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: 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, 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.
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, arthritis, menstruation, or other conditions. People with certain medical conditions should not take these medications.
The following drugs are also used for treatment:
- 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)
- Ergots including: Dihydroergotamine (D.H.E. 45 Injection, Migranal 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:
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.
Preventive: 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:
- Antidepressants: amitriptyline (Elavil), nortriptyline (Aventyl, Pamelor)
- 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)
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.
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.