In short: Migraine is usually treated in two ways: medicines taken at the start of an attack (acute treatment) and, for frequent attacks, daily or regular treatment to reduce how often they happen (prevention). Painkillers, anti-sickness medicines and triptans are the usual first options. For people whose migraines have not responded to several older preventive medicines, NICE has approved newer options, including CGRP-targeting treatments and botulinum toxin injections for chronic migraine. A clinician decides which treatment is suitable for you.

This guide, written by a Ready Health prescribing pharmacist and based on NICE guidance and technology appraisals, explains current UK migraine treatment options and when to seek help.

What are the symptoms of migraine?

moderate or severe headache, often one-sided and throbbing
feeling or being sick
sensitivity to light, sound or smells
headache made worse by everyday activity
in about one in three people, aura beforehand, such as zigzag lines, blind spots or tingling

Attacks commonly last from 4 hours to 3 days. Chronic migraine means headache on 15 or more days a month, with migraine features on at least 8 of them, for over 3 months.

How is a migraine attack treated?

NICE recommends options for acute treatment that can be used alone or combined:

an anti-inflammatory painkiller (such as ibuprofen or aspirin) or paracetamol
a triptan, which is a migraine-specific medicine
an anti-sickness medicine, which can also help absorption

Treatment works best taken early in the headache phase. If one triptan does not work, another may. Opioid painkillers such as codeine are not recommended for migraine.

For adults whose attacks have not responded to at least two triptans (or who cannot take them), NICE has recommended rimegepant, a tablet from a newer class called gepants, as an acute treatment option.

What is medication overuse headache?

Taking painkillers too often can make headaches more frequent. This is a risk if you use simple painkillers on 15 or more days a month, or triptans, opioids or combination painkillers on 10 or more days a month, for over 3 months. If you need acute treatment this often, speak to a clinician about prevention.

What preventive treatments are available for migraine?

First-line preventive medicines

NICE advises considering amitriptyline, propranolol or topiramate. Each has benefits and possible side effects, and the choice depends on your health, other conditions and preferences. Topiramate carries a risk of harm in pregnancy and must not be used by women or girls who could become pregnant unless the requirements of a pregnancy prevention programme are met. Some other medicines are sometimes used off-label on specialist advice.

Newer options when other treatments have not worked

Treatment type	How it is given	NICE position (summary)
CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab, eptinezumab)	Injection monthly or quarterly; eptinezumab is an infusion	For chronic or episodic migraine (at least 4 days a month) when at least 3 preventive treatments have not worked
Gepants for prevention (rimegepant, atogepant)	Tablets	For people with at least 4 migraine days a month when at least 3 preventive treatments have not worked (exact criteria differ by medicine)
Botulinum toxin type A	Injections into head and neck muscles every 12 weeks	For chronic migraine when at least 3 preventive medicines have not worked and medication overuse has been addressed

These treatments are prescription-only and usually started or supervised by a headache specialist or neurologist. Each NICE appraisal includes conditions about stopping treatment if migraine frequency does not reduce enough.

Non-drug approaches

keeping a headache diary to spot patterns and triggers
regular sleep, meals and fluids
regular exercise and stress management
acupuncture, which NICE says can be considered for prevention
for menstrual migraine, specific short-term preventive options may be discussed

When is a headache an emergency?

Call 999 or go to A&E for:

a sudden, severe headache that peaks within about a minute (thunderclap headache)
headache with weakness, slurred speech, confusion or loss of vision
headache with fever, stiff neck or a rash
headache after a head injury

See a GP soon for a new headache pattern after age 50, headache that steadily worsens, or headache with weight loss or other new symptoms.

Frequently asked questions

Can I get triptans without a prescription?

Sumatriptan 50mg is available from pharmacies without a prescription for adults with an established migraine diagnosis, after a pharmacist's assessment. Other triptans need a prescription.

Are the newer migraine treatments available on the NHS?

Yes, for people who meet NICE criteria, usually via a GP and specialist headache service. Access routes and waits vary by area.

How long do preventive treatments take to work?

Most need several weeks to months before the benefit can be judged, so they are reviewed after a set period.

Do I need a brain scan for migraine?

Usually not. Migraine is diagnosed from your history and examination. Scans are considered if there are red flag features.

Key takeaways

Treat attacks early with painkillers, triptans and anti-sickness medicine as advised.
Avoid using acute treatments too often to prevent medication overuse headache.
Amitriptyline, propranolol and topiramate are first-line preventive options.
NICE-approved newer treatments are for people whose migraines have not responded to other treatments.
A prescriber decides which treatment is suitable after an assessment.

Sources and further reading

Last reviewed: October 2026 by Shamir Patel, Independent Prescribing Pharmacist, Ready Health. This article is general information and does not replace advice from your own clinician. Brand names are trademarks of their respective owners.

If migraines are affecting your daily life, you can book a private GP appointment or a consultation with a consultant neurologist at Ready Health in Standish, Wigan, to review your diagnosis and discuss suitable treatment options.

Migraine Treatment Options in the UK: Acute Relief, Prevention and Newer Therapies