Acute Migraine Treatment in Ottawa: Medications to Stop an Attack

• Non-medication strategies first

• Acetaminophen is first-line

• NSAIDs only in limited situations (avoid in third trimester)

• Sumatriptan is the best-studied triptan in pregnancy and may be used when needed

• Avoid gepants in pregnancy

• Craniofacial nerve blocks (e.g. occipital nerve blocks) are a safe option in pregnancy

We can help you decide on the acute strategies that are right for you.

Most migraine medications are compatible with breastfeeding and lactation.

Of the triptans, sumatriptan and eletriptan carry the most evidence for use.

Gepants have yet to be proven safe in breastfeeding and lactation, although some specialists prescribe them with caution. We can help you choose and time doses safely. 

• Dark, quiet environment

• Cold pack on head or neck

• Hydration

• Relaxation breathing or mindfulness

• Neuromodulation devices

Options include:

• Anti-nausea medications (e.g., metoclopramide)

• Nasal or injectable triptans

• Treating migraine attacks early before severe nausea/vomiting kicks in

Triptans act on serotonin receptors in the brain. This helps:

• Calm overactive migraine pain pathways

• Reduce migraine-related inflammation

• Restore normal nerve signalling

They are migraine-specific medications rather than general painkillers.

No.

Although triptans work on serotonin receptors, they are different than the serotonin receptors involved in serotonin syndrome. They are safe to take even if you take other medications that act on serotonin receptors.

• A triptan should be tried for at least 3 separate migraine attacks before deciding whether it is effective.

• Response can vary depending on timing, severity, and formulation.

• If one triptan doesn't work, a different one can be trialed.

Often, yes. A common effective approach (when appropriate) is:

• Triptan + NSAID

• Add an anti-nausea medication if needed

• Avoid taking two different triptans on the same day unless instructed.

• Gepant with a triptan or NSAID

When combining medications it is still important to stay under the monthly medication use limits given by your doctor.

Yes.

Common and usually harmless sensations include:

• Warmth or flushing

• Tightness in the neck, jaw, or chest

• Tingling or pins-and-needles

• Mild dizziness or sleepiness

These usually pass within 30–60 minutes.
Seek medical attention if chest pain is severe, prolonged, or different from previous reactions.

Gepants block CGRP (calcitonin gene–related peptide), a neuropeptide involved in migraine. 

• They do not constrict blood vessels

• They may be safer for people with vascular or coronary artery disease

• They are less likely to cause medication-overuse headache

• They may be better tolerated

• Studies show that for most people triptans may be more effective, while gepants may be better tolerated. Everybody is different, and it is difficult to predict which medication will work best for you.

Yes.

Mild fatigue, nausea, or dry mouth can occur. 

Current evidence suggests gepants are unlikely to cause medication-overuse headache.