Migraine: Effective Medications and Prevention That Really Works

This is not an ordinary headache. When a migraine strikes, the world ends. Pulsating, searing pain on one side of the head. Nausea so intense you can't eat. Light hurts your eyes. Every sound is torture. You lie in a dark room and pray for it to finally stop.

If you know this, then you know that a migraine is not a whim. It's a real neurological condition that can knock you out of life for hours, sometimes days. And while you can't "cure" it once and for all, you can effectively control it - if you know how.

Let's talk honestly about what really works. Which medications to get, how to identify your triggers, and what to do to make attacks less frequent and less severe. No medical jargon - plain language.

What is a migraine and why does it happen?

A migraine is a neurological disorder that affects about 15% of the population. Women suffer three times more often than men (hormones play a huge role here). We don't fully understand why it occurs, but we know that the following are involved:

• Genetics - if your parents had migraines, you have a higher risk too
• Blood vessel changes in the brain (constriction, then dilation)
• Neurotransmitters - serotonin, CGRP (calcitonin gene-related peptide)
• Brain hyperexcitability - people with migraines have brains that react more strongly to stimuli (light, noise, stress)

How to recognise a migraine? It's not just a headache

A migraine has characteristic features. If at least several of these apply to you, it's probably a migraine:

• Unilateral pain (though it can be bilateral) - usually on one side of the head
• Pulsating character - it feels like someone is hammering from the inside
• Intensity - moderate to very severe pain, preventing normal functioning
• Nausea and/or vomiting
• Photophobia (sensitivity to light) and phonophobia (sensitivity to sound)
• Worsening with physical activity (even walking intensifies the pain)
• Duration - 4 to 72 hours (without treatment)

About 30% of people with migraines experience an aura - neurological symptoms before or during the pain. Most commonly, these are visual disturbances: flashes of light, flickering spots, zigzag lines, sometimes loss of visual field. The aura can also manifest as tingling in the hand, face, or speech disturbances.

What triggers migraines? Know your triggers

This is crucial. A migraine doesn't appear from nowhere. There are factors that provoke it - and everyone has their own individual ones. The better you know them, the easier it will be to prevent attacks.

The most common triggers

1. Hormones (in women)

• Oestrogen drop before menstruation (so-called menstrual migraine)
• Oral contraceptives (especially those containing oestrogen)
• Pregnancy (first trimester often worse, then may improve)
• Menopause (hormonal fluctuations)

2. Stress and emotions - both stress itself and... sudden relaxation after stress (so-called "weekend migraine"). That's why attacks often appear on Saturday, when you finally rest.

3. Sleep - too little sleep AND too much sleep (that's why weekend lie-ins can trigger an attack). An irregular sleep pattern is a nightmare for people with migraines.

4. Food and hunger

• Skipping meals, fasting
• Alcohol (especially red wine, champagne)
• Caffeine - both excess and sudden withdrawal (e.g., at the weekend, when you don't drink coffee)
• Foods rich in tyramine: aged cheeses, cured meats, pickled herring
• Chocolate (in some people)
• Artificial sweeteners (aspartame)
• Monosodium glutamate (MSG) - in Chinese dishes, instant noodles

5. Sensory stimuli

• Bright, flickering light (e.g., a nightclub, sun coming through trees while driving)
• Strong scents (perfumes, solvents, petrol)
• Loud sounds

6. Weather - changes in atmospheric pressure, storms, foehn winds. Unfortunately, you can't change this.

7. Physical exertion - intense, sudden exercise (e.g., sprinting) can trigger an attack in some people. Moderate, regular exercise usually helps.

Practical advice: Keep a migraine diary for at least 3 months. Record: date, duration, pain intensity, what you ate the day before, stress level, menstrual cycle phase (for women), sleep, weather. After a few months you'll see patterns. This is an invaluable tool.

Medications for acute migraine attacks - what works?

The golden rule: the sooner you take the medication, the better. Waiting thinking "maybe it'll pass" is the worst thing you can do. In the first minutes, an attack can be effectively stopped. After 2 hours, it's much harder.

1. Triptans - the migraine specialists

These are medications created specifically for treating migraines. They work on serotonin receptors, constrict blood vessels in the brain, and inhibit the release of CGRP (a protein that causes pain).

Available triptans:

• Sumatriptan (Imigran, Sumatriptan) - most commonly prescribed, available in tablets, injections (fastest action), nasal spray
• Zolmitriptan (Zomig) - tablets, orally disintegrating tablets (no need to drink water)
• Rizatriptan (Maxalt) - dissolvable tablets
• Almotriptan (Almogran)
• Eletriptan (Relpax)

How to use? One dose as early as possible from the start of the attack. If after 2 hours the pain hasn't improved, you can take a second dose (but not sooner!). Maximum 2 doses per attack.

Effectiveness: In 60-70% of people, they effectively halt the attack. They work within 30-60 minutes (injection within 10-15 minutes).

Side effects: Feeling of pressure in the chest, neck (harmless but concerning), dizziness, fatigue.

Important! Triptans are not all-purpose painkillers. They only work for migraines. Don't take them for an ordinary tension headache - they won't help.

Price: 8-20 EUR per pack (2-6 tablets). Sumatriptan is the cheapest (generics available). Check CheaperForDrug - the difference between pharmacies can be 5-8 EUR.

2. NSAIDs - non-steroidal anti-inflammatory drugs

Classic painkillers. They can help with mild/moderate migraine attacks, especially at the start.

Which work best?

• Ibuprofen - 400-600 mg at the start of the attack
• Naproxen - 500-750 mg (lasts longer than ibuprofen)
• Diclofenac - 50-100 mg
• Acetylsalicylic acid (aspirin) - 900-1000 mg

Pros: Cheap, available without prescription, generally safe (with occasional use).

Cons: Work less well than triptans; in many people, they don't help with migraines at all. Frequent use damages the stomach.

3. Paracetamol - does it make sense?

Honestly? It works poorly for migraines. It may help in very mild attacks, but most people need something stronger.

When to try? If you can't take NSAIDs (e.g., stomach problems) and don't have triptans. Dose: 1000 mg.

4. Anti-emetics

Nausea and vomiting are often the worst part of a migraine. Anti-emetics (Metoclopramide, Domperidone) not only help with nausea but also improve absorption of painkillers.

Practical advice: Take an anti-emetic 15-20 minutes before the triptan or NSAID. This increases treatment effectiveness.

5. Combination: triptans + NSAIDs

Some patients respond best to a combination of a triptan with ibuprofen or naproxen. Worth trying (after medical consultation, of course).

What to avoid? Painkiller overuse

This is a serious problem. If you take painkillers (any kind!) more than 10 days per month, you can develop medication overuse headache (MOH). The paradox: the medications meant to help start causing increasingly frequent headaches.

If you take medication more than twice a week - talk to a neurologist about prevention!

Migraine prevention - how to prevent attacks?

If you have migraines more than 4 times a month, if attacks are very severe, or if acute medications don't work well - you need prevention. These are medications (or supplements) you take daily to reduce the frequency and severity of attacks.

Preventive prescription medications

1. Beta-blockers (Propranolol, Metoprolol)

• Slow the heart rate, lower blood pressure, stabilise blood vessels
• Effectiveness: reduce attack frequency by 40-50%
• Side effects: fatigue, cold hands/feet, low blood pressure
• For whom? Especially if you have hypertension or a fast heart rate

2. Anti-epileptic drugs (Topiramate, valproic acid)

• Stabilise neurons in the brain
• Effectiveness: in 50-60% of people, they reduce attack frequency
• Side effects: tingling in hands/feet, loss of appetite (Topiramate may cause weight loss), concentration difficulties
• For whom? Often prescribed when beta-blockers don't work

3. Antidepressants (Amitriptyline)

• Act on serotonin and noradrenaline
• Effectiveness: work well for chronic migraine
• Side effects: drowsiness, dry mouth, weight gain
• For whom? Especially if you have migraines alongside mood disorders, anxiety, sleep problems

4. Anti-CGRP drugs (Erenumab, Fremanezumab, Galcanezumab)

• Modern biological drugs, subcutaneous injections once a month
• Effectiveness: reduce attack frequency by 50-70% in many people
• Side effects: minimal (injection site pain, sometimes constipation)
• For whom? People with frequent migraines who haven't responded to other medications
• Drawback: very expensive (about 250-500 EUR/month), reimbursement only in certain cases

How long to use prevention? At least 3-6 months. Effects don't appear immediately - it takes 4-8 weeks to assess whether the medication works.

Supplements - natural prevention

Some supplements have proven effectiveness in migraine prevention. They work more slowly and less powerfully than medications, but are safer and worth considering, especially at the start.

1. Magnesium (magnesium citrate)

• Dose: 400-600 mg daily
• Effectiveness: reduces attack frequency, especially in people with magnesium deficiency
• Side effect: diarrhoea (at too-high doses)

2. Riboflavin (vitamin B2)

• Dose: 400 mg daily
• Effectiveness: studies show a 50% reduction in attack frequency after 3 months
• No side effects (may turn urine bright yellow - that's normal)

3. Coenzyme Q10

• Dose: 100-300 mg daily
• Effectiveness: reduces attack frequency and severity
• Safe, no significant side effects

4. Butterbur (Petasites hybridus)

• Herbal extract, proven effectiveness in studies
• CAUTION: buy only certified products (some may contain toxic pyrrolizidine alkaloids)

Where to buy supplements at a lower price? Prices for magnesium, B2, Q10 differ between pharmacies by up to 40%. Check CheaperForDrug before buying - you'll save tens of euros each month.

Lifestyle - natural prevention methods

No medication will work if your lifestyle constantly provokes attacks. These changes truly make a difference:

1. Regularity

• Go to bed and wake up at consistent times (even on weekends!)
• Eat regularly (don't skip meals)
• Avoid sudden, excessive physical exertion

2. Hydration

Dehydration is a common migraine trigger. Drink at least 1.5-2 litres of water daily. More in hot weather.

3. Stress management

• Relaxation techniques (breathing, meditation, yoga)
• Biofeedback (learning to control the body's stress response)
• Cognitive behavioural therapy

4. Moderate exercise

Regular, gentle exercise (walking, swimming, yoga) reduces migraine frequency. Intense, sudden exertion can trigger them.

5. Avoid your triggers

This is where the migraine diary comes back. Once you know what provokes you - avoid it. Yes, sometimes that means giving up favourite foods. But would you rather skip chocolate once a week, or lie in bed for two days a month with a migraine?

When to see a neurologist?

You don't have to manage on your own. See a specialist if:

• You have migraines more than 4 times a month
• Attacks are very severe, preventing normal functioning
• OTC medications don't help
• You're overusing painkillers (more than 10 days/month)
• New symptoms have appeared: sudden, explosive headache (like a "thunderclap"), fever, neck stiffness, altered consciousness, limb weakness - this ALWAYS requires URGENT consultation!
• First attack after the age of 50

A neurologist can order tests (sometimes brain MRI), prescribe more effective medications (triptans, preventive treatment), and help establish an individual treatment plan.

Summary - what to remember?

Know your triggers - a migraine diary is the best tool.

Take acute medication as early as possible - the earlier, the more effective.

Triptans are the gold standard in migraine treatment. If you don't have them yet, talk to your doctor.

Don't overuse painkillers - more than 10 days/month is the road to medication overuse headache.

If attacks are frequent - consider prevention - medications or supplements (magnesium, B2, Q10).

Regularity is key - sleep, meals, hydration, moderate exercise.

Compare medication prices - triptans and supplements on CheaperForDrug can be 30-40% cheaper than at the first pharmacy you walk into.

Disclaimer

This information is for educational purposes and does not constitute medical advice. Migraine is a condition that requires an individual approach. If you have frequent or severe attacks, consult a neurologist. Don't take prescription medications without medical consultation.

Remember: A migraine doesn't have to control your life. With the right medications, prevention, and lifestyle changes, you can significantly reduce the frequency and severity of attacks. Be patient, keep your diary, work with your doctor - and don't overpay for medication. CheaperForDrug will help you save hundreds of euros a year.

Health and peace of mind are priceless. But medication can be affordable. Check CheaperForDrug.