Abortive Migraine Treatment

When you feel the first familiar, unwelcome signs of a migraine attack, your first thought is likely, "How can I make this stop?" This is where abortive treatment comes in. Abortive therapies, also known as acute treatments, are the medications you take to stop a migraine attack after it has started. The goal is to find a treatment that works quickly and consistently to relieve your pain and other symptoms, allowing you to get back to your life. The world of abortive treatments can seem complex, but understanding your options is the first step toward feeling empowered and in control. This guide is here to offer a compassionate and clear overview of the different types of abortive treatments available, helping you to have more informed conversations with your doctor.

The Golden Rule of Abortive Treatment: Treat Early

Before we dive into the specific types of medication, the most important principle of acute treatment is to treat as early as possible. A migraine is a cascading neurological event. The longer you wait, the more entrenched the pain and other symptoms become, and the harder they are to treat. Taking your medication at the first sign of an attack—whether that’s a visual aura or the first hint of pain—gives it the best possible chance to work effectively.

Common Types of Abortive Treatment

There are many different classes of abortive medications. What works for one person may not work for another, so it often takes some patient trial and error with your doctor to find the right fit for you.

1. Over-the-Counter (OTC) Pain Relievers

For people with mild to moderate migraine attacks, over-the-counter options can sometimes be enough. These include:

NSAIDs (Nonsteroidal Anti-Inflammatory Drugs): Medications like ibuprofen (Advil, Motrin) and naproxen sodium (Aleve) work by reducing inflammation and pain.
Acetaminophen (Tylenol): A pain reliever that works differently from NSAIDs.
Combination Products: Some products, like Excedrin Migraine, combine acetaminophen, aspirin (another NSAID), and caffeine. The caffeine helps to boost the effectiveness of the pain relievers.

A gentle but critical reminder: It is very important to limit the use of any acute medication, including OTC products, to no more than two days per week. More frequent use can lead to a condition called medication overuse headache, where the treatment itself begins to cause more frequent headaches.

2. Triptans

Triptans are a class of prescription medications specifically designed to treat migraine. They have been the first-line treatment for moderate to severe migraine for many years. They work by binding to serotonin receptors in the brain, which helps to constrict the dilated blood vessels and block the release of pain-causing chemicals.

There are seven different triptans available, including sumatriptan, rizatriptan, and eletriptan. They come in many forms—pills, dissolving tablets, nasal sprays, and injections—which is very helpful for people who experience nausea and vomiting. If one triptan doesn't work for you, another one might, so it's worth discussing the options with your doctor.

3. CGRP Inhibitors ("Gepants")

This is a newer and very exciting class of abortive medications. They work by blocking a protein called calcitonin gene-related peptide, which is often called CGRP. CGRP is a key player in transmitting migraine pain signals. By blocking it, these medications can stop an attack.

The two main gepants used for acute treatment are ubrogepant (Ubrelvy) and rimegepant (Nurtec ODT). They are oral medications that are often very effective and tend to have fewer side effects than triptans for some people. They are a particularly valuable option for individuals who cannot take triptans due to cardiovascular risk factors.

4. Ditans

Lasmiditan (Reyvow) is another newer prescription medication. Like triptans, it targets a serotonin receptor, but a different one. This means it does not constrict blood vessels, making it another safe option for people with cardiovascular concerns. It is important to note that this medication can cause significant dizziness, and you should not drive or operate machinery for at least eight hours after taking it.

5. Anti-Nausea Medications

For many, nausea is one of the worst parts of a migraine attack. Your doctor may prescribe an anti-nausea medication (an antiemetic) to take alongside your primary abortive treatment. This can not only relieve the nausea but can also help your body to absorb your pain medication more effectively.

Building Your Migraine Toolkit

A good migraine treatment plan is like a toolkit. You may have different tools for different types of attacks. For a mild headache, an OTC medication might be enough. For a severe attack, you might need a triptan or a gepant, along with an anti-nausea medication. Working with your doctor to build this personalized toolkit can help you feel prepared and less fearful of an impending attack.

A Final, Hopeful Thought

It can be a long and sometimes frustrating process to find the abortive treatment that works best for you. Please don’t lose hope. The field of migraine medicine is advancing rapidly, and there are more options available now than ever before. By partnering with a knowledgeable and compassionate healthcare provider, you can find a treatment plan that helps you stop the storm and reclaim your life from migraine.

Trusted Resources

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