Muscle relaxers aren’t a first-line treatment for migraine. Still, a doctor or healthcare professional may prescribe certain muscle relaxers, such as tizanidine, to treat migraine or other types of headaches. But in most cases, the risks may outweigh the benefits.
Migraine is a debilitating, intense form of headache that usually affects one side of your head. The pain can last from a few hours to a few days. People may also experience:
- sensitivity to light and sound
- aura (flashing lights or spots in their line of vision)
There are several treatment options for migraine. But when preferred treatments fail, a doctor may look for alternative ways to relieve symptoms or prevent headaches from occurring.
Muscle relaxers aren’t a first-line treatment for migraine. Still, a doctor may prescribe a muscle relaxer to help relieve certain migraine symptoms. Doctors sometimes prescribe them to treat other types of headaches as well.
A clinical trial is underway to determine if one muscle relaxer, tizanidine, could also help prevent migraine.
Muscle relaxers come in two broad categories:
- Antispasmodics: These drugs treat muscle spasms and cramps. Doctors often use them to treat stomach cramps and fibromyalgia.
- Antispastics: These drugs reduce muscle tone and stiffness that may occur in conditions such as multiple sclerosis (MS), cerebral palsy, or spinal cord injuries.
It’s not clear why muscle relaxers may work for migraine. Antispasmodics don’t work directly on your muscles but have a sedating effect.
Each muscle relaxer works a bit differently and has a unique safety profile.
Doctors also use tizanidine off label to treat chronic migraine. That’s when you experience migraine headaches at least 15 days each month. They may also use it to help with rebound headaches from medication withdrawal.
Other off-label uses of tizanidine include chronic neck and lower back pain, as well as some regional pain syndromes.
An ongoing clinical trial is testing whether tizanidine can prevent acute migraine attacks in people with a history of migraine.
Some common side effects of tizanidine
- involuntary muscle movement
- muscle weakness
- blurred vision
Off-label uses of cyclobenzaprine include treating fibromyalgia and myofascial pain from jaw joint disorders.
Cyclobenzaprine has a structure similar to a group of drugs that may be effective at preventing migraine headaches. But there’s little data to support the use of cyclobenzaprine to prevent migraine.
The most common side effects of cyclobenzaprine are:
- extreme fatigue
- dry mouth
Cyclobenzaprine may also cause more serious side effects
- rapid heart rate (tachycardia)
- urinary retention
- loss of bowel muscle movement (ileus)
Side effects of methocarbamol include:
- blurry vision
- upset stomach
- metallic taste
- dark urine that’s often green, black, or blue
Other muscle relaxers
Researchers have looked into other muscle relaxers as migraine therapy. But there’s little data to support their safety or effectiveness for migraine. Examples include:
Natural muscle relaxers
Although they may not all function as muscle relaxers, several natural remedies and
Butterbur is another natural remedy with some potential to treat migraine. But it’s best to use it with caution.
In 2015, the American Academy of Neurology
Some muscle relaxers may help treat other kinds of headaches besides migraine.
Tension headaches are very common and occur when muscles in your head and neck contract. Doctors sometimes prescribe tizanidine off label to prevent chronic tension headaches. But there’s not much evidence to support their use for this purpose.
Because muscle relaxers come with a risk of dependence, a doctor is likely to suggest other options to treat tension headaches.
Occipital neuralgia is a rare chronic headache disorder. These short, painful headaches start in your occipital nerves, which run through your neck and the back of your head.
Muscle relaxers may help treat occipital neuralgia.
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- local nerve blocks
A sinus headache is actually pressure caused by sinusitis. Treatment for sinusitis typically does not involve muscle relaxers. If sinusitis is because of a bacterial infection, a doctor may prescribe antibiotics.
Options for managing sinusitis at home may include:
- nasal wash
- using a humidifier
- taking over-the-counter (OTC) decongestants
Cluster headaches can be as painful as migraine, but they’re usually shorter. Some doctors
Doctors may also use verapamil, a blood pressure medication, to treat cluster headaches and migraine.
Rebound headaches, also known as
Treatment for migraine falls into two broad categories: abortive and preventive. Abortive medications help treat migraine headaches as they occur. Preventive medications help reduce the number and severity of your migraine attacks.
During a migraine attack, you may take a prescription or OTC pill to relieve symptoms. Options include:
- Pain relievers: OTC pain relievers, such as acetaminophen (Tylenol), and NSAIDs, such as ibuprofen, naproxen, and aspirin, can help with mild to moderate migraine headaches.
- Triptans: These prescription drugs cause blood vessels to contract. Doctors prescribe triptans if NSAIDs or acetaminophen are ineffective. Common triptans include:
- sumatriptan (Imitrex)
- Gepants: These prescription drugs block calcitonin gene-related peptide (CGRP). They include ubrogepant (Ubrelvy) and rimegepant (Nurtec ODT).
- Ditans: Prescription medications, such as lasmiditan (Reyvow), work to counter specific serotonin receptors in the brain.
Preventive migraine treatments
To prevent the onset of migraine attacks, a doctor may recommend certain medications, electrical current stimulation, or alternative forms of therapy.
- Beta-blockers: Certain beta-blockers, such as propranolol, may be most effective at preventing migraine.
- Antiepileptics: Topiramate (Topamax) and valproate are antiepileptics that are often effective in migraine prevention.
- Antidepressants: Two antidepressants may be effective at treating migraine. Doctors often prescribe amitriptyline, a tricyclic antidepressant, and fluoxetine, a selective serotonin reuptake inhibitor.
- Calcium channel blockers: Verapamil, a blood pressure medication, may also help prevent migraine.
- CGRP inhibitors: Like gepants, monoclonal antibodies can also block CGRP. Popular prevention options include erenumab (Aimovig) and fremanezumab (Ajovy).
Some gepants, such as atogepant and rimegepant, can also help prevent migraine.
- Botulinum toxin A (Botox): Widely known as a wrinkle reducer, botox injections can help prevent migraine. A clinician injects the toxin into specific points in your head and neck every 3 months.
Another option may be transcranial magnetic stimulation (TMS). TMS is a noninvasive procedure that involves magnetic pulses that stimulate nerve cells in your brain.
Migraine is a disabling disorder with many first-line treatment options. If OTC medications don’t work, a doctor might prescribe triptans, gepants, or ditans, among other options. Some muscle relaxers may also be effective in treating migraine or other headache types, but this is an off-label use.
Some muscle relaxers may have serious side effects. They may even carry a risk of overuse or dependency. Be sure to discuss these with a doctor before starting treatment.