There are two categories of drugs used to treat migraine. Acute treatment is for pain and other symptoms during a migraine headache. Preventive treatment is to reduce the frequency and severity of headaches.
Drugs for Acute Treatment
All of the drugs below are taken at the onset of migraine symptoms or auras and have been proven to stop or reduce the severity of a headache. Taking any of these drugs too often can lead to medication-overuse headaches (see Migraine Complications). If you need to use the acute migraine drugs more than nine times per month, tell your doctor so he or she can consider preventive treatments.
These drugs may reduce the pain of a migraine headache but will not stop one from occurring. Over-the-counter formulations are commonly used for migraine, but many of these drugs are also available in prescription-only strengths. Aside from acetaminophen, an analgesic drug that only relieves pain, the drugs on the following list are all non-steroidal anti-inflammatory drugs (NSAIDs), which relieve pain and reduce inflammation.
- acetaminophen (Excedrin, Tylenol)
- diclofenac (Cataflam)
- ibuprofen (Advil, Motrin)
- ketorolac (Toradol)
- naproxen (Aleve)
Many over-the-counter products marketed specifically for migraine or headaches in general combine one or more of the drugs above with a small amount of caffeine, which can make them work more quickly and effectively, especially for mild migraine headaches.
Possible side effects of long-term NSAIDs use include heart attack, stroke, kidney damage, and stomach ulcers.
Ergotamines were the first class of drugs used specifically for migraine. They cause blood vessels around the brain to contract and can stop a migraine headache within a few minutes. Ergotamines are available as traditional swallowed pills, tablets that dissolve under the tongue, nasal sprays, suppositories, and injections. They are generally taken at the first sign of headache symptoms, and some delivery methods have the option to take additional doses every 30 minutes if the headache continues.
- dihydroergotamine (DHE-45, Migranal)
- ergotamine (Ergomar)
- ergotamine and caffeine (Cafatine, Cafergot, Cafetrate, Ercaf, Migergot, Wigraine)
- methysergide (Sansert)
- methylergonovine (Methergine)
Ergotamines have a number of potentially dangerous side effects. They can cause birth defects and heart problems and are toxic in high doses. If you are pregnant or breastfeeding or have heart disease, you should not take ergotamines. Ergotamines can also interact negatively with other drugs, including antifungal and antibiotic medications.
Triptans are a newer class of drugs that increase levels of serotonin in the brain. This reduces inflammation and constricts blood vessels, effectively ending a migraine headache. Triptans are available as traditional swallowed pills, nasal sprays, injections, and tablets that dissolve under the tongue. They work very quickly to stop migraine symptoms.
- almotriptan (Axert)
- eletriptan (Relpax)
- frovatriptan (Frova)
- naratriptan (Amerge)
- rizatriptan (Maxalt, Maxalt-MLT)
- sumatriptan (Imitrex)
- sumatriptan and naproxen (Treximet)
- zolmitriptan (Zomig)
Possible side effects of triptans include tingling or numbness in the toes, drowsiness, dizziness, nausea, and tightness or discomfort in the chest or throat. People with heart problems or serious stroke risk should avoid triptans. Triptans can also cause serotonin syndrome —a potentially fatal complication—if taken with another drug that increases serotonin, such as many antidepressants.
These drugs reduce the nausea and vomiting that can accompany migraine headaches. They are usually taken along with a painkiller as they do not reduce pain.
- dimenhydrinate (Gravol)
- domperidone (Motilium)
- metoclopramide (Reglan)
- prochlorperazine (Compazine)
- promethazine (Phenergan)
- trimethobenzamide (Tigan)
These drugs may make you drowsy, less alert, or dizzy and have other possible side effects.
If migraine pain does not respond to other painkillers and a patient cannot take ergotamines or triptans, a doctor may prescribe opioids, much more powerful painkillers. There are also many drugs that combine an opioid with one of the painkillers listed above.
- meperidine (Demerol)
- oxycodone (OxyContin)
Opioids carry a serious risk of addiction, so they are usually prescribed sparingly.
Drugs for Preventive Treatment
If you experience migraine headaches frequently, your doctor may prescribe a preventive drug to reduce the frequency and intensity of headaches. These drugs are taken on a regular basis, usually daily, and may be prescribed alone or in combination. It may take several weeks or months before effects are experienced. Preventive drugs for migraine are all most commonly used for other conditions but have been found to be effective for migraine as well.
Commonly prescribed for high blood pressure, beta blockers decrease the effects of stress hormones on the heart and blood vessels. They can help reduce both frequency and intensity of migraine headaches.
- atenolol (Tenormin)
- metoprolol (Toprol XL)
- nadolol (Corgard)
- propranolol (Inderal)
- timolol (Blocadren)
Side effects of beta blockers include fatigue, nausea, dizziness when standing, depression, and insomnia.
Calcium Channel Blockers
Calcium channel blockers are blood pressure drugs that moderate the constriction and dilation of blood vessels; something believed to play a role in migraine pain.
- diltiazem (Cardizem, Cartia XT, Dilacor, Tiazac)
- nimodipine (Nimotop)
- verapamil (Calan, Covera, Isoptin, Verelan)
Side effects of calcium channel blockers include low blood pressure, weight gain, dizziness, and constipation.
Antidepressants affect levels of various brain chemicals, including serotonin.
- amitriptyline (Elavil, Endep)
- fluoxetine (Prozac, Sarafem)
- imipramine (Tofranil)
- nortriptyline (Aventyl, Pamelor)
- paroxetine (Paxil, Pexeva)
- sertraline (Zoloft)
- venlafaxine (Effexor)
Side effects of antidepressants include weight gain and decreased libido.
Anticonvulsants prevent seizures caused by epilepsy or other conditions. They work for migraine by calming overactive nerves in the brain.
- divalproex sodium (Depakote, Depakote ER)
- gabapentin (Neurontin)
- levetiracetam (Keppra)
- pregabalin (Lyrica)
- tiagabine (Gabitril)
- topiramate (Topamax)
- valproate (Depakene)
- zonisamide (Zonegran)
Side effects of anticonvulsants include nausea, vomiting, diarrhea, weight gain, sleepiness, dizziness, and blurred vision.
Botulinum Toxin Type A (Botox)
Botulinum toxin type A (Botox) injections in muscles of the forehead or neck can be helpful for some people with chronic migraine when other treatments fail. Generally they are repeated every three months so they can be costly.