Migraine is a neurological condition that leads to recurrent headaches characterized by intense throbbing or pulsing pain. According to the National Institute of Neurological Disorders and Stroke, about 12 percent of people in the United States have migraine.
There are two types of migraine treatment: abortive and preventive. Abortive treatments work to stop a migraine attack as it’s happening, while preventive treatments aim to prevent additional migraine attacks.
There are several different types of medications that are used as abortive migraine treatments. Keep reading to learn what they are, how they work, and more.
Abortive migraine medications are used to relieve the symptoms of a migraine attack as it’s occurring. You may also see abortive migraine medications referred to as acute migraine medications.
These medications are most effective when taken early in a migraine attack. Because of this, it’s important to take them as soon as you feel the symptoms of migraine begin to come on.
The specific type of abortive medication that’s recommended will depend on several factors. These include things like the severity, frequency, and symptoms of your migraine.
Now let’s explore the different types of abortive treatments in greater detail.
Over-the-counter (OTC) medications
A variety of over-the-counter (OTC) medications can be used to treat a migraine attack. Some examples include:
- nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin), naproxen (Aleve), aspirin, acetaminophen (Tylenol)
- a combination of aspirin, acetaminophen, and caffeine (Excedrin Migraine)
OTC medications are typically used as one of the first-line treatments for migraine. They’re taken as an oral pill or tablet.
These medications can typically help to ease mild migraine pain. However, if you have more severe migraine pain, they may not be as effective at alleviating your symptoms.
The side effects of the OTC abortive medications depend on which one is used:
- NSAIDs. Digestive side effects like stomach upset, nausea, and diarrhea are some of the most common side effects of NSAIDs.
- Acetaminophen. Some people may experience an allergic reaction to acetaminophen. In rare cases, it may cause liver damage.
- Caffeine (in combination pills). Some potential side effects of caffeine include nervousness, nausea, and dizziness.
There are seven different types of triptans that have been approved by the Food and Drug Administration (FDA) for the treatment of migraine. They include:
- sumatriptan (Imitrex)
- rizatriptan (Maxalt)
- zolmitriptan (Zomig)
- almotriptan (Axert)
- eletriptan (Relpax)
- naratriptan (Amerge)
- frovatriptan (Frova)
Triptans are available in many different forms, including:
- a pill or capsule
- a tablet or wafer that you dissolve on your tongue
- a nasal spray
- an injection
Triptans are the preferred first-line abortive treatment for migraine pain that’s moderate to severe in intensity. You’ll likely be prescribed a triptan if OTC medications haven’t been effective at relieving your migraine symptoms.
Some of the common side effects of triptans include:
- muscle aches and pains (myalgia)
- a feeling of pressure or tightness in the chest, jaw, or throat
- a sensation of heaviness in the limbs
There are two types of ergot derivative that are used as abortive migraine treatments. These are dihydroergotamine (Migranal) and ergotamine tartrate.
Ergot derivatives are often used as a second-line abortive treatment. For example, you may be prescribed an ergot derivative if your migraine attacks don’t respond well to OTC medications or triptans.
Similar to triptans, ergot derivatives can be found in a variety of forms, such as:
- a pill or capsule
- a tablet or wafer that you dissolve on your tongue
- a nasal spray
- an injection
Some of the potential side effects of ergot derivatives are:
- nausea or vomiting
- abdominal cramps
- leg cramps
- chest discomfort
- numbness or tingling in the hands or feet
Some people may experience migraine that happens with nausea. Because of this, a few different anti-nausea medications, also called antiemetics, may be prescribed in combination with an OTC medication, triptan, or ergot derivative.
Anti-nausea medications are typically taken orally. Some examples of medications that may be used for migraine are:
- metoclopramide (Reglan)
- prochlorperazine (Compazine)
- chlorpromazine (Thorazine)
The possible side effects of anti-nausea medications can include:
In rare cases, a group of symptoms called extrapyramidal symptoms can occur with these medications. Extrapyramidal symptoms can include tremors, involuntary muscle contractions, and involuntary movements.
Some of the most common side effects of lasmiditan are:
- paresthesia, a feeling of pins and needles
The most common side effects associated with ubrogepant are:
- feeling tired
- dry mouth
Now that we’ve covered the different types of abortive migraine medications, let’s take a look about how each type works.
The OTC medications that are used in abortive migraine treatment have different mechanisms of action:
- NSAIDs. NSAIDs work by inhibiting an enzyme called cyclooxygenase (COX) 1 and 2. This blocks the production of chemicals called prostaglandins, which contribute to pain and inflammation.
- Acetaminophen. The exact way in which acetaminophen works to alleviate symptoms like pain and inflammation has yet to be determined.
- Caffeine (in combination pills). Caffeine can work to tighten, or constrict, blood vessels. This can reduce blood flow in the brain, helping to ease migraine symptoms. It also has anti-inflammatory properties.
Triptans work through binding to certain types of receptors in the brain that are specific for the neurotransmitter serotonin.
When triptans bind to these receptors, blood vessels in the brain constrict. This decreases pain signaling. Triptans can also reduce inflammation levels.
Ergot derivatives work in a similar way to triptans in that they bind to certain serotonin receptors in the brain. This constricts blood vessels and reduces pain signaling.
However, ergot derivatives are less specific than triptans and can potentially bind to other receptors as well. Because of this, they often have more side effects than triptans.
The common types of anti-nausea medications used for migraine work by blocking a certain type of receptor in the brain. These are receptors that are specific for the neurotransmitter dopamine.
When these medications bind to the dopamine receptor, they help to prevent nausea or vomiting.
Lasmiditan (Reyvow) works by targeting a specific serotonin receptor in the brain called 5-HT 1F. It’s the first type of migraine medication to do so.
The exact mechanism by which lasmiditan eases acute migraine symptoms is unknown.
Unlike triptans and ergot derivatives, lasmiditan doesn’t cause blood vessels to constrict. This may make it a good treatment option in people with health conditions that impact the blood vessels.
Ubrogepant (Ubrelvy) inhibits a receptor called a calcitonin gene-related peptide (CGRP) receptor. It’s the first type of abortive migraine medication to act through this mechanism.
Ubrogepant prevents CGRP from binding to its receptor. When this occurs, it helps to stop the pain and vasodilation associated with migraine.
There are also several ways that you can prevent a migraine attack from happening in the first place. Let’s take a look at these now.
Know and avoid your triggers
In many people, migraines come on in response to different triggers. Some examples of migraine triggers include:
- lack of sleep
- skipped meals
- bright lights, loud sounds, or strong odors
- changes in the weather
- changes in hormones, such as during the menstrual cycle or during pregnancy
- caffeine or alcohol
- certain compounds in foods and drinks, such as nitrates, monosodium glutamate (MSG), and aspartame
Knowing and avoiding your triggers is a good way to prevent a migraine from happening. Depending on your specific migraine triggers, this typically involves specific lifestyle changes like:
- making sure to get enough sleep
- taking steps to lower stress
- avoiding certain types of foods and beverages
- aiming to eat regularly scheduled meals
Take preventive medications
In addition to abortive medications, you can also take preventive medications for migraine. When taken as directed, these medications can help to keep migraine attacks from occurring.
Some examples of preventive migraine medications include:
- beta-blockers like propranolol (Inderal) or timolol (Blocadren)
- calcium channel blockers like verapamil
- tricyclic antidepressants like amitriptyline (Elavil)
- selective-serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac)
- antiseizure drugs like valproate and topiramate (Topamax)
- CGRP monoclonal antibodies like fremanezumab-vfrm (Ajovy), erenumab-aooe (Aimovig), galcanezumab-gnlm (Emgality)
Try dietary supplements
According to the National Center for Complementary and Integrative Health, several types of dietary supplement may be beneficial at helping to prevent migraine. These are:
If you’d like to add dietary supplements to your migraine treatment plan, be sure to talk to your doctor first. They can advise you of any potential side effects or interactions with your current medications.
Migraine causes a recurrent headache with an intense pulsing or throbbing pain. Most of the time, this impacts only one side of the head. Other symptoms can include nausea, vomiting, and sensitivity to lights, sounds, or odors.
Some people may also have a set of symptoms called aura that happens prior to a migraine attack. Some examples of aura symptoms are:
- vision changes, such as seeing bright spots or partial vision loss
- pins and needles sensation in the face or hands
- muscle weakness impacting one side of the body
- trouble speaking, such as mumbling or slurred speech
Migraine attacks can be brought on by various triggers, which can include stress, changes in hormones, or sudden changes in the weather. Without treatment, a migraine attack can last between 4 and 72 hours.
The exact cause of migraine is unknown. It’s believed that changes in certain neurotransmitters, such as serotonin, play a role.
Abortive medications work to ease the symptoms of a migraine attack. They’re most effective when taken early, so be sure to take them as soon as you begin to experience symptoms.
Typically, the first-line treatments for migraine are OTC medications or triptans. Other medications may be used if these aren’t effective at alleviating your symptoms. You may also take medication to ease nausea that happens with migraine.
It’s important to take your abortive medications exactly as directed by your doctor. If you find that you’re needing to take them more than 3 times in a week, make an appointment with your doctor to discuss this.