June 01, 2021


Advances in treatment

Amaal Starling, M.D., Neurology/Headache Medicine

Amaal Starling, M.D., Neurology/Headache Medicine


Migraine is a common and potentially disabling disorder. Migraine attacks can cause not only severe throbbing head pain or pulsing sensations but also nausea, vomiting, and extreme sensitivity to light and sound.

There are as-needed treatments to stop symptoms of a migraine attack (acute treatment) and long-term treatments to decrease the frequency and severity of migraine attacks (preventive treatment).

As-needed treatments include nonprescription pain relievers such as aspirin, acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others), or nonprescription pain relievers that include caffeine (Excedrin Migraine). Additionally, triptans, a class of prescription medications designed specifically for migraine — including drugs such as sumatriptan (Imitrex, Tosymra, others), rizatriptan (Maxalt), naratriptan (Amerge), eletriptan (Relpax) and zolmitriptan (Zomig) — can be taken as pills, injections or nasal sprays. However, if taken too frequently, these acute treatments may lead to medication overuse headaches.

For many years, preventive options for managing migraine were limited to medications originally intended to treat other conditions. These included certain drugs to lower blood pressure, antidepressants and anti-seizure drugs. Although effective, these drugs can cause side effects, such as nausea and dizziness, which can make it difficult to stick to the treatment.

But the list of available treatments is expanding. Read on for an interview with Amaal Starling, M.D., a Mayo Clinic neurologist.

Q: How are preventive treatments for migraine changing?

A: Before 2018, there were...