Quick Answer
Migraine treatment is decided by how many days a month are affected rather than by severity. Acute treatment addresses an attack; preventive treatment reduces frequency, and the two use different medications and different logic. You leave the first visit with a written plan and a follow-up interval, not just a referral.
Part ofThis guide sits beneath headache and migraine, which covers the study itself, how it is performed and what the report should contain.
our Headache and Migraine hub →Key Takeaways
- Treatment has two halves: acute, for an attack, and preventive, for frequency.
- Acute medication taken often enough sustains the headaches it was taken to relieve.
- Preventive options include older oral classes, CGRP therapy, and in-office Botox where the chronic threshold is met.
- Response to a preventive is judged on monthly headache days across months, not on single attacks.
- Recurrent facial pressure treated as sinus disease is frequently migraine.
Migraine
Migraine is a neurological disorder in which attacks of head pain occur alongside other nervous-system symptoms such as nausea, light or sound sensitivity, and visual aura. It is a disorder of how the brain processes sensory input, not simply a bad headache.
How migraine is treated
Migraine treatment has two halves that are frequently confused: treating an attack, and reducing how often attacks happen. They use different medications and different logic.
Acute treatment
Aimed at stopping an attack once it has begun. Effectiveness depends heavily on timing, since acute treatment taken early in an attack works considerably better than the same treatment taken late. The critical constraint is frequency: acute medication taken often enough sustains the headaches it was taken to relieve, which is why the count matters even for someone who only wants something for attacks.
Preventive treatment
Aimed at reducing attack frequency, taken regardless of whether an attack is present. The threshold for considering it is how many days a month are affected and how disabling they are, not severity alone. Options include older oral classes, CGRP-targeted therapy, and where the chronic migraine threshold is met, in-office Botox. Response is judged on monthly headache days across months.
What determines which
Frequency. A patient with two attacks a month needs effective acute treatment; a patient with fifteen headache days needs prevention, and treating the second with only acute medication is how medication overuse develops. That is why a month of dates changes what a first appointment can conclude.
The contributors worth addressing alongside
Sleep, since irregular or shortened sleep is a potent trigger. Untreated sleep apnoea, which causes headache present on waking. And the misattribution worth correcting: recurrent facial pressure treated as sinus disease is frequently migraine, because migraine activates a pathway producing nasal congestion and facial pressure.
| Also considered | How it is distinguished |
|---|---|
| Tension-type headache | Pressing, bilateral pain without nausea, aura or movement sensitivity. |
| Cluster headache | Strictly one-sided, 15 minutes to about 3 hours, with tearing, nasal congestion or a drooping eyelid, and restlessness rather than stillness. |
| Medication-overuse headache | A pattern change: headaches become more frequent as acute medication use rises, and the history rather than a scan identifies it. |
| Secondary headache | Red flags — sudden 'worst-ever' onset, fever with neck stiffness, new deficit, or onset after head injury — prompt urgent imaging rather than a headache diagnosis. |
What the practice does, and what to bring
01
What brings people in
Frequent or changing headaches, attacks that are no longer controlled by what used to work, or a new headache pattern that needs an explanation.
02
What the evaluation settles
Which headache disorder the pattern fits, whether any red flag needs imaging, and which preventive and acute options are appropriate.
03
What you leave with
A named diagnosis where one can be made, a written acute and preventive plan, and a follow-up interval to judge whether it is working.
Bring a month of dates
Which days you had a headache, roughly how severe, and what you took. That single record converts an approximate conversation into a decision, and its absence is the commonest reason a first appointment ends with a request to return.
Medication overuse checked before a preventive is added
Acute headache medication taken frequently enough can sustain the headaches it was taken to relieve. Common, not a failure of willpower, and it changes the plan: addressing it usually has to come before or alongside a new preventive, because a preventive started on top of an unrecognised overuse pattern works against a headwind.
Treatment options performed here
Botox for chronic migraine and CGRP therapy are both available, on the Botox page and the CGRP page. Where pain localises to a specific nerve on examination, a targeted nerve block may apply. Coverage and prior authorisation are completed before the appointment.
How prevention is assessed
On the change in headache frequency across months rather than on whether it stopped one attack. Abandoning a preventive after two weeks is the commonest way a workable plan gets discarded before it has been tested. Practice guidance is from the American Academy of Neurology.
The first 30, 60 and 90 days
Step 1
First visit
History and neurological examination, a review of records and prior imaging, and a decision on which studies are actually indicated. You leave with the plan, not just a referral.
Step 2
Within 30 days
Indicated in-office studies are performed and interpreted by the neurologist who ordered them, in our AANEM-accredited laboratories. Results are explained in plain language.
Step 3
60 to 90 days
Follow-up to judge whether the plan is working, adjust it, and coordinate with your referring clinician. Where a diagnosis needs time to confirm, this is where it is revisited.
Not sure which headache type you have?
Bring a month of dates and what you took. Classification comes before treatment.
The Bottom Line
Count the days rather than describing the pain. Frequency determines whether you need better acute treatment or prevention, and they are not the same thing.
Frequently Asked Questions
What counts as chronic migraine?
Fifteen or more headache days a month, with migraine features present on at least eight of them. It is a numerical definition rather than a description of severity, and it determines candidacy for several preventive treatments. Episodic migraine, meaning fewer than fifteen headache days a month, is managed differently, so establishing which side of that line you sit on changes which options are open to you.
Why does frequency matter more than severity?
Because treatment decisions run on how many days a month are affected rather than how bad the worst day was. Most people underestimate their count substantially when reconstructing from memory, which is why a month of dates is worth more than any description. A written record of dates is the only thing that settles the count reliably.
Could my sinus headaches be migraine?
Frequently. Migraine activates a pathway producing nasal congestion, facial pressure and tearing, which are exactly the symptoms people attribute to sinuses. Recurrent sinus headache without infection is uncommon, so episodic attacks with clear intervals point toward migraine. Sinus imaging in these patients is frequently normal, and that is often the point at which migraine is finally considered.
Can painkillers make my headaches worse?
Yes. Acute headache medication taken frequently enough can sustain the headaches it was taken to relieve. It is common and not a failure of willpower, but addressing it usually has to come before or alongside a new preventive. The pattern to watch for is acute medication on more than about ten days a month, sustained across several months.
When is a headache an emergency?
When it reaches maximum intensity within seconds, or comes with fever and neck stiffness, new weakness, difficulty speaking or vision loss. Those need an emergency department rather than an appointment. A sudden severe headache brought on by exertion, or a first severe headache after about age fifty, also warrants urgent assessment rather than a routine appointment.
Do I need acute or preventive treatment?
It depends on frequency. Two attacks a month needs effective acute treatment; fifteen headache days needs prevention, and treating the second with only acute medication is how medication overuse develops. Many patients need both, with acute treatment kept for the attacks that break through a working preventive, and the aim is to reduce how often that happens.
Will I have to stop the medication I am using now?
Not abruptly, and not without a plan. Where an acute medication is being taken often enough to be sustaining the headaches, reducing it is planned deliberately alongside starting a preventive, because doing one without the other usually fails. Bring the bottles so the actual pattern can be seen rather than estimated.
How many headache days should I record before coming in?
A month is ideal and two weeks is useful. Record the date, roughly how bad it was, and what you took including anything bought without a prescription. That record is what establishes frequency, and frequency rather than severity decides which treatments are open to you, so it does more work than any description can.
Can I be treated if imaging has already been done and was normal?
Yes, and a normal scan is the expected finding in migraine. Imaging looks for a structural cause; it does not diagnose or exclude a headache disorder, which is established from the pattern. Bring the report rather than repeating the scan, because knowing it was normal changes what still needs considering.
What happens after the appointment?
You leave with an explanation and either a plan or a specific study ordered to answer a specific question, plus a follow-up interval. Where testing is indicated it is performed in-office and interpreted by the ordering neurologist. Your referring clinician receives the findings, so care continues rather than stopping at the door.
How this page was sourced
Practice facts come from Clinical Neurology Specialists directly: that Botox for chronic migraine and CGRP therapy are both available in-office, and that the practice performs no cosmetic injections and runs no interventional pain programme. Clinical context is sourced to the organisations listed below.
No named agents, response rates, reduction percentages or dosing appear, because selection is a clinical decision and response varies between individuals. Treatment approaches are described by class and mechanism rather than by product. No outcome is promised. Scope is adults 18 and older.
Change log
- 2026-07-28 — page published; clinical content reviewed.
- 2026-07-28 — last reviewed against AAN, AANEM and NINDS guidance; internal links and schema verified.
- Review cadence: quarterly, or sooner if guidance changes.
How to cite this page
Clinical Neurology Specialists. “What is the Trusted treatment for migraine.” Reviewed 2026-07-28. https://www.cnsnevada.com/conditions/headache-migraine/what-is-the-best-treatment-for-migraine/
References
- American Headache Society — classification and clinical guidance for headache disorders.
- American Academy of Neurology — practice guidance on preventive treatment.
- National Institute of Neurological Disorders and Stroke — the reference catalogue of nervous-system disorders.
This page is for general information about a Clinical Neurology Specialists office and is not medical advice, a diagnosis, or a treatment recommendation. It does not create a physician-patient relationship. Adults 18 and older. For an active stroke, a first-time or prolonged seizure, sudden severe headache, sudden weakness, sudden vision loss, or a head injury with loss of consciousness, call 911 or go to the nearest emergency department.