Often, triggers are partial and additive: You might not get a migraine attack after drinking one glass of red wine, but a glass of red wine plus a bad night’s sleep might do it, Dr. Cowan said. A headache diary can also help you identify your triggers and figure out if you have chronic migraine, which is defined as having headaches on 15 or more days per month for more than three months, and when at least eight of those headache days have migraine-like features.
Based on your symptoms and their frequency, your doctor may recommend a preventive migraine treatment to stop the headaches from starting. These types of medicines include antidepressants like amitriptyline, blood pressure medications such as propranolol, and epilepsy drugs including valproate, Dr. Cowan said.
The problem with these drugs is that often “they have nasty side-effects,” Dr. Cowan said, so they aren’t always recommended or tolerated. I briefly took propranolol to control my migraines, but every time I exercised, I felt light-headed and faint.
Your doctor might suggest taking medication at the onset of migraine to ease your symptoms, in addition to or instead of preventive treatments. For treatment of migraine after onset, doctors have long prescribed triptans — drugs such as sumatriptan that reduce inflammation and constrict blood vessels — and anti-inflammatory pain medications such as ibuprofen. But these methods don’t always work either, and triptans can cause side effects like nausea and dizziness.
If you can’t get relief, discuss new treatments with your doctor.
Over the past five years, a handful of new drugs and devices have been approved for prevention and acute treatment of migraine.
Many of these drugs block the activity of a pain-related protein called C.G.R.P., Dr. Ozudogru explained. These include, for migraine prevention, monoclonal antibodies that are periodically injected or administered intravenously. There are also pills, called gepants and ditans (with brand names like Nurtec ODT, Ubrelvy and Reyvow) that can be taken at the onset of migraine to block the activity of C.G.R.P. Rimegepant (Nurtec ODT) has been approved by the F.D.A. to both prevent and treat migraine, Dr. Ozudogru said, which is notable because most drugs do only one or the other.