Migraine relief

Medical information

Written and reviewed by a team of doctors. Dr Fox is regulated by the CQC & GPhC.

Symptoms of migraines

A migraine headache will usually have several of the following features:

• Typically throbbing and severe.
• Usually at the front of the head.
• Usually localised to one side of the head but not always.
• Nausea, queasiness, vomiting.
• Intolerance of bright light (photophobia).
• Other heightened sensitivities, e.g. to noise and strong smells.
• A sufferer will often need to avoid normal activities.
• Usually last a few hours but can last up to 3 days.
• Aura - a migraine may start with symptoms such as flashing lights, seeing zigzag lines, blurring, having a blind spot. Other sensory aura may include tingling sensations, problems with coordination and concentration, speech difficulty, and blackouts (rare).
• After the migraine headache has gone, tiredness and 'washed out' feelings are common and can last several days.
• Symptom-free between headaches.

Migraine is common affecting about 1 in 4 women and 1 in 12 men in the UK.

• A quarter of people who get migraines have a warning or aura before their headaches.
• It is unusual for migraines to first start after the age of 40.
• Some women get migraines around the time of their periods.
• Migraine attacks can be triggered by stress, tiredness, and some medication. In some cases trigger foods can be identified.

See NHS migraine page for further details.

'Triptans'

Triptan medication is for people under 65, who have been diagnosed with migraine, not for other types of headaches.

Migraine headaches are linked to swelling and leakage of blood vessels in and around the brain. Triptans (5HT₁-receptor agonists) work by reversing this expansion of blood vessels.

Dr Fox supplies a choice of triptan medication and formulations including tablets, melt-in-the-mouth tablets, and nasal sprays. Strict order limits are enforced (maximum 12 tablets or sprays per month).

If your first choice of triptan does not work, alternative triptans are worth trying. You must leave at least 24 hours between taking different triptans.

Do NOT mix different types of triptans for the same headache episode.

Triptans are not licensed for use by those aged over 65.

Vydura (rimegepant)

Vydura 75mg is a migraine treatment which has been developed to target the underlying chemical changes which lead to a migraine developing. Vydura blocks the action of CGRP in the brain and this stops the swelling of brain blood vessels and the pain of a migraine.

Vydura is a mint flavoured lyophilisate, which is a freeze-dried wafer that dissolves under the tongue.

Vydura is recommended for people who cannot take triptans either due to side effects or their age, or other medical conditions, or for whom triptans are not effective. It is recommended that you have tried at least two different triptans before moving onto Vydura.

Vydura is used to treat migraines but it is also effective as a migraine preventative. The preventative dose is recommended if having more than 4 migraines in a month: one Vydura lyophilisate wafer to be taken every other day, also available from Dr Fox.

Vydura has been used in the USA since 2020, and it appears to be safe to use alongside all preventative migraine treatments and other migraine therapies. However, there is still limited research data and the manufacturers make no recommendations about use with other migraine treatments.

Vydura is slightly less effective at treating a migraine compared to triptans, but there are fewer side effects.

Vydura can be used by any adult, even the elderly, with the only contraindications being severe liver or severe kidney disease, pregnancy, and breastfeeding. It can be taken by people who have heart or circulation problems which prevents them from taking triptans.

Other treatments for acute migraine

Once a migraine has started, rest and taking medication is usually the quickest way to settle the symptoms.

In many cases, people find simple anti-inflammatory tablets such as ibuprofen (400mg-600mg), or aspirin (900mg) are effective on their own without needing to use a specific anti-migraine medicine.

Caution: anti-inflammatory painkillers and aspirin can be associated with acid indigestion and even intestinal bleeding.

Anti-sickness tablets if taken early can also help. They can aid absorption of the anti-migraine medication as well as reducing symptoms of nausea. However some migraine treatments including Maxalt melts, Zomig rapimelts, orodispersible tablets and Vydura are designed to melt in the mouth and so are absorbed quickly and effectively even if there is nausea and vomiting.

If suffering more than one migraine per week, you may benefit from preventative treatment. The Migraine Trust has more information about the various types available. Dr Fox can supply Vydura, but we recommend that you speak with your usual GP to discuss your options, Dr Fox does not supply other migraine preventative treatments.

Cautions with triptans

Triptans have been used by millions of people throughout the world for decades and are generally considered safe drugs.

Triptans can cause a temporary narrowing of all blood vessels. People should not take triptans if they have had:

• Strokes or mini-strokes (TIAs).
• Problems with poor circulation.
• Angina (heart pain on exertion).
• Heart attack.
• Irregular heart rhythm.

Even in people who have never had circulation problems, triptans can, in rare situations, trigger serious heart problems. To reduce this risk, the following groups should check with a GP before taking triptan medication:

• Heavy smokers (over 25 cigarettes/day) or have been a heavy smoker in the past.
• Men over 40.
• Women after the menopause.

In some rare serious cases migraine headaches are associated with temporary paralysis, loss of vision, and loss of speech. Triptans are not to be used in these cases.

If triptans and other painkillers are used too frequently (more than 10-15 times per month) they can actually cause headaches, often called medication overuse headaches.

There are some medications which should not be taken at the same time as triptans. Checks are carried out in the online consultation and full details are in manufacturers' patient information leaflets (see links below) supplied with your medication.

Possible side effects of triptans

All medications have the potential to cause unwanted side effects but not everyone gets them. When taking migraine therapies, it can sometimes be hard to tell if a symptom is from the migraine itself or is a medication side effect. There is no major difference between the different triptans and their side effects.

The following are commonly reported (may affect up to 1 in 10 people) when taking triptans:

• Headache.
• Dizziness, sleepiness, and tiredness.
• Aching or weak muscles.
• Abnormal sensations such as tingling, numbness, hot or cold flushes, over sensitive/less sensitive skin - these can be intense but generally pass quickly.
• Feeling sick (nausea), dry mouth, throat discomfort, vomiting, diarrhoea, indigestion.
• Palpitation.

More serious but rare side effects can include:

• Heavy, pressure, tight feelings or pain/discomfort in the throat, neck, arms, and chest. If these occur, stop using the medication. If they do not settle within 15-20 minutes or become very severe, get emergency medical help - telephone 999 in the UK. In a very small number of susceptible people triptans can trigger angina or a heart attack.
• In rare cases there is an allergy to triptans, leading to skin rash. The signs of serious allergy can include rash, hives, wheezing, swollen eyelids, face or lips, followed by complete collapse. If this develops, get emergency medical help straight away - telephone 999 in the UK.

For a full list of side effects and cautions see the Patient Information Leaflet included with medicine packs (links below).

Possible side effects of Vydura

The most common side effect when using Vydura as a migraine treatment is nausea, which may affect up to 1 in 10 people.

An allergic reaction including severe rash or shortness of breath is uncommon, being reported in up to 1 in 100. If this does happen, stop using Vydura and contact your doctor or emergency services.

As Vydura is new to the UK, it is subject to additional monitoring and reporting side effects will help to identify new safety information. Side effects can be reported directly via the MHRA Yellow Card Scheme or their app which can be downloaded from Google Play or Apple App Store.

Treatments available from Dr Fox

Dr Fox offers three different triptan medications in tablet, dissolving tablet, and nose spray preparations. There is little clinical difference in effect between the products but the rate of migraine recovery is often better using the nose sprays. It is usual to try sumatriptan first and move onto the other products if required. Vydura (rimegepant) wafers can be taken to prevent or relieve migraines.

When to see a GP

• Before self medicating for migraine headaches it is best to see a GP for a diagnosis.
• Very sudden onset of very severe headache, sometimes called 'thunderclap' headache.
• When headaches start for the first time over the age of 40.
• When headaches are getting more frequent and lasting longer.
• If headaches are worsening after taking triptans for over 10 days or other pain killers for over 15 days. Your doctor may recommend stopping treatment for a month, as this could be medication overuse headache/withdrawal headache.
• When headaches are different from before (new symptoms).
• If there are new headaches and other signs of being generally unwell, e.g. unintentional weight loss, neurological symptoms, eye symptoms.
• People who experience two or more attacks a month which cause disability, or who are not responding to treatment, should also consult their GP.
• If you develop a new severe headache in pregnancy.

Further information

• NHS - Migraine
• The Migraine Trust - Treatments

Dr Fox supplies migraine treatment on prescription - you are required to answer a short medical questionnaire before your order can be completed.

Authored 18 February 2010 by Dr Tony Steele
MB ChB Sheffield University 1983. Former hospital doctor and GP. GMC no. 2825328

Reviewed by Dr A. Wood, Dr C. Pugh, Dr B. Babor
Last reviewed 18 March 2024
Last updated 11 December 2024
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