or morphine) or butalbital-containing medications for migraine treatment. 1, 2

• These medications lead to dependency, rebound headaches, and loss of efficacy 1, 2
• They have questionable efficacy for migraine and carry significant risks 1, 4

Managing Nausea and Vomiting

• If nausea is present, take an antiemetic with your acute migraine medication 1
• Consider non-oral routes (nasal spray, subcutaneous injection) if vomiting prevents oral medication absorption 1, 2
• Metoclopramide or prochlorperazine can be prescribed by your physician for home use 1, 2

Essential Lifestyle Modifications

Implement these strategies to reduce migraine frequency and severity: 1

• Maintain adequate hydration throughout the day 1
• Eat regular meals without skipping 1
• Secure 7-9 hours of consistent sleep on a regular schedule 1
• Engage in regular moderate to intense aerobic exercise 1
• Practice stress management through relaxation techniques or mindfulness 1
• Achieve weight loss if overweight or obese 1
• Identify and avoid your personal migraine triggers 1

When to Seek Medical Attention

Contact your physician if:

• Attacks occur more than 2 days per week (you need preventive therapy) 1
• Current treatments provide inadequate response 1
• Headache pattern changes or worsens 1
• New neurologic symptoms develop 1

Cost Considerations

• Generic NSAIDs and older triptans (sumatriptan, naratriptan) are significantly less expensive than newer agents 1
• CGRP antagonists cost $4,959-$8,800 annually, making them appropriate only after first-line treatments fail 1
• Prioritize cost-effective recommended medications when multiple options are equally effective 1