Migraines are not just “bad headaches.” They are complex neurological conditions that can cause severe, disabling pain alongside a range of other symptoms, including visual disturbances, nausea, and extreme sensitivity to light and sound.
For many in the UK, migraines occur only occasionally and can be managed with lifestyle adjustments and over-the-counter remedies. However, for those experiencing chronic migraines — defined as headaches occurring on 15 or more days per month, with migraine symptoms on at least eight of those days — the impact on work, relationships, and mental health can be profound.
At that point, it may be time to discuss prescription medications with your GP or a specialist. This guide explores when to consider moving beyond self-care and OTC treatments, the types of prescription options available in the UK, and how to work with your healthcare team for safe, effective relief.
Understanding Chronic Migraine
Chronic migraine is a long-term neurological disorder, often involving a mix of migraine attacks and tension-type headaches. Unlike occasional migraines, which may last a day or two, chronic migraines can leave you feeling unwell for much of the month.
Common features include:
- Severe, throbbing pain (often on one side of the head)
- Nausea and/or vomiting
- Sensitivity to light, sound, or smells
- Visual aura (flashing lights, blind spots) before or during the attack
- Fatigue and difficulty concentrating
Living with chronic migraine often means balancing work responsibilities, social commitments, and personal wellbeing around unpredictable, often debilitating attacks.
When to Move Beyond Over-the-Counter Medications
Over-the-counter pain relief — such as ibuprofen, paracetamol, or aspirin — can be helpful for occasional migraines, particularly when taken early in an attack. However, if you find yourself:
- Using painkillers on more than 10 days per month
- Experiencing headaches more than 15 days a month
- Not responding to OTC options
- Losing significant time from work or daily activities
…it’s time to speak to your GP about prescription alternatives. Overuse of OTC painkillers can also lead to medication-overuse headaches, which make migraines worse over time.
Types of Prescription Migraine Medications in the UK
Prescription migraine treatments generally fall into two categories: acute (to stop or reduce an attack once it starts) and preventive (to reduce the frequency and severity of attacks).
Acute Prescription Treatments
- Triptans – Examples: sumatriptan, rizatriptan, zolmitriptan.
- Mechanism: Stimulate serotonin receptors to reduce inflammation and constrict blood vessels in the brain.
- Use: Taken at the first sign of a migraine; available as tablets, nasal sprays, or injections.
- NHS Note: Widely prescribed, often the first acute prescription tried.
- Anti-nausea medications – Examples: metoclopramide, domperidone.
- Mechanism: Reduce migraine-related nausea and vomiting, which can help painkillers work more effectively.
- Use: Often combined with triptans or other acute medications.
- Stronger NSAIDs (on prescription strength) – For patients not responding to OTC doses.
Preventive Prescription Treatments
If you have chronic migraine, preventive medications may be considered to reduce attack frequency. These include:
- Beta-blockers (e.g., propranolol) – Reduce nerve impulses and stress-related migraine triggers.
- Anti-seizure medications (e.g., topiramate) – Stabilise brain electrical activity.
- Tricyclic antidepressants (e.g., amitriptyline) – Modify pain processing pathways.
- Botulinum toxin type A (Botox) – Approved for chronic migraine prevention in the UK when other treatments fail.
- CGRP monoclonal antibodies (e.g., erenumab, fremanezumab) – Target specific migraine-related pathways; increasingly available through NHS specialist services.
How to Decide on Prescription Treatment
The decision to start prescription migraine medication in the UK depends on:
- Frequency and severity of your migraines
- Impact on quality of life
- Previous response to OTC medications and lifestyle changes
- Presence of other health conditions
- Risk of medication side effects
Most GPs will recommend keeping a migraine diary for several weeks to track triggers, frequency, and response to treatment before finalising a prescription plan.
Working with Your GP or Specialist
In the UK, your GP is your first point of contact. If your migraines are severe, persistent, or complex, you may be referred to a neurologist or headache specialist. Effective communication is key:
- Bring your migraine diary to appointments
- Be honest about medication use, including OTC drugs
- Discuss side effects openly so adjustments can be made
- Ask about both NHS and private treatment options if needed
Lifestyle and Complementary Approaches
Even with prescription medications, most migraine treatment plans in the UK include lifestyle adjustments:
- Maintaining regular sleep patterns
- Staying hydrated and eating regular meals
- Managing stress through mindfulness, yoga, or gentle exercise
- Avoiding known dietary triggers (e.g., red wine, aged cheese, processed meats)
Some patients also explore acupuncture, magnesium supplementation, or biofeedback therapy alongside prescription care.
FAQs
When should I see a doctor for migraines?
If you have frequent or severe headaches, or if OTC treatments no longer work, see your GP. Seek urgent medical care if your headache is sudden, extremely severe, or accompanied by neurological symptoms like weakness or confusion.
Are migraine prescription drugs available on the NHS?
Yes. Most acute and preventive treatments, including triptans, beta-blockers, and some CGRP inhibitors, are available on prescription through the NHS.
Can I combine prescription and OTC medications?
Sometimes, but only under medical guidance to avoid medication-overuse headaches and dangerous drug interactions.
Do I have to take preventive medication forever?
Not necessarily. Many UK patients try preventive medication for six months to a year, then re-evaluate with their doctor.
Are there risks with long-term triptan use?
Triptans are generally safe for occasional use, but overuse can lead to rebound headaches and reduced effectiveness.