Medicines used to treat migraines
There are two main categories of drugs to manage migraines: those taken to prevent them from happening and those used for the acute treatment of a migraine that is already in progress. Health professionals often refer to these as “abortive” drugs.
Under the umbrella of abortifacient migraine treatments, there are medications ranging from over-the-counter pain relievers (analgesics) to prescription drugs that not only treat headaches, but other migraine symptoms as well.
Finding what’s best for you can take some time and requires guidance from your health care provider.
For most migraine sufferers, the first line of defense against an impending headache is an over-the-counter pain reliever. There are two classes of over-the-counter pain relievers: acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs).
This medication works by blocking chemical messengers that help send pain signals to the brain. There are dozens of brand names for acetaminophen, the most common being Tylenol. There are also many generic and store brand versions available.
It is important to never mix acetaminophen with alcohol and to speak to your health care provider if you are also taking other medications, as drug interactions may occur. When not taken correctly, acetaminophen has been shown to cause liver damage in some people.
NSAIDs relieve pain by decreasing the production of hormone-like compounds called prostaglandins that send pain messages to the brain. They understand:
NSAIDs are associated with stomach pain and gastrointestinal bleeding. Additionally, aspirin is linked to a life-threatening condition in children called Reye’s syndrome, so it should not be prescribed to children under 19.
For some people, an over-the-counter pain reliever is not strong enough to provide relief. Stronger versions of acetaminophen and NSAIDs are available by prescription. Also, an NSAID called Cambia (diclofenac) is often effective. Cambia comes in the form of a powder mixed with water.
Other prescription NSAIDs that have been studied for the treatment of migraine are:
- Diclofenac epolamine
Triptans are a class of prescription medications often used to prevent an already ongoing migraine attack from getting worse. They are also used to help prevent migraines in women who tend to get them when they have their period (i.e. menstrual migraines).
Triptans are most effective for moderate to severe migraines and work best when taken at the first sign of an impending attack.
Not only do these drugs fight pain, but they also help relieve nausea and sensitivity to light and sound, which are common symptoms of migraine attacks. They do this by stimulating the receptors for the neurotransmitter (brain chemical) serotonin, reducing the inflammatory cascade that leads to migraines. Triptans can also reduce levels of a protein called calcitonin gene-related peptide (cGRP), which is elevated during migraine attacks.
There are seven triptans available for the acute treatment of migraines. Unless otherwise stated, they are only available in tablet form. They are:
- Axert (almotriptan)
- Relpax (eletriptan)
- Frova (frovatriptan)
- Amerge (naratriptan)
- Maxalt, Maxalt-MLT (rizatriptan), which comes as a tablet or blister that melts on the tongue
- Imitrex (sumatriptan), which is available as a tablet, nasal spray, or subcutaneous (under the skin) injection
- Zomig (zolmitriptan), available as a tablet, nasal spray, or strip
In addition to these single ingredient triptans, there is a drug called Treximet which combines sumatriptan with the NSAID naproxen.
Research suggests that taking sumatriptan and naproxen as one pill may be more effective for some people than taking them separately.
Like any medication, triptans have potential side effects. The most common are nausea, paresthesia, fatigue, and tightness in the chest or throat. People with heart disease or uncontrolled high blood pressure should not take triptans because these drugs can cause blood vessels to constrict.
Lasmiditan, currently sold under the brand name Reyvow, is a prescription medication approved for the acute treatment of migraine headaches with or without aura in adults. Similar to triptans, lasmiditan can block a number of processes that lead to the development of a full-blown headache by stimulating serotonin (5 HT) – but this drug is different in that it does not bind to heart arteries. This means that lasmiditan does not cause narrowing of blood vessels and is therefore safer for patients with heart problems.
Dihydroergotamine, available as DHE 45 or Migranal, belongs to a class of medications called ergot alkaloids. It relieves pain by inducing vasoconstriction (narrowing of blood vessels in the brain) and inhibiting the release of cGRP, thereby reducing inflammation.
Dihydroergotamine is formulated in a way that makes it more tolerable for people prone to the nausea and vomiting that can sometimes accompany other medications. It is given by subcutaneous injection, usually in the thigh, or by nasal spray.
If you are prescribed dihydroergotamine, the health care provider may give you your first dose to monitor your reaction and also to make sure you understand how to give yourself the injection or use the spray.
The most common side effects of this drug include upset stomach, dizziness, weakness, and fatigue; nasal spray may cause a stuffy or dry nose, tingling or pain in the nose or throat, and nosebleeds.
Some unusual but potentially serious problems associated with dihydroergotamine require immediate medical attention: numbness, tingling, or color changes in the fingers or toes; muscle pain or weakness; chest pain; heart rate changes; and swelling, itching, dizziness, or fainting.
You should not take dihydroergotamine if you are taking a triptan, have poorly controlled blood pressure and/or have heart disease or are pregnant.
Many migraine sufferers experience nausea and vomiting as well as headaches. Not only are these symptoms unpleasant, but they can lead to dehydration and make it difficult to take medication. For this reason, drugs called antiemetics are often part of the pharmacological arsenal for the treatment of migraine.
Antiemetics belong to a class of drugs called dopamine receptor antagonists. Antiemetics can be prescribed for home use and can be given orally or rectally. In the emergency room, they can be given intravenously or by injection into a muscle. These drugs include:
- Compro, Procomp (prochlorperazine)
- Haldol (haloperidol)
Steroids can ease the pain of a migraine and can also prevent a headache from coming back. It is important.
According to a study published in 2015 in the journal Headache“Headaches recur in up to 87% of migraine patients who visit the emergency room.”
This research, which reviewed 25 studies in which corticosteroids were used to treat migraines, found that when a patient received a single injection of steroids as part of emergency treatment for migraine (usually with a triptan), he was less likely to have another migraine. within 72 hours.
Also, recurring headaches tended to be milder. Similarly, in research cited by the National Headache Foundation, a dexamethasone injection given with a triptan reduced headache recurrence by 26% within 72 hours.
CGRP antagonists work by blocking the binding of cGRP to receptors in the brain, thereby minimizing vasodilation and neurogenic inflammation. Unlike other acute migraine medications, these medications do not induce vasoconstriction, which means they may be a safer option for people at increased cardiovascular risk.
The FDA has approved two cGRP antagonists for the acute treatment of migraine with or without aura:
- Nurtec ODT (rimegepant)
- Ubrelvy (ubrogepant)
In May 2021, the FDA expanded the approved uses of Nurtec ODT to include migraine prevention, making it the first and only drug to both treat and prevent migraines.
Both of these drugs are taken orally in the form of pills. In most cases, cGRP antagonists can relieve migraines as quickly as one hour after ingestion. The most common side effects are dizziness, drowsiness, numbness and nausea.
Although rare, serious allergic reactions can occur. If you start to develop symptoms of an allergic reaction, such as rash, hives, or swelling of your face, tongue, throat, or lips, you should seek medical attention immediately.
A word from Verywell
There is no one-size-fits-all approach to treating migraines. People react differently to different types of medications, doses, and combinations of medications, and there are so many options. It can be overwhelming and frustrating, but trust that even if it takes a bit of trial and error, you and your healthcare provider will find an effective way to manage your migraines.