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23-05-2025

Migraine: Expert Advice on How to Treat It Rationally and Safely

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Migraine is one of the most common chronic neurological disorders, affecting millions of people worldwide, including Lithuania. Although the symptoms of this condition can be extremely debilitating, with the right combination of medication and non-medication treatments, it is possible to significantly reduce the frequency and intensity of attacks and improve patient’s quality of life.

A nationwide study conducted by specialists from the National Health Insurance Fund revealed that there are cases where migraine medications are prescribed and used irrationally. A more responsible approach is needed: an accurate diagnosis, an individualized treatment plan, and conscious use of medication.

Worsens life quality, reduces working capacity

Migraine is a neurological condition characterised by recurrent headaches (often throbbing and involving one side of the head), nausea, vomiting, mood swings, fatigue, and sensitivity to light, sounds or smells. Around a third of migraine sufferers present with aura: temporary visual, sensory, speech or motor disturbances. Symptoms may occur all or part of the time, in combination with a migraine attack or in between. Attacks can last from a few hours to several days. 

According to the Institute of Hygiene, 24 000 people in Lithuania were diagnosed with migraine in 2023 (with at least one attack in the last two years). However, according to the Eurolight survey, 18.8% of the population had migraine attacks at least once a year. This means that the real prevalence of migraine may be even higher, as some people do not consider their symptoms to be migraine, while others do not seek medical attention due to stigma or other reasons.

Migraines can start at any age – from adolescence to old age – but are most common in people of working age, especially around the age of 40. Around 35% of women and 15% of men suffer from migraine then.

Rational treatment and prevention of migraine is important both for the individual and for the state, as migraine affects quality of life and working capacity, with an average reduction in working capacity of around 3.5-4.5%.

Treatment with medications

According to Prof. Romaldas Mačiulaitis, chairman of the Committee for the Promotion of Rational Use of Medicines, migraine can be managed in two ways: by treating a current attack, and by prevention, which aims to reduce the frequency or severity of future attacks.

For mild migraine attacks where headache is not accompanied by nausea or vomiting, non-steroidal anti-inflammatory drugs (such as ibuprofen) or paracetamol are recommended. In moderate to severe cases, drugs from the triptan group, or combinations with anti-inflammatory drugs, are prescribed.

If nausea or vomiting occurs, additional anti-nausea medications may be prescribed, which are best administered intravenously to ensure absorption in case of vomiting. If nausea or vomiting happens frequently, it is advisable to discuss with a doctor the possibility of using triptans in nasal spray form — this way the medication enters the systemic circulation faster if vomiting occurs. When treatment with at least two different triptans is ineffective, not tolerated, or their use is contraindicated, the doctor may prescribe treatment with rimegepant.

Prophylactic medication is recommended when migraine attacks recur 4 or more times a month. They can also be prescribed in other cases, such as when attacks last for a long time or cause severe disability. 

Beta adrenoblockers, antidepressants, anti-epileptic drugs, biologics or other drugs are commonly prescribed as first-line drugs for preventive treatment. In case of contraindications or insufficient effect, second-line drugs may be prescribed: certain antihypertensives, antidepressants, antiepileptic drugs.

“All of these medicines cause more or less adverse reactions, but the doctor’s aim is to achieve the right effect with the least risk to the patient. Research has shown that there are cases where a patient continues with treatment that is not working for him/her. Such treatment is not only unnecessary, but also unsafe and therefore irrational,” says Prof. R. Mačiulaitis.

Specialist recommends

  • If you have not yet been diagnosed with migraine, but are experiencing migraine-like symptoms, it is recommended that you consult your family doctor in order to set up an appropriate monitoring and treatment plan. If left untreated or inadequately treated, episodic migraine can progress to chronic migraine.
  • Early treatment of migraine headaches is more effective than delayed treatment. 
  • Be sure to tell your doctor about any comorbidities, medications you are taking and any adverse reactions you are experiencing – not all medications may be suitable for you.
  • It is essential to take all the medicines prescribed by your doctor on a regular basis – only then will treatment be successful.
  • It can take weeks or even months for prophylactic medicines to become effective, so it’s important not to rush off them.
  • If you suspect that a prophylactic medicine is not working as it should, contact your GP. He or she will assess your condition and, if necessary, adjust your treatment or refer you to a neurologist for advice.
  • Keeping a diary of your migraine attacks is useful to help your doctor assess the severity of your migraine symptoms and the effectiveness of your medication.
  • Do not adjust your migraine treatment plan (dose, frequency, discontinuation, combination, etc.) on your own without your doctor’s knowledge.
  • Remember that non-medication measures are also important: regular sleep, rest, stress management, a healthy and regular diet, physical activity, limiting caffeine, recognising and avoiding individual migraine triggers. These measures may be more difficult to implement than taking medication, but their effects are long-lasting, important and significant.

Rational migraine management is about finding the most effective, yet safe and economically sustainable solutions for each individual patient. The professor warns that information about medicines and their selection is based on studies and data on the majority of patients. However, it is always important to discuss treatment plan and course of treatment with your GP or neurologist in each case.

(Getty Images photo)

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Last updated: 17-06-2025

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