Migraine is a neurological disease, not a bad headache. Treating it as the latter is why so many people cycle for years between the emergency room and their own medicine cabinet.
How migraine is recognised
The classic attack is moderate to severe, often one-sided, pulsating rather than pressing, made worse by routine movement, and accompanied by nausea and by sensitivity to light or sound. Untreated it runs somewhere between four hours and three days. Around a quarter of people get an aura first — most often visual, a spreading zigzag or blind spot developing over five to twenty minutes.
Not every attack has every feature. One-sidedness in particular is common but not required, and a bilateral migraine is still a migraine.
Stopping the attack you have now
If oral medication has already failed, or you are vomiting, the practical problem is absorption. Migraine slows gastric emptying as part of the disease, so a tablet taken three hours in may never reach the bloodstream in useful quantity. Intravenous therapy removes that variable — an anti-nausea agent with genuine anti-migraine activity, an anti-inflammatory, magnesium where indicated, and in some cases a single dose of dexamethasone to reduce the chance of the headache returning the next day.
Where the attack has a strong autonomic component, or where the usual drugs are contraindicated, a sphenopalatine ganglion block is an option that requires no needle and no sedation.
If you are having headache on 15 or more days a month, the conversation shifts from stopping attacks to preventing them — see Botox for chronic migraine and headache prevention.
Why opioids are the wrong tool for migraine
Opioids are still handed out for migraine in urgent care and emergency departments, and for this condition they are close to the worst available option. They do not address the underlying mechanism, they are less effective than migraine-specific treatment, they worsen the nausea, and they interact badly with the antiemetics that actually help.
The larger problem is what repeated use does. Frequent acute treatment of any kind — opioids most readily, but also combination analgesics and triptans — can convert episodic migraine into medication-overuse headache, in which attacks become more frequent and less responsive precisely because of the treatment. People arrive having taken something almost daily for months, convinced the disease has worsened, when a large part of what has worsened is the rebound cycle. Unwinding it means withdrawing the offending drug while covering the withdrawal period with something that does not feed it — which is exactly what infusion therapy and nerve blocks are for.
Questions people ask
Is this a migraine or a cluster headache?
Cluster pain is strictly one-sided, centred in or behind the eye, and comes with a watering eye, drooping lid or blocked nostril on that same side. It peaks within minutes and lasts under three hours, and people pace rather than lie still. Migraine builds more slowly, drives you to a dark quiet room, and lasts far longer. The distinction matters because the treatments differ completely — see cluster headache treatment.
Does oxygen help migraine?
High-flow oxygen is a first-line treatment for cluster headache, not for migraine. Hyperbaric oxygen has been studied in acute migraine with some positive but low-quality evidence. We set out both honestly on the oxygen therapy page.
Can a nerve block help migraine?
Sometimes. An occipital nerve block is most clearly indicated when there is a cervical or occipital contribution — scalp tenderness, neck-triggered attacks, pain running from the base of the skull. If numbing that nerve abolishes the pain, that tells you where it was coming from.
I take something for headache most days. Is that a problem?
Probably yes. Acute headache medication taken on more than about ten to fifteen days a month, depending on the drug, is the threshold associated with medication-overuse headache. It is common, it is reversible, and it is worth raising at your visit rather than hiding.