There are many things you can get from your local pharmacy to manage your migraine that don't require a prescription. There are also many prescribed medications that can help manage your symptoms. Please talk to your pharmacist and your doctor about what would be right for you.
We're all familiar with paracetamol (Panadol, Panamax) and ibuprofen (Nurofen, Advil) and Aspirin is an essential part of the care plan for many people. Non-steroidal anti-inflammatory drugs (NSAIDs) are generally believed to be better for managing migraine pain than paracetamol. Taking an NSAID at the same time as your triptan can also help your triptan work better.
Here's a few other pain relief options available over the counter you might want to talk to your pharmacist about:
- Other NSAIDs like ibuprofen include diclofenac (Voltaren) and piroxicam which some may find helpful.
- Naproxen (Aleve, Naprogesic) and mefenamic acid (Ponstan) are long-acting NSAIDs often marketed as a period pain treatment. These medications can be used both as an acute treatment (when you have an attack) and daily in the few days before your period if you have menstrual migraine as a preventative measure.
- Long-acting paracetamol (Panadol Osteo) can also provide relief for longer than normal paracetamol.
- Combination caffeine and analgesic medications, such as Panadol Extra, may provide more relief than either drug alone.
If your pain persists, is not being adequately controlled or you are not sure how to cope with your pain, you should speak to your doctor. Commonly prescribed pain medications include:
- Codeine, which until recently was available over the counter to treat moderate pain, is available by itself or in combinations such as Panadiene Forte (paracetamol plus codeine); Aspalgin (aspirin plus codeine) and Mersyndol (paracetamol plus codeine plus doxylamine).
- Stronger dose NSAIDs like Voltaren 50 and Indomethacin are available with a prescription
- Tramadol, a synthetic opioid, or Endone, a morphone derivative opiate, are stronger options your GP can prescribe.
If you are using any kind of opioid you may be restricted to small pack sizes and need to see a second doctor to continue using the medication long term.
Any use of pain medication puts you at risk of developing medication overuse headache. As a general rule, limit your use of pain medications to 10 days per month. Read more here.
Read more about the role of medication in managing pain at Painaustralia
Sleeping well is very important to managing your migraine. Sometimes we can get stuck in a migraine cycle that keeps us up at night and drowsy during the day. Here's some things to consider to help you get your sleep back to normal:
- Doxylamine is a common anti-histamine that makes many people sleepy. It's in Mersyndol, but it's also available without the codeine (and therefore without prescription) from your pharmacy as Restavit, Dozile, or there are generic brands.
- Promethazine (Phenergan) is another antihistamine that can help with sleep.
- Melatonin (Circadin) can be taken to help get your sleep cycle back in rhythm.
If insomnia persists please see your doctor. There is a big range of sedatives that can be prescribed, including:
- Benzodiazepines and benzodiazepine-like medication. These are the most commonly used sleeping tablets in Australia and include temazepam (Temaze, Normison), zopiclone (Imovane) and zolpidem (Stilnox). They work by enhancing the activity of sleep pathways in the brain. They are recommended for short term use (less than 4 weeks).
- Suvorexant (Belsomra). This works by reducing the activity of the wake pathways in the brain. It is more helpful for people with chronic insomnia who spend time awake during the night after initially falling asleep. It can be used for longer periods than conventional sleeping tablets
- Antidepressants and antipsychotics (e.g., Endep, Avanza, Seroquel). These medications are generally used for people with underlying mental health conditions and are not recommended for use in primary insomnia.
Find out more about options for better sleep from the Sleep Health Foundation
Nausea is a common problem and difficult to manage.
- Hyoscine Hydrobromide (Travacalm, Kwells)
- Cyclizine hydrochloride (Nausicalm)
are anti-nausea medications available from your pharmacy. If your nausea persists see your doctor about getting a prescription anti-emetic. The three most commonly prescribed are:
- Prochlorperazine (Stemitil) which is also believed to be helpful in managing migraine attacks
What is the Aspirin Bomb?
You will hear people in the migraine community talk about an 'Aspirin Bomb' as something to take at the onset of a migraine attack. This refers to taking:
- 900mg (or a bit more) of Aspirin
- Either your normal triptan or 5mg of Stemitil
- Caffeine, usually in the form of a strong coffee or can of Coke
all at once and as soon as you can. If you have had a food or environmental trigger you may also want to add a common anti-histamine like Claratyne or Zyrtec to your aspirin bomb.
As always this information is for informational purposes only and does not constitute medical advice, please see your doctor to discuss your symptoms.