Migraine is a long‑term brain condition, not just a series of isolated headaches. Effective management usually involves three pillars: lifestyle modification, acute treatments for attacks, and preventive strategies to reduce how often migraines occur. At Axon Neurology in Murdoch, we work with patients, their GPs and other health providers across Perth and regional Western Australia to combine these approaches in a way that fits each person’s life.
Importantly, the medicines mentioned below are examples of groups and commonly used drug names, not instructions to self‑treat. The right choice and dose for you must be decided together with your GP or specialist.
1. Lifestyle foundations: raising your migraine threshold
Lifestyle changes do not “cure” migraine, but they can make the brain less sensitive and help your other treatments work better.
Sleep and routine
- Aim for regular bed and wake times, even on weekends.
- Avoid large swings in sleep pattern (very late nights or long sleep‑ins).
- Create a calm, dark, quiet sleep environment and limit screens in the hour before bed.
Food and hydration
- Eat regular meals; avoid skipping breakfast or going many hours without food.
- Focus on whole, minimally processed foods (vegetables, fruit, whole grains, legumes, nuts, seeds and unprocessed protein sources).
- Limit highly processed foods, sugary drinks and excessive caffeine or alcohol.
- Drink water steadily throughout the day; adjust for heat and activity.
Exercise and movement
- Build up to regular, moderate exercise most days of the week (for example, walking, cycling, swimming or gym‑based routines).
- Include some strength work and stretching if possible.
- Start gently and progress gradually; benefits usually appear over weeks to months, not days.
Stress, mood and pacing
- Use stress‑management techniques such as breathing exercises, relaxation, mindfulness or yoga.
- Pay attention to mood; anxiety and low mood are common in migraine and worth addressing.
Pace activities to avoid big swings between overdoing it and “crashing”. - Even small, consistent lifestyle improvements can raise your migraine threshold and make medications more effective.
2. Acute treatments: treating attacks early and safely
Acute treatments are medicines you take when a migraine attack starts, with the goal of reducing pain and associated symptoms, and helping you return to normal activity.
Treat early
- Take acute medication as soon as you recognise your typical migraine symptoms, rather than waiting until pain is severe.
- Early treatment often works better and may shorten the attack.
Common groups and examples of acute medications
Which specific medicine and dose you use should always be decided with your GP or headache specialist, but typical classes (with common examples) include:
- Simple pain relievers (analgesics)
- Paracetamol.
- Anti‑inflammatory pain relievers (NSAIDs)
- Aspirin, ibuprofen, naproxen, indomethacin.
- Migraine‑specific medicines (triptans and gepants)
- Triptans: sumatriptan (Imigran), rizatriptan (Maxalt), eletriptan (Relpax), zolmitriptan (Zomig), naratriptan (Naramig).
- Gepants: rimegepant (Nurtec), which can be used as an acute treatment for migraine attacks and, in some cases, also as a preventive (see below).
- Anti‑nausea medicines (antiemetics)
- Metoclopramide (Maxolon), prochlorperazine, or ondansetron (Zofran) wafers.
Your doctor may recommend combining drugs from different groups (for example, paracetamol plus an NSAID plus an anti‑nausea medication), but you should only do this under medical guidance. Some medicines are not suitable for everyone – for example, particular heart conditions, pregnancy, or migraine with aura may change which drugs are safe.
Avoiding medication overuse
Using acute medicines too often can lead to medication‑overuse headache, where headaches become more frequent and the brain becomes more sensitive. Principles include:
- Try to keep use of paracetamol, NSAIDs, triptans, gepants and codeine‑containing medicines to a limited number of days per month.
- If you find you are reaching for pain relief on many days, this is a sign to review your plan and consider preventive options with your GP or specialist, rather than simply increasing acute medication.
3. Preventive treatments: reducing how often migraines occur
Preventive (prophylactic) treatments are taken regularly to reduce how often and how severely migraines occur. They are usually considered when:
- You have frequent attacks (for example, more than three significant migraines per month).
- Attacks are very disabling, even if less frequent.
- Acute medications are not working well or are needed too often.
Natural and complementary preventives
These may include:
- Riboflavin (vitamin B2).
- Magnesium.
- Coenzyme Q10.
- Vitamin B12.
- Herbal options such as feverfew.
It is also important to check for and correct deficiencies in iron, vitamin D, B12 or thyroid function through your GP. Even with “natural” products, you should speak with your doctor to avoid interactions and to choose appropriate doses.
Oral preventive medications – classes and examples
These medicines were originally developed for other conditions but are widely used for migraine prevention. Common groups and examples include:
- Blood pressure medications
- Beta‑blockers: propranolol.
- Angiotensin‑receptor blockers: candesartan.
- Calcium‑channel blockers: verapamil.
- Antidepressant medications
- Tricyclic antidepressants: amitriptyline, nortriptyline.
- Serotonin–noradrenaline reuptake inhibitors (SNRIs): venlafaxine, duloxetine.
- Anti‑epileptic medications
- Topiramate (Topamax).
- Sodium valproate (Epilim, valproate).
- Lamotrigine (especially in certain aura‑dominant patterns).
- Allergy‑related medications (antihistaminic/serotonergic)
- Pizotifen (Sandomigran).
- Cyproheptadine (Periactin).
Each of these has its own potential benefits and side effects. Your GP or neurologist will help decide which is most suitable for you, and at what dose, based on your broader health profile and other medications. This is not a list to work through on your own without medical advice.
Injectable and advanced preventive treatments
For people with frequent, disabling migraine who have not improved enough with several oral preventives, we may consider:
- Botulinum toxin type A injections (Botox) for chronic migraine, given at regular intervals (for example, every 12 weeks) in people who meet specific criteria.
- CGRP‑targeting medications
- Monoclonal antibodies such as fremanezumab (Ajovy), galcanezumab (Emgality) and eptinezumab (Vyepti).
- Oral CGRP receptor blockers (gepants), such as rimegepant (Nurtec), which can be used as a preventive on a regular schedule in addition to its role as an acute treatment, although it is not currently PBS‑funded.
These advanced therapies are usually started and monitored under the guidance of a neurologist or headache specialist, often with PBS and safety criteria to consider.
4. Putting it all together: a stepwise plan
In practice, most people do best with a structured, stepwise plan rather than a single “magic” treatment. A typical journey might involve:
- Establishing lifestyle foundations (sleep, food, hydration, exercise, stress).
- Developing a clear acute treatment plan, including which medicines to use (for example, a chosen triptan or Nurtec, plus an NSAID and an anti‑nausea option), how to combine them safely, and when to seek help.
- Adding or adjusting preventive therapies if attacks are frequent, disabling or leading to medication overuse.
Reviewing regularly with a GP or headache specialist to assess what is working, what is not, and what might need to change as life circumstances evolve.
The medication names and groups above are the tools we commonly use, but they are not instructions to self‑medicate. Your GP is often the first point of contact to start this process. A neurology or dedicated headache clinic, such as Axon Neurology in Murdoch, can provide more detailed assessment and help navigate the full range of options when needed.
How Axon Neurology can support you
At Axon Neurology, we view migraine management as a partnership between the person with migraine, their GP and our headache specialists. During your assessment we can:
- Confirm or refine your diagnosis and identify any red flags that need further investigation.
- Outline lifestyle strategies that are most relevant to your situation.
- Help your GP select and sequence appropriate groups of acute and preventive medications (for example, which triptan, which preventive class, or whether a gepant such as Nurtec might be appropriate to discuss).
- Advise on when to consider advanced options such as botulinum toxin type A, CGRP‑targeting treatments or procedures like nerve blocks, and whether you may be eligible for subsidised therapies.
If you or your GP feel that your migraines are not adequately controlled, or your pattern has changed, our team at Axon Neurology in Murdoch is available to review your case and provide guidance on the next steps in your migraine management journey.