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Migraine Headache Treatment

Medically Reviewed by Jennifer Robinson, MD on December 20, 2022

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.

Abortive medication for migraine

The goal of abortive treatment is to stop a migraine once it starts. Abortive medications stop a migraine when you feel one coming or once it has begun. Abortive medications can be taken by self-injection, mouthskin 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.

Abortive 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, arthritismenstruation, or other conditions. People with certain medical conditions should not take these medications.

  • Almotriptan (Axert)
  • Eletriptan (Relpax)
  • Frovatriptan (Frova)
  • Naratriptan (Amerge)
  • Rizatriptan (Maxalt)
  • Sumatriptan (AlsumaImitrexOnzetraSumavelZembrace)
  • Zolmitriptan (Zomig)

The following drugs are also used for treatment:

  • OTC pain meds and combination pain meds including: Advil Migraine (containing ibuprofen), Excedrin Migraine (containing aspirinacetaminophen, caffeine), isometheptene-dichloralphenazone-acetaminophen (Midrin), and Motrin Migraine Pain (containing ibuprofen)
  • Ergots including: Dihydroergotamine (D.H.E. 45 InjectionMigranal Nasal Spray), Ergotamine tartrate (Cafergot)
  • CGRP antagonists: rimegepant (Nurtec ODT) and ubrogepant (Ubrelvy)

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.

CategoryGeneric NameExamples of Brand NamesMay be used during an aura?Some Side Effects
Over the counteribuprofenAdvil, Motrin 

Stomach upset or bleeding
Rash
Swelling

May raise risk of heart attack or stroke

 aspirin + acetaminophen + caffeineExcedrin Migraine,
Excedrin,
Goody's
 Heartburn
Anxiety
Insomnia
Allergic reaction
Liver damage
Blood in stool or vomit
Dizziness
Easy bruising
 acetaminophenTylenol
 
 Liver damage
Allergic reactions
Rashes
 naproxen

Aleve,
Anaprox DS (prescription only),
Naprosyn (prescription only)

 

 Stomach upset
Stomach bleeding
Nausea
Vomiting
Rash
Liver damage
May raise risk of heart attack or stroke
ErgotdihydroergotamineDHE-45 injection,
Ergotamine tartrate,
Migranal nasal spray
YesNausea
Numbness of fingers and toes
Triptanssumatriptan succinate

Imitrex injection, oral, intranasal
Zembrace injection,

Onzetra inhaled,

Tosymra nasal spray

Not with hemiplegic migraine, migraine with brainstem aura, stroke, heart disease, or uncontrolled hypertension, or pregnancyDizziness
Tingling
Flushing
Feelings of chest heaviness, burning, or tightness
Nausea
 zolmitriptanZomigNot with hemiplegic migraine, migraine with brainstem aura, stroke, heart disease, or uncontrolled hypertensionDizziness
Tingling
Flushing
Feelings of chest heaviness, burning, or tightness
Nausea
 rizatriptanMaxaltNot with hemiplegic migraine, migraine with brainstem aura, stroke, heart disease, or uncontrolled hypertensionDizziness
Tingling
Flushing
Feelings of chest heaviness, burning, or tightness
Nausea
 naratriptanAmergeNot with hemiplegic migraine, migraine with brainstem aura, stroke, heart disease, or uncontrolled hypertensionDizziness
Tingling
Flushing
Feelings of chest heaviness, burning, or tightness
Nausea
 almotriptanAxertNot with hemiplegic migraine, migraine with brainstem aura, stroke, heart disease, or uncontrolled hypertensionTiredness
Dizziness
Headache
Nausea
Chest pain
 frovatriptanFrovaNot with hemiplegic migraine, migraine with brainstem aura, stroke, heart disease, or uncontrolled hypertensionDizziness
Flushing
Palpitations
Chest pain
Headache
Tingling
Nausea
 eletriptanRelpaxNot with hemiplegic migraine, migraine with brainstem aura, stroke, heart disease, or uncontrolled hypertensionDizziness
Tingling
Flushing
Feelings of chest heaviness, burning, or tightness
Nausea
Headache
Combination triptan + NSAIDsumatriptan + naproxenTreximetNot with hemiplegic migraine, migraine with brainstem aura, stroke, heart disease, or uncontrolled hypertensionHead, jaw, chest, and arm discomfort, tightening, or tingling
Throat discomfort
Muscle cramps
Flushing
Stomach upset or bleeding
Nausea
Vomiting
Rash
Liver damage
Ditan

Lasmiditan

 

Reyvowyes

Dizziness

Sleepiness

Numbness

Feeling tired

Tingling

CGRP AntagonistsRimegepantNutrec

yes

 

Nausea

UTI 

Allergic reaction

 UbrogepantUbrelvyyes

Drowsiness

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, timololmetoprolol)
    • calcium channel blockers (verapamil)
  • Antidepressantsamitriptyline (Elavil), nortriptyline (AventylPamelor)
  • Antiseizure 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)
  • Botox
CategoryGeneric NameExamples of Brand NamesTreatment InformationPossible Side Effects
Nonsteroidal anti-inflammatories

diclofenac

 

Cataflam

generics available

Headache pain relief,
Menstrual migraine prevention
Stomach upset
Drowsiness
Dizziness
Vision problems
Ulcers
May raise risk of heart attack or stroke
 ibuprofenAdvil
Motrin
Headache pain relief
Menstrual migraine prevention
Stomach upset or bleeding
Nausea
Vomiting
Rash
Liver damage
May raise risk of heart attack or stroke
 naproxen sodium

Aleve
Anaprox DS

Naprosyn

Headache pain relief
Menstrual migraine prevention
Stomach upset or bleeding
Nausea
Vomiting
Rash
Liver damage
May raise risk of heart attack or stroke
Tricyclic antidepressantsamitriptylinegenerics availableOften 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-blockersatenolol
metoprolol
nadolol
propranolol
timolol

Tenormin

Lopressor, Toprol XL

Corgard

Inderal

Depending on the form, may be taken one to three times a dayFatigue
Depression
Weight gain
Memory disturbance
Faintness
Diarrhea
AnticonvulsantstopiramateQudexy XR
Topamax
Trokendi XR
Often started at low dosages and slowly increased to a helpful levelTingling in the arms
Nausea
Drowsiness
Weight loss
 valproateDepakene
Depakote
Stavzor
Depends on the form. Usually once or twice a day.Nausea
Tiredness
Tremor
Dizziness
Weight gain
Hair loss
Birth defects

CGRP 

Antagonists

AtogepantQulipta 

Constipation

Nausea

Upper respiratory infection

 eptinezumabVypetiQuarterly IV by health care providerStuffy nose
Scratchy throat
Allergic reactions
 erenumabAimovigOnce a month, self-injections with a prefilled penMild pain and redness at the injection site
Constipation
Allergic reactions
 fremanezumabAjovyMonthly 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
 galcanezumabEmgalityMonthly, 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
 rimegepantNurtecUp to 18 doses per month by mouth for both acute and preventive therapy.

Nausea 

UTI
Allergic reaction 

Botulinum toxin type Aonabotulinumtoxin ABotoxMultiple 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 NameExamples of Brand NamesPossible Side Effects
promethazine hydrochloride (tablet, syrup, injection, or suppository)PhenerganConfusion, drowsiness, dizziness, upset stomach, excitability, nightmares, uncontrollable muscle movements, lip smacking or chewing movements
chlorpromazine (suppository)ThorazineConfusion, drowsiness, dizziness, upset stomach, excitability, nightmares, uncontrollable muscle movements, lip smacking or chewing movements
prochlorperazine (tablet and suppository)CompazineConfusion, drowsiness, dizziness, upset stomach, excitability, nightmares, uncontrollable muscle movements, lip smacking or chewing movements
Trimetho-benzamide hydrochloride (capsule, injection, syrup, or suppository)TiganLow blood pressure, blurred vision, drowsiness, dizziness, feeling disoriented, uncontrollable muscle movements, lip smacking or chewing movements
metoclopramide hydrochloride (syrup, tablet, or injection)ReglanUncontrollable 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.

Show Sources

Photo Credit: 

jcphoto / Getty Images

SOURCES:

National Headache Foundation: "Migraine."  

Journal of the American Medical Association, June 24, 2009. 

National Institute of Neurological Disorders and Stroke: "Migraine Information Page." 

NuPathe Inc.

FDA.

MedlinePlus. 

Cleveland Clinic.

UpToDate.

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