OCtober 25, 2025
During a migraine attack the aim is to reduce the pain, shorten the attack and keep the strain on the nervous system to a minimum. Treatment goes in two directions: without medication and with medication.
Measures without medication
When an attack begins, changes to the surroundings and to behaviour should be made at an early stage. By reducing the stimuli reaching the brain, this eases the severity of the pain.
Withdrawing to a quiet, dark place
You need to get away from noise and bright light. Lying down in a dark, cool and quiet room calms the nervous system and eases the pain. It helps to stay away from electronic devices, the television and the phone.
A cold or warm compress
Placing a cold compress on the forehead and temples helps the blood vessels to narrow and the pain to ease. Applying a warm compress to the neck and shoulders relaxes the muscles and reduces tension.
Keeping caffeine under control
Drinking a small amount of coffee or tea narrows the blood vessels and can reduce the pain. However, taking a lot of caffeine, or stopping it suddenly, can make the attack worse.
Fluid intake
Becoming dehydrated during an attack can make the condition worse. You should drink plenty of water and maintain the electrolyte balance.
A short sleep
In some cases a sleep of 30–60 minutes calms the nervous system and eases the attack. A short rest reduces the strain on the brain and can help the pain to pass.
Treatment with medication
The medications used during the attack phase fall into two main groups: simple analgesics and medications specific to migraine.
Simple analgesics
Medications such as ibuprofen (400–800 mg), naproxen (500 mg), diclofenac (50–100 mg) or paracetamol (1000 mg) are effective when taken at the start of an attack. They must not be used often, because this can lead to medication-overuse headache.
Triptans
These are the medications used in the specific treatment of migraine. By acting on serotonin receptors they reduce the widening of the blood vessels and the spread of the pain. Medications such as sumatriptan (50–100 mg), rizatriptan (10 mg) and zolmitriptan (2.5–5 mg) should be taken at the onset of the pain. When there is vomiting, the nasal spray and injection forms are more suitable.
Antiemetics
Metoclopramide (10 mg) or domperidone (10 mg) is used to relieve nausea and vomiting. These medications speed up the emptying of the stomach and increase the effect of painkillers.
Combination medications
In some cases medications containing paracetamol, caffeine and aspirin are effective in mild forms of migraine. These medications, too, should only be used in a limited way.
Preventing attacks
The preventive measures that reduce migraine attacks are these:
Keeping a regular sleep routine
Limiting trigger foods in the diet (cheese, wine, chocolate, etc.)
Managing stress and using relaxation techniques
Monitoring hormonal changes (particularly in women during menstruation)
Taking preventive medications (propranolol, topiramate, amitriptyline, etc.) on a doctor's advice
Situations that require seeing a doctor
Medical help is essential in the following cases:
Pain that starts suddenly and is very severe
An attack that does not respond to the usual treatment
Vomiting, disturbed vision, difficulty speaking or clouding of consciousness
Attacks becoming more frequent and more severe
A change in the character of the headache
Such conditions can be a sign of serious neurological disease and require urgent assessment.