Tablets and syringe for treatment

At a glance:

12 home remedies and tips for headaches

Tablets for mild migraines

To treat an acute migraine attack, tablets can be taken to relieve pain. The German Migraine and Headache Society has issued the following recommendations for effective tablets and medication for self-treatment:

• Single dose of 1,000 mg acetylsalicylic acid (ASA) (for better effectiveness as a chewable or effervescent tablet)

• Single dose of 400 mg ibuprofen (as a tablet)

• Single dose of 1000 mg paracetamol (for better effectiveness as suppositories)

• Single dose of the combination of 500 mg acetylsalicylic acid, 500 mg paracetamol and 130 mg caffeine (as tablets)

Triptans for migraines

Triptans (serotonin receptor agonists) such as sumatriptan or zolmitriptan are used for moderate to severe migraines. They are prescription-only and are available as

They are very effective and should be used when analgesics such as NSAIDs (non-steroidal anti-inflammatory drugs) or ibuprofen do not help. If a particular triptan ingredient does not work, treatment can be tried with another one.

Triptans constrict blood vessels by influencing serotonin metabolism and thus have an analgesic effect.

Although triptan treatment can be started at any time during a migraine attack, they work better the sooner they are taken after the onset of the migraine attack. Here too, the package leaflet and the doctor’s instructions should be taken into account.

Triptans should not be used for more than ten days per month, as this can lead to, among other things, persistent headaches.

If triptans are not tolerated, taking lasmiditan is suitable according to the current guidelines of the German Society of Neurology (DGN) and the German Migraine and Headache Society (DMKG).

Anti-nausea medications (antiemetics)

To treat an acute migraine attack, medications against nausea and vomiting (antiemetics) such as domperidone are also available in tablet form.

It is generally important to take the medication for gastrointestinal complaints about 20 minutes before the painkiller in tablet form so that both migraine medications can work well.

This way, the nausea has already subsided by the time the painkillers or triptans reach the stomach. There is no longer any risk of the patient vomiting and the tablets not working.

Migraine: Active ingredients for prevention

Especially in cases of particularly frequent migraine attacks (more than two to three severe migraine attacks per month) or severe, long-lasting migraine attacks (more than 48 hours), those affected are advised to take suitable medication for prevention.

According to the guidelines of the German Society of Neurology (DGN), medicinal migraine prophylaxis is indicated

• if you are suffering from frequent migraines, or if
• the attacks are experienced as unbearable despite acute treatment.

In this case, long-term medication may be necessary.

Various active ingredients have been proven to be effective as a preventative measure:

Which active ingredient and which dosage are suitable in the individual case must be clarified with the treating doctor.

Migraine injection for prevention

Drugs used to prevent migraines were originally developed to treat other diseases (for example, beta-blockers for high blood pressure).

Migraine injections enable targeted prophylaxis of migraines. They contain so-called CGRP antibodies. CGRP (calcitonin gene-related peptide) is released by nerve cells during a migraine attack and is involved in inflammatory reactions in migraines. To do this, it binds to CGRP receptors.

The CGRP antibodies contained in syringes or pens bind directly to the CGRP protein or settle in the receptors. This interrupts the pathway that causes migraines and can prevent the pain from developing.

According to the guidelines of the German Society of Neurology (DGN) and the German Migraine and Headache Society (DMKG), the antibodies are particularly recommended for people with chronic or episodic migraines who struggle with at least four migraine days per month.

CGRP antibodies against migraine should only be used with caution if the following conditions exist:

• certain cardiovascular diseases
• inflammatory bowel diseases
• COPD
• Raynaud-Syndrom
• Wound healing disorders
• after organ transplants
• Pregnancy or breastfeeding

The use in children and adolescents has not yet been sufficiently studied.

Botox against migraines

Botox (botulinum toxin) has been approved for the treatment of chronic migraines since 2011. The frequency and severity of pain can be improved by Botox injections.

The poison interrupts the transmission of stimuli from nerve to muscle by inhibiting various messenger substances. Treatment is usually carried out every three months. The injections are administered at specific points on the head (for example, forehead or neck).

The costs of Botox treatment for migraines are usually covered by statutory and private health insurance companies if the migraine is chronic (lasting more than 3 months on at least 15 days per month). In addition, other prophylactic treatment measures, such as taking topiramate, must be unsuccessful.

Further measures for migraine prophylaxis

In addition to drug therapy for migraines, the following measures can provide improvement:

• regular endurance sports
• Behavioral therapy measures such as relaxation techniques or biofeedback
• Psychological pain therapy, for example pain management or stress management
• Keeping a migraine diary
• daily intake of magnesium

In addition, so-called external transcutaneous stimulation of the trigeminal nerve in the supraorbital area can provide relief. Electrodes are stuck to the forehead above the eye sockets.

The overstimulated trigeminal nerve is supposed to be calmed down by micro-impulses, which can reduce the sensation of pain. This procedure can be used in the case of an acute attack and as a preventative measure.

Migraine tablets during pregnancy

During pregnancy, taking migraine medication is often not necessary: ​​70 to 80 percent of women do not experience migraine attacks at all or they are less severe.

The fact that migraines often improve during pregnancy is due to the consistently high estrogen levels, especially after the third month. Pregnant women who still suffer from headaches due to migraines can take tablets as painkillers, but not all active ingredients are suitable during pregnancy.

These medications can be used during pregnancy after consultation with your doctor:

• Paracetamol: A large-scale cohort study in Sweden, which lasted from 1995 to 2021, examined the development of over two million children. The result shows that taking paracetamol during pregnancy is possible and can be used to treat migraine attacks. Like any other medication, it should only be taken with a clear indication and as rarely as possible during pregnancy.

• Acetylsalicylic acid (ASA) in the 1st and 2nd trimester: Since aspirin is not only a painkiller but also a blood-thinning drug, women should not take it later in pregnancy because of the increased risk of bleeding.

• Ibuprofen in the 1st and 2nd trimester: Taking ibuprofen is not recommended in the last trimester as it can cause damage to the heart, lungs and kidneys of the unborn child.

• Sumatriptan (triptan) for severe migraine: Various studies show that there is probably no increased risk of complications or malformations when taking sumatriptan during pregnancy.

During breastfeeding, you should always try to treat a migraine attack and its pain without medication and with rest and isolation.

Ibuprofen and ASA pass into breast milk only in small amounts. If used for a short period of time, it is therefore not necessary to interrupt breastfeeding.

Sumatriptan can be used while breastfeeding. In principle, mothers can pump milk before taking medication and feed this milk to the baby. This ensures that there are no active ingredients or breakdown products in the breast milk.

Relaxation techniques are also recommended to relieve headaches during pregnancy and breastfeeding. Magnesium can also relieve pain – partly because it has an antispasmodic effect. However, pregnant women should take the mineral before a migraine attack even occurs. It is therefore advisable to take magnesium daily.