Acute migraine attacks

Note about medicine names

Most medicines have two names: the active ingredient and the brand name. The active ingredient is the chemical in the medicine that makes it work. The brand name is the name given to the medicine by its manufacturer. There may be several brands that contain the same active ingredient. This website uses active ingredient names, with brand names in brackets. We also discuss medicines in groups or ‘classes’, when their effects or actions are very similar.

To find out more about active ingredients and brand names see our Brand choices information.

Stepped medicine treatment for managing migraine

Doctors recommend a stepped approach to treatment; that is, trying the simplest remedies first. If these fail to manage the pain — as a general rule on 3 consecutive occasions — then the next treatment is tried. The best judge of whether a treatment is effective is you, the person being treated.

To get the best results, medicine treatment should be combined with rest or sleep in a quiet dark room. However, for some people this might not always be practical.

Step 1 — Simple pain relief medicines alone

Most simple pain relief medicines are available to buy over-the-counter in pharmacies and supermarkets.

Pain relief medicines should always be taken at the first sign of migraine symptoms. As a migraine progresses, your stomach emptying can slow and this can affect the absorption of pain relievers into the bloodstream, making them less effective. This is especially important if you experience nausea and vomiting with migraine. For the same reason, doctors recommend you take soluble tablet preparations, as they are absorbed quicker and can act a bit faster.

Read more about simple pain relief medicines.

Step 2 — Simple pain reliever and medicine for nausea and vomiting

If nausea is a problem, or if pain relievers alone do not relieve the pain of migraine, they can be taken with medicines to treat nausea and vomiting.

Read more about anti-nausea/vomiting medicines.

Step 3 — Anti-migraine medicines: the triptans

If pain relievers — with or without anti-nausea/anti-vomiting medicines — are not relieving your migraine symptoms, triptan medicines  are usually the next step.

Triptans work differently to pain relievers. They cause the blood vessels around the brain to contract (narrow). You will need to get a prescription from your doctor to obtain a triptan. There are a number of different triptans available in Australia.

Read more about triptan medicines.

Step 4 — Medicines for more frequent and troublesome migraines (preventive therapy)

The aim of preventive therapy for migraine is to reduce the number of attacks, either because:

  • the medicines used to treat attacks fail to control your symptoms adequately, or
  • migraine attacks, even though well controlled, are happening far too often, placing you at risk of developing medication overuse headache.

In general, if you are experiencing two or more severe migraine attacks a month, you could be a candidate for preventive therapy.

Preventive therapy is used in addition to treatments for acute attack, not in place of it.

Read more about preventive therapy.

  • British Association for the Study of Headache. Guidelines for all health professionals in the diagnosis and management of migraine, tension-type-type headache, cluster headache and medication overuse headache. Hull: BASH, 2010. (accessed 13 December 2011)
  • Neurology Writing Group. Therapeutic Guidelines: Neurology, Version 4 Updated November 2011 [eTG complete CD-ROM]. Melbourne: Therapeutic Guidelines Ltd, 2011.
  • Rossi S, ed. Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd, 2012.
  • Evers S, Afra J, Frese A, et al. EFNS guideline on the drug treatment of migraine - a revised report of an EFNS task force. European Journal of Neurology 2009;16:968-81.