Migraine Medicine
Drugs for migraine headaches can relieve the pain and symptoms of a migraine attack and help prevent further migraine attacks.
Migraines can be treated with two types of drugs: abortive and preventive.
Acute medications for migraine
The goal of acute treatment -- also called abortive treatment -- is to stop a migraine once it starts. Acute medications stop a migraine when you feel one coming or once it has begun. You can take acute medications by self-injection, mouth, skin patch, or nasal spray. These forms of medication are especially useful for people who have nausea or vomiting related to their migraine, and they work quickly.
Your first line of acute treatment may be one of the OTC pain meds and combination pain meds including: Advil Migraine (containing ibuprofen), Excedrin Migraine (containing aspirin, acetaminophen, caffeine), isometheptene-dichloralphenazone-acetaminophen (Midrin), and Motrin Migraine Pain (containing ibuprofen)
Prescription NSAIDS (non-steroidal anti-inflammatory drugs) include celecoxib (Elyxyb), diclofenac potassium (Cambia), indomethacin (Indocin)
Other acute treatments include the triptans and ditans, which specifically target serotonin. They are all very similar in their action and chemical structure. The triptans are used only to treat headache and do not relieve pain from back problems, arthritis, menstruation, or other conditions. People with certain medical conditions should not take these medications. The triptans include:
- Almotriptan (Axert)
- Eletriptan (Relpax)
- Frovatriptan (Frova)
- Naratriptan (Amerge)
- Rizatriptan (Maxalt)
- Sumatriptan (Alsuma, Imitrex, Onzetra, Sumavel, Zembrace)
- Zolmitriptan (Zomig)
The following drugs are also acute migraine treatments:
- CGRP antagonists: rimegepant (Nurtec), ubrogepant (Ubrelvy), and zavegepant (Zavzpret)
- Ergots including: Dihydroergotamine (D.H.E. 45 Injection, Migranal Nasal Spray), Ergotamine tartrate (Cafergot)
If your migraine attacks last a long time -- 72 hours or more -- your doctor may prescribe the steroid drug prednisone to shorten them. This drug can have serious side effects, including dizziness, sleep issues, and more headaches. It's important to take it exactly as your doctor tells you to.
The following drugs are sometimes used for nausea related to migraine headaches, in addition to migraine treatment:
- Chlorpromazine (Thorazine)
- Droperidol
- Metoclopramide (Reglan)
- Prochlorperazine (Compro)
Some drugs are used for headache pain but are not specific for migraines. These include analgesics, narcotics, and barbiturates. Since some of these can be habit forming, they are less desirable than specific headache drugs listed above. These drugs should be used primarily as a "backup" for the occasions when a specific drug does not work.
| Category | Generic Name | Examples of Brand Names | May be used during an aura? | Some Side Effects |
| NSAIDS and Pain Meds | ibuprofen | Advil, Motrin | Stomach upset or bleeding May raise risk of heart attack or stroke |
|
| aspirin + acetaminophen + caffeine | Excedrin Migraine, Excedrin, Goody's |
Heartburn Blood in stool or vomit |
||
| acetaminophen | Tylenol |
Liver damage Allergic reactions Rashes |
||
| naproxen | Aleve,
|
Stomach upset Stomach bleeding Nausea Vomiting Rash Liver damage May raise risk of heart attack or stroke |
||
| celecoxib | Celebrex | Yes | Gas, bloating Constipation Sore throat Cold symptoms Lingering metallic or salty tastes in the mouth |
|
| Ergot | dihydroergotamine | DHE-45 injection, Ergotamine tartrate, Migranal nasal spray |
Yes | Nausea Numbness of fingers and toes |
| Triptans | sumatriptan succinate | Imitrex injection, oral, intranasal Onzetra inhaled, Tosymra nasal spray |
Not with hemiplegic migraine, migraine with brainstem aura, stroke, heart disease, or uncontrolled hypertension, or pregnancy | Dizziness Tingling Flushing Feelings of chest heaviness, burning, or tightness Nausea |
| zolmitriptan | Zomig | Not with hemiplegic migraine, migraine with brainstem aura, stroke, heart disease, or uncontrolled hypertension | Dizziness Tingling Flushing Feelings of chest heaviness, burning, or tightness Nausea |
|
| rizatriptan | Maxalt | Not with hemiplegic migraine, migraine with brainstem aura, stroke, heart disease, or uncontrolled hypertension | Dizziness Tingling Flushing Feelings of chest heaviness, burning, or tightness Nausea |
|
| naratriptan | Amerge | Not with hemiplegic migraine, migraine with brainstem aura, stroke, heart disease, or uncontrolled hypertension | Dizziness Tingling Flushing Feelings of chest heaviness, burning, or tightness Nausea |
|
| almotriptan | Axert | Not with hemiplegic migraine, migraine with brainstem aura, stroke, heart disease, or uncontrolled hypertension | Tiredness Dizziness Headache Nausea Chest pain |
|
| frovatriptan | Frova | Not with hemiplegic migraine, migraine with brainstem aura, stroke, heart disease, or uncontrolled hypertension | Dizziness Flushing Palpitations Chest pain Headache Tingling Nausea |
|
| eletriptan | Relpax | Not with hemiplegic migraine, migraine with brainstem aura, stroke, heart disease, or uncontrolled hypertension | Dizziness Tingling Flushing Feelings of chest heaviness, burning, or tightness Nausea Headache |
|
| Combination triptan + NSAID | sumatriptan + naproxen | Treximet | Not with hemiplegic migraine, migraine with brainstem aura, stroke, heart disease, or uncontrolled hypertension | Head, jaw, chest, and arm discomfort, tightening, or tingling Throat discomfort Muscle cramps Flushing Stomach upset or bleeding Nausea Vomiting Rash Liver damage |
| Ditans | Lasmiditan
|
Reyvow | yes | Dizziness Sleepiness Numbness Feeling tired Tingling |
| CGRP Antagonists | Rimegepant | Nurtec | yes
|
Nausea UTI |
| Ubrogepant | Ubrelvy | yes | Drowsiness Nausea Dry mouth |
|
| Zavegepant | Zavzpret | yes | Dizziness Nausea Dry mouth |
Preventive medication for migraine
This type of treatment is considered if migraines occur frequently, typically more than one migraine per week, or if migraine symptoms are severe. The goal is to lessen the frequency and severity of the migraine attacks. Medication to prevent a migraine can be taken daily. Preventive treatment medications include the following:
- Medications used to treat high blood pressure:
- beta-blockers (propranolol, timolol, metoprolol)
- calcium channel blockers (verapamil)
- Antidepressants: amitriptyline (Elavil), nortriptyline (Aventyl, Pamelor)
- Anti-seizure medications: gabapentin (Neurontin), topiramate (Topamax), valproic acid (Depakote)
- CGRP inhibitors used to block the calcitonin gene-related peptide: atogepant (Qulipta), eptinezumab (Vyepti), erenumab (Aimovig), fremanezumab (Ajovy), galcanezumab (Emgality), rimegepant (Nurtec), zavegepant (Zavzpret)
- Botox
| Category | Generic Name | Examples of Brand Names | Treatment Information | Possible Side Effects |
| Tricyclic antidepressants | amitriptyline | generics available | Often started at low dosages and slowly increased to a helpful level EKG may be needed Blood tests may be needed while taking this medication. Taken nightly |
Fatigue Dry mouth Weight gain Constipation Drowsiness Blurred vision Older adults also may feel confusion or faintness. |
| SNRI antidepressants | venlafaxine duloxetine |
Effexor Cymbalta generics available |
Sleep problems Drowsiness Dizziness Vision changes Less sexual desire or ability Headaches |
|
| Beta-blockers | atenolol metoprolol nadolol propranolol timolol |
Tenormin Lopressor, Toprol XL Corgard Inderal |
Depending on the form, may be taken one to three times a day | Fatigue Depression Weight gain Memory disturbance Faintness Diarrhea |
| Anticonvulsants | topiramate | Qudexy XR Topamax Trokendi XR |
Often started at low dosages and slowly increased to a helpful level | Tingling in the arms Nausea Drowsiness Weight loss |
| valproate | Depakene Depakote Stavzor |
Depends on the form. Usually once or twice a day. | Nausea Tiredness Tremor Dizziness Weight gain Hair loss Birth defects |
|
CGRP Antagonists |
Atogepant | Qulipta | Constipation Nausea |
|
| eptinezumab | Vyepti | Quarterly IV by health care provider | Stuffy nose Scratchy throat Allergic reactions |
|
| erenumab | Aimovig | Once a month, self-injections with a prefilled pen | Mild pain and redness at the injection site Constipation Allergic reactions |
|
| fremanezumab | Ajovy | Monthly or quarterly, self-injection with a prefilled syringe. Use with caution in people with heart or blood vessel disease. | Mild pain and redness at the injection site Allergic reactions |
|
| galcanezumab | Emgality | Monthly, self-injection with a prefilled pen or syringe. Use with caution in people with heart or blood vessel disease. | Mild pain and redness at the injection site Allergic reactions |
|
| rimegepant | Nurtec | Up to 18 doses per month by mouth for both acute and preventive therapy. | Nausea UTI |
|
| zavegepant | Zavzpret | Dizziness Nausea Dry mouth |
||
| Botulinum toxin type A | onabotulinumtoxin A | Botox | Multiple injections are given about every 3 months to prevent chronic headache. | Headache Neck pain |
Nausea drugs for migraine
Many people who have migraines often have nausea and vomiting along with head pain. Those symptoms usually get better when you treat the migraine. But sometimes, the nausea and vomiting are bad enough to keep a person from taking their migraine medications. In these cases, a nausea drug can ease your symptoms so you can get the treatment you need.
Most nausea medicines come in pill form, but if the problem is severe, you can take them as a rectal suppository.
| Generic Name | Examples of Brand Names | Possible Side Effects |
| promethazine hydrochloride (tablet, syrup, injection, or suppository) | Phenergan | Confusion, drowsiness, dizziness, upset stomach, excitability, nightmares, uncontrollable muscle movements, lip smacking or chewing movements |
| chlorpromazine (suppository) | Thorazine | Confusion, drowsiness, dizziness, upset stomach, excitability, nightmares, uncontrollable muscle movements, lip smacking or chewing movements |
| prochlorperazine (tablet and suppository) | Compazine | Confusion, drowsiness, dizziness, upset stomach, excitability, nightmares, uncontrollable muscle movements, lip smacking or chewing movements |
| Trimetho-benzamide hydrochloride (capsule, injection, syrup, or suppository) | Tigan | Low blood pressure, blurred vision, drowsiness, dizziness, feeling disoriented, uncontrollable muscle movements, lip smacking or chewing movements |
| metoclopramide hydrochloride (syrup, tablet, or injection) | Reglan | Uncontrollable muscle movements, lip smacking or chewing movements, sensitivity to sunlight, aching in the lower legs, diarrhea |
Warning: You should not take triptans with SSRI or SNRI antidepressants. You may get a life-threatening condition called serotonin syndrome. Check all your medications with your doctor.
Migraine devices
If you can't take medication or wish not to, a device might be worth considering. These include:
- Cefaly, a small headband device that sends electrical pulses through the forehead to stimulate a nerve linked with migraines
- Spring TMS or eNeura sTM, a device for people who have an aura before migraine headaches. You hold it at the back of your head at the first sign of a headache, and it gives off a magnetic pulse that stimulates part of the brain.
- Noninvasive vagus nerve stimulator (nVS). GammaCore is a hand-held portable device placed over the vagus nerve in the neck. It releases a mild electrical stimulation to the nerve's fibers to relieve pain.
- Nerivio, a wireless remote electrical neuromodulation device that is self-applied to the upper arm and should be used in the home environment at the onset of migraine headache.
Supplements for migraine
Some nontraditional supplement treatments for migraine prevention include certified PA-free butterbur, coenzyme Q10, and feverfew. Whether they really help isn't known, because studies have shown mixed results. Check with your doctor before using any supplements as they are not regulated like prescription medicines and they may contain substances that are not safe.
