My heart goes out to migraine sufferers as it really is a living hell. I have a few clients who get them and seeing them during is just awful. Given the debilitating effects of migraines and the prevalence of them, it is surprising that current treatments are not more effective and safe. Hope this helps point someone in the right direction.
There are at least 200 medications used for migraines; most are used off label and many have unknown levels of effectiveness so research the medications you are given as there is no reason to start with a questionable drug when there are ones that have helped a good portion of migraine sufferers. A favorite here for frequent migraine sufferers is Topamax and the triptins. The triptans are the first to be used as up to 3/4 of people get some level of relief from the pain, throbbing, and nausea, but they really are more rescue meds. Some people however get no relief at all. Of the triptan class, Sumatriptan is often the preferred drug for moderate to moderate severe migranes. Treximet may show promise as well. Gabapentin for prevention is great if it works, but it is a hit or miss. Lyrica (pregabalin) is starting to be used off label and there is not enough evidence to say how helpful it is, although many individual users report sustained relief.
As opposed to traditional caffeine products taken after onset, guarana has the potential to stop some migraines on its own and prevent them. Numerous blinded studies has shown it has statistically significant effects. It acts as a stimulant and has a lot of caffeine in it, but it does not give you the caffeine jitters of coffee provided you are getting unprocessed guarana seed extract which can be found almost everywhere. Also, guarana speeds metabolism and gastric emptying, increases long term memory better than ginseng, aids in thermal regulation, and aids in blood flow. A few of the body changes guarana causes are thought to produce a compilation effect. It is also a primary ingredient in energy drinks and why some people feel better after drinking them, although they do NOT have much guarana in them compared to taking it as a supplement and I doubt the amount of it would have any effect on a true migraine. The other supplement which may hold value is called Kratom, and it becoming more and more popular in the western world.
As far as rescue for the most severe migraines, many users never find relief and often are the most frustrated as most doctors will not prescribe any pain medication that is considered a narcotic, which is sometimes largely warranted. Metoclopramide (Reglan) does have a reduction affect for migraine pain. Promethazine (Phenergen) helps the GI aspect dramatically and some people report pain relief, although I doubt it is from the promethazine directly. Unfortunately, once a severe migraine is in full swing, opioids may be the best option for satisfactory relief. Tramadol and codeine may bring some relief, but for others they are often not enough. The use of methadone, oxycodone, hydromorphone, fentanyl, and morphine sulfate for migraines has been so minimal, that not enough studies exist to make any intelligent statement about rates of effectiveness and rates of misuse. However, virtually all studies show that stronger opioids have the best pain-reducing capability and some opioids can be administered via a patch or lollipop, which is a major advantage for migraines as many people simply cannot take a pill once they reach a certain point of pain and stomach sickness without vomiting. Hydromorphone (commonly Dilaudid or Palladone) has become a standard of severe pain control and may have beneficial affect for severe migraines. It's onset is among the fastest of narcotics and it has fewer moderate-severe reactions than morphine sulfate. If other treatments fail, it may be a viable option. Unfortunately, as said earlier, not enough is known to say a whole lot about opioids and migraines and more research is needed. Furthermore, some people may have amplified pain from lower doses of certain narcotics.
Finally, a medication called ketorolac (Toradol), an unusually potent cox1 NSAID and can provide relief at the narcotic level. It's first dose needs to be IV/IM and you cannot use it more than 4 days straight. Above all, it is probably the most dangerous medication on the US market today as it has a tremendous side effect profile, can cause permanent disability, and thousands of deaths may be directly linked to its use (much like Vioxx and Celebrex). Personally, I do not even consider its use unless every other option fails, and even then, I am very, very cautious about its use, especially with older adults with preexisting chronic disease, especially cardiovascular related. Some ERs however, will use it as a first line treatment for moderate to severe pain before using strong opioids, which I feel is wrong as it shows more concern about your medical license than the patient. If you know you may go to the ER for a migraine, read up on ketorolac before going and decide if you want to have it given to you if need be. If not, make it clear when arriving. If you have any cardiovascular condition, do NOT accept it.
Above all, for something like migraines which are chronic conditions, you need to be your own medical proxy and advocate. No standard treatment exists and so you need to be aware of what your best option may be. PCPs and GPs may or may not have enough experience in the area, and so seeing a specialist is a good thing. If you have frequent migraines, you need to see a neurologist as it has been theorized (with some evidence) that recurring migraines are actually related to a regressive brain disease. You will probably also need to get a MRI. There are neurologists who deal with nothing but migraines and they are who you want to see, as standard neurologists may tell you that there is nothing they can do. It is well worth the time and money as your odds of getting sustained relief and learning what the underlying cause is (and how to manage it) will be best done by the people who deal with the migraine issue frequently. Migraines are a very, very complex issue and while they are very poorly understood, migraine specialists can still help you get relief. Hope this helps point anyone suffering in the right direction.