Treatment of migrane

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treatment of mograine

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migraine treatment acute preventive treatment patient guideline American Headache Society 2024

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migraine AND treatment

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PMID: 40277321

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Quick answer

For migraine treatment, separate it into treating an attack now and preventing frequent attacks.

During a migraine attack

Take medicine early in the attack if safe for you:

Simple pain relievers: paracetamol (acetaminophen), ibuprofen, naproxen, or aspirin.
Anti-nausea medicine: e.g., metoclopramide or prochlorperazine, prescribed by a clinician if nausea/vomiting is prominent.
Triptans: e.g., sumatriptan, rizatriptan, zolmitriptan. These are migraine-specific prescription medicines and work best early. Do not use if you have certain heart/vascular diseases, previous stroke/TIA, uncontrolled hypertension, or hemiplegic/brainstem aura migraine unless a doctor says it is appropriate.
If triptans are unsuitable or ineffective, clinicians may prescribe newer options such as gepants (ubrogepant, rimegepant) or lasmiditan, depending on local availability.

Resting in a dark, quiet room, drinking fluids, using a cold pack, and sleeping can help symptoms.

Avoid using acute headache medicines on more than 2 to 3 days a week when possible. Frequent use, especially combination painkillers, opioids, or triptans, can cause medication-overuse headache. Opioids are generally avoided for migraine.

Preventing migraine

Discuss preventive treatment if you have about 4 or more migraine days a month, disabling attacks, prolonged attacks, or are overusing rescue medicines.

Options include:

Beta-blockers: propranolol, metoprolol
Anti-seizure medicines: topiramate, valproate. Valproate should generally be avoided in pregnancy and in people who could become pregnant because of serious fetal risks.
Antidepressants: amitriptyline or venlafaxine
CGRP-targeting medicines: injections such as erenumab, fremanezumab, galcanezumab, eptinezumab; or oral agents such as atogepant/rimegepant where available. These are now considered a first-line prevention option by the American Headache Society.
Onabotulinum toxin A (Botox) for chronic migraine, typically defined as headache on 15 or more days/month with migraine on at least 8 days/month.

Keep a headache diary recording headache days, severity, aura, periods, sleep, foods, and medication use. Regular sleep, meals, hydration, exercise, stress management, and limiting excess caffeine can reduce attacks.

Seek urgent medical care now if

This is the first or worst headache of your life, starts suddenly like a thunderclap, follows a head injury, occurs with fever/stiff neck, fainting, weakness/numbness, trouble speaking, confusion, seizure, new visual loss, or is new during pregnancy/postpartum or after age 50.

A 2025 evidence-based pharmacological guideline and recent systematic reviews support the above approach, but the best drug depends on your migraine pattern, other illnesses, pregnancy plans, and current medications.

Create a quick-reference PDF for migraine treatment

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American Migraine Foundation acute preventive migraine treatment medication overuse headache

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migraine AND treatment

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mkdir -p "/tmp/workspace/migraine-quick-reference/output"

Your credits are exhausted. You can purchase a top-up or subscribe to a plan to continue using Orris. If you're already subscribed, your daily credits will reset tomorrow.For migraine treatment, separate it into treating an attack now and preventing frequent attacks.

During a migraine attack

Take medicine early in the attack if safe for you:

Simple pain relievers: paracetamol (acetaminophen), ibuprofen, naproxen, or aspirin.
Anti-nausea medicine: e.g., metoclopramide or prochlorperazine, prescribed by a clinician if nausea/vomiting is prominent.
Triptans: e.g., sumatriptan, rizatriptan, zolmitriptan. These are migraine-specific prescription medicines and work best early. Do not use if you have certain heart/vascular diseases, previous stroke/TIA, uncontrolled hypertension, or hemiplegic/brainstem aura migraine unless a doctor says it is appropriate.
If triptans are unsuitable or ineffective, clinicians may prescribe newer options such as gepants (ubrogepant, rimegepant) or lasmiditan, depending on local availability.

Resting in a dark, quiet room, drinking fluids, using a cold pack, and sleeping can help symptoms.

Avoid using acute headache medicines on more than 2 to 3 days a week when possible. Frequent use, especially combination painkillers, opioids, or triptans, can cause medication-overuse headache. Opioids are generally avoided for migraine.

Preventing migraine

Discuss preventive treatment if you have about 4 or more migraine days a month, disabling attacks, prolonged attacks, or are overusing rescue medicines.

Options include:

Beta-blockers: propranolol, metoprolol
Anti-seizure medicines: topiramate, valproate. Valproate should generally be avoided in pregnancy and in people who could become pregnant because of serious fetal risks.
Antidepressants: amitriptyline or venlafaxine
CGRP-targeting medicines: injections such as erenumab, fremanezumab, galcanezumab, eptinezumab; or oral agents such as atogepant/rimegepant where available. These are now considered a first-line prevention option by the American Headache Society.
Onabotulinum toxin A (Botox) for chronic migraine, typically defined as headache on 15 or more days/month with migraine on at least 8 days/month.

Keep a headache diary recording headache days, severity, aura, periods, sleep, foods, and medication use. Regular sleep, meals, hydration, exercise, stress management, and limiting excess caffeine can reduce attacks.

Seek urgent medical care now if

This is the first or worst headache of your life, starts suddenly like a thunderclap, follows a head injury, occurs with fever/stiff neck, fainting, weakness/numbness, trouble speaking, confusion, seizure, new visual loss, or is new during pregnancy/postpartum or after age 50.

A 2025 evidence-based pharmacological guideline and recent systematic reviews support the above approach, but the best drug depends on your migraine pattern, other illnesses, pregnancy plans, and current medications.

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TONSILEECTOMY INDCIATION

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tonsillectomy indications recurrent throat infection obstructive sleep disordered breathing guideline AAO-HNS

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tonsillectomy AND indications

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Indications for Tonsillectomy

1. Recurrent acute tonsillitis or throat infection

Tonsillectomy may be considered when episodes are well documented and meet the Paradise frequency criteria:

≥7 episodes in 1 year, or
≥5 episodes/year for 2 consecutive years, or
≥3 episodes/year for 3 consecutive years

Each episode should include sore throat plus at least one of: fever >38.3°C, cervical lymph-node enlargement, tonsillar exudate, or a positive group A streptococcal test. Below these thresholds, watchful waiting is usually preferred. AAO-HNS criteria

2. Obstructive sleep-disordered breathing / obstructive sleep apnea

Especially in children with enlarged tonsils causing:

Habitual loud snoring
Witnessed apneas, gasping, restless sleep
Mouth breathing
Daytime sleepiness, behavioral or learning problems
Poor growth, cor pulmonale, or significant airway obstruction

Adenotonsillectomy is commonly the first surgical treatment in children with tonsillar hypertrophy and obstructive sleep apnea.

3. Recurrent or complicated peritonsillar abscess

Recurrent peritonsillar abscess (quinsy)
More than one abscess is a recognized modifying factor favoring surgery
Acute tonsillectomy may rarely be considered for airway compromise or selected severe cases

4. Suspected tonsillar malignancy

Unilateral tonsillar enlargement or asymmetry with concerning features
Persistent ulcer, neck node, unexplained weight loss, bleeding, or suspected cancer
Tonsillectomy may be diagnostic and/or therapeutic.

5. Modifying factors despite not meeting infection-frequency criteria

Tonsillectomy may still be appropriate in selected patients with:

PFAPA syndrome: periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis
Multiple antibiotic allergies or intolerance making recurrent infections difficult to treat
Severe episodes causing dehydration, hospitalization, or major school/work absence
Recurrent tonsillitis associated with febrile seizures or exacerbation of a serious comorbidity

Less common indications

Chronic tonsillitis with persistent symptoms despite appropriate treatment
Tonsillar hypertrophy causing significant swallowing difficulty
Diphtheria carrier state in exceptional settings
Surgical access for selected oropharyngeal/parapharyngeal procedures

Important: Tonsillectomy has risks, particularly postoperative pain and bleeding, so it should be decided after ENT assessment. In children, the two major indications are recurrent throat infection and obstructive sleep-disordered breathing, as summarized in AAO-HNS guidance.