Acute Medicines for Headaches

Important information about acute medicines:

Acute medicines are taken immediately at the onset of an attack to stop or decrease pain. If the acute medicine is not working, we may increase the dose or ask you to take a combination of acute medicines. If this still doesn’t work, we may also prescribe a rescue, or second-line, medicine to prevent you from needing to go to the emergency department.

When are acute medicines prescribed?

You may benefit from acute medicines if:

• Headaches or other migraine symptoms occur that interfere with school or activities.

• 15 minutes of rest, water, and a snack alone do not work.

What types of medicines are used for acute treatment?

There are several types of medicines used for headache acute treatment, including NSAIDS (non-steroidal ant-inflammatory drugs), triptans, dopamine blockers, anti-emetics, gepants, and steroids. Sometimes we prescribe more than one class of medication and will tell you if they can be taken together.

Are there side effects?

All medicines may cause side effects. It is important to be familiar with common side effects so that you are prepared to deal with them. Do not use acute medicines more than two to three days a week. Using acute medications too often can cause rebound headaches (also called medication overuse headache).

How long do the medicines take to work?

The goal of acute medicines is complete relief or tolerable pain within 1-2 hours. Do not give up on an acute medicine plan unless it was tried exactly as prescribed and taken immediately at the onset of migraine attack for at least 3 attacks.

What can I do to make sure the acute medicine has a chance to work?

• Take it as soon as symptoms start. If you have constant headache and you are treating a more severe flare, take the acute medicine as soon as you realize that your symptoms are getting bad. If you wait until the pain is at its most severe the medicine may not work as well.  

• Limit the use of acute medications to 2-3 days a week.

• Work hard to stick to your prevention routine, including SMART lifestyle changes. See SMART lifestyle changes handout.

Reviewed July 2024 by Christina L. Szperka, MD, MSCE