Migraine treatment starts with stopping the attack you have now. That means IV therapy with an anti-nausea agent, an anti-inflammatory and magnesium, or a no-needle sphenopalatine ganglion block. No opioids. At 15 or more headache days a month, the focus shifts to prevention.
Migraine is a neurological disease, not a bad headache. Treating it as a bad headache is why so many people cycle for years. They go back and forth between the emergency room and their own medicine cabinet.
How do you know if it is a migraine?
The classic attack is moderate to severe and often one-sided. It throbs rather than presses. Routine movement makes it worse. It comes with nausea and with 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 that develops over five to twenty minutes.
Not every attack has every feature. One-sidedness in particular is common but not required. A bilateral (both-sided) migraine is still a migraine.
How do you stop a migraine attack when pills have failed?
If oral medication has already failed, or you are vomiting, the real problem is absorption. Migraine slows stomach emptying as part of the disease. So a tablet taken three hours in may never reach the bloodstream in useful amounts. Intravenous therapy removes that problem. It uses an anti-nausea agent that also fights migraine. It adds an anti-inflammatory, and magnesium where indicated. In some cases it adds a single dose of dexamethasone (a steroid) to reduce the chance of the headache returning the next day.
Some attacks have a strong autonomic component, or the usual drugs are contraindicated (unsafe for you). Then a sphenopalatine ganglion block is an option. It requires no needle and no sedation.
Are you having headache on 15 or more days a month? Then the conversation shifts from stopping attacks to preventing them — see Botox for chronic migraine and headache prevention.
Why are opioids the wrong treatment for migraine?
Urgent care and emergency departments still hand out opioids for migraine. 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 (anti-nausea drugs) that actually help.
The larger problem is what repeated use does. Frequent acute treatment of any kind can convert episodic migraine into medication-overuse headache. Opioids do this most readily, but combination analgesics and triptans do too. Attacks become more frequent and less responsive precisely because of the treatment. People arrive having taken something almost daily for months. They are convinced the disease has worsened. But a large part of what has worsened is the rebound cycle. Unwinding it means withdrawing the overused drug while covering the withdrawal period with something that does not feed it — which is exactly what infusion therapy and nerve blocks are for.
Frequently asked questions
Is this a migraine or a cluster headache?
Cluster pain is strictly one-sided, centered in or behind the eye. It comes with a watering eye, drooping lid or blocked nostril on that same side. It peaks within minutes and lasts under three hours. People pace rather than lie still. Migraine builds more slowly, drives you to a dark quiet room, and lasts far longer. The difference 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. There is 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 (neck) or occipital (back of the head) contribution. Signs include 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. There is a threshold associated with medication-overuse headache. It is acute headache medicine taken on more than about ten to fifteen days a month. The exact number depends on the drug. It is common, and it is reversible. Raise it at your visit. Do not hide it.
What is the difference between a headache and a migraine?
Migraine is a neurological disease, not a bad headache. A typical attack is moderate to severe and often one-sided. It throbs rather than presses, and routine movement makes it worse. It comes with nausea and sensitivity to light or sound. Untreated, it lasts four hours to three days. About a quarter of people see an aura first, most often a spreading zigzag or blind spot.
What is the fastest way to relieve a migraine?
If tablets have already failed or you are vomiting, IV therapy is the most direct route. That is because migraine slows the stomach, and a pill taken hours in may never be absorbed. The infusion combines an anti-nausea agent, an anti-inflammatory and magnesium where indicated. A sphenopalatine ganglion block is another option that needs no needle and no sedation.
How do you treat daily migraines?
At 15 or more headache days a month, the goal shifts from stopping each attack to preventing them. Options include Botox for chronic migraine. The first thing to check is medication overuse. Taking acute medicine most days can itself drive daily headache. Unwinding it means stopping the offending drug. Meanwhile, infusion therapy and nerve blocks cover the withdrawal period.
What is the 5-4-3-2-1 rule for migraines?
It is a grounding exercise borrowed from anxiety care, not a migraine treatment. The version that circulates online has you name five things you can see, four you can touch, three you can hear, two you can smell and one you can taste. Counting can take the edge off the panic that builds during a bad attack, and that has value, because a surging stress response amplifies pain. It does not stop the attack. Migraine runs through the trigeminal nerve system, and what shortens it is treatment that reaches the bloodstream early, before the stomach stalls. Learn more: what IV therapy does when a migraine will not break.
Sources
- Marmura MJ, Silberstein SD, Schwedt TJ. The acute treatment of migraine in adults: the american headache society evidence assessment of migraine pharmacotherapies. Headache, 2015. PMID 25600718. pubmed.ncbi.nlm.nih.gov
- Eken C. Critical reappraisal of intravenous metoclopramide in migraine attack: a systematic review and meta-analysis. The American journal of emergency medicine, 2014. PMID 25579820. pubmed.ncbi.nlm.nih.gov
- Ailani J, Burch RC, Robbins MS, et al. The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache, 2021. PMID 34160823. pubmed.ncbi.nlm.nih.gov
Booking online shows our scheduled openings; call or text for hours that are not listed. Please contact us before coming in rather than arriving unannounced — we need to know what is happening to have the right treatment ready.
A note on coverage, and on timing. Same-day treatment and prior authorization do not run on the same clock. Many insurers take days to weeks to decide, and some acute headache treatments are not covered at all. Your headache will not wait for that process.
We will verify your benefits and, where a treatment needs prior authorization, we will attempt to obtain it. An authorization confirms that a service meets criteria for review — it is not a guarantee of payment, and no clinic can make that promise on your insurer’s behalf. Where something is unlikely to be covered, or cannot be certified in time to treat you today, we will tell you before we treat rather than after, so the decision is yours. Payment is due at the time of service.