Latest Medications and Treatments for Migraine

Preventive medications

A preventive strategy is often the first line of defense against chronic migraine. Rather than simply treating the symptoms of a migraine episode, preventive medications aim to reduce the number of migraine episodes you get. This can improve your quality of life and reduce your need for pain relievers and other medications.

Interestingly, most of these medications weren’t developed to treat migraine. But experts have found that they help prevent migraine episodes in many people.

Although each medication has a risk of certain side effects, not everyone will have these problems, and some side effects may be very mild.

Talk with your doctor about these issues, and come up with a plan. If the side effects are too bothersome, you can try switching medications or lowering the dose.

Beta-blockers

Beta-blockers are a type of blood pressure medication. Beta-blockers may be one of the first medications your doctor tries because of their effectiveness.

A 2019 review of studies found high quality evidence that propranolol, a specific type of beta-blocker, worked better than a placebo for episodic migraine treatment.

Side effects include:

• fatigue
• depression
• dizziness
• nausea

Calcium channel blockers

Like beta-blockers, these were developed for high blood pressure but may also work as migraine preventers. They are well tolerated by most people.

The National Headache Foundation notes that verapamil is the most studied of these medication types for migraine and so it’s often recommended.

Side effects include:

• low blood pressure
• weight gain
• constipation

Antidepressants

These medications were created to treat depression, but certain kinds also work well to prevent migraine episodes. In particular, drugs called tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) work well for some people. Another type that also shows some effectiveness in migraine prevention is serotonin antagonists.

Side effects include:

• weight gain
• decreased libido
• drowsiness

Anticonvulsants

Anticonvulsants are medications that prevent seizures, but they work well to prevent migraine episodes in some people.

Side effects include:

• weight gain
• weight loss
• fatigue

BOTOX

BOTOX is an injectable medication that can help prevent chronic migraine episodes. Chronic migraine is when migraine episodes occur 15 or more days in at least 3 consecutive months.

BOTOX injections are given every 12 weeks. You’ll receive a series of injections in the head and neck area during each treatment. The needle is small and most people say the pain involved is minimal.

Side effects include:

• neck pain
• neck stiffness
• muscle weakness

Anti-CGRP injections or infusions

These newer options are the first medications specifically designed to treat migraine. They target a protein called calcitonin gene-related peptide (CGRP) that causes the pain associated with migraine. These are available in different forms.

As a self-administered injection, the options are:

• erenumab (Aimovig)
• fremanezumab (Ajovy)
• galcanezumab (Emgality)

As an IV infusion, available through a health professional, the only option is eptinezumab (Vyepti).

While these medications may reduce the number of migraine episodes experienced during a month, they come at a higher cost than some other treatment options.

Natural or herbal remedies

Feverfew and butterbur are two herbs that may prevent migraine episodes in some people. Some supplements, including magnesium, riboflavin (a B vitamin), and coenzyme Q10, may also be helpful.

Although these remedies are considered natural, they can interact with other medications. If you’re interested in these options, talk with your doctor before taking them.

Acute (abortive) medications

Unlike preventive medications, acute medications (sometimes referred to as abortive) are taken when you feel a migraine episode coming on.

These may be part of your treatment plan along with preventive medications. If you only get occasional migraine episodes, abortive medications may be all you need.

General pain relievers

You’ve probably taken these types of pain relievers for headaches or muscle aches. They may be over-the-counter or prescription and come in a variety of brands and forms.

Some pain relievers include other ingredients such as caffeine. In moderate amounts, caffeine can alleviate headaches. But when overused, it can cause withdrawal headaches and make a migraine episode worse.

If you only use these medications occasionally, there’s very little risk of side effects. Regular use, or twice a week or more, puts you at risk of side effects such as stomach bleeding. They can also cause rebound or medication overuse headaches (MOHs) if you use them too much.

Talk with your doctor about preventive options if you use pain relievers more than twice a week.

Triptans

These are prescription medications that work well for treating migraine episodes. If general pain relievers don’t help you, your doctor may recommend a triptan.

Triptans constrict blood vessels and stop pain signals in the brain. They are available as pills, nasal sprays, and injections.

Side effects include:

• dizziness
• drowsiness
• weakness

Ergots

These medications aren’t as popular as triptans, because they’re more likely to cause side effects like nausea and vomiting. They may also lead to MOHs in some people.

However, a form of ergot known as dihydroergotamine appears to be less likely to cause these issues. If you can’t take triptans or they don’t work for you, ergots may be another option to try.

Gepants

This newer medication option is similar to triptans in that they block a protein that initiates pain signals called calcitonin gene-related peptide (CGRP) from attaching to its receptor.

The two options currently approved by the Food and Drug Administration (FDA) for acute migraine treatment are the tablet form of ubrogepant (Ubrelvy) and an orally dissolvable form of rimedgepant (Nurtec).

Side effects of these medications tend to be reported as mild and may include fatigue and nausea. These may interact with other medications and are not indicated for use during pregnancy, so it’s important to talk with your doctor about your options.

Ditans

Ditans work similarly to triptans in stopping pain signals, but they don’t constrict the blood vessels, making them an appealing option for those with a higher risk of heart disease or stroke.

They operate by affecting the pain receptors within the brain, which means they may cause more side effects, like dizziness and sedation.

Anti-nausea medications

Many people experience nausea and vomiting with a migraine. If this happens to you, an anti-nausea prescription may help you find relief. They will likely be prescribed along with another medication that treats the migraine pain. Side effects can include extreme drowsiness.

Nerve blocks

Some people have migraine episodes that won’t stop, even after using abortive medications. Migraine episodes can last days with no relief.

In these cases, a nerve block may be useful. A nerve block is an injection given in the doctor’s office. It numbs the nerves in the head causing migraine.

Side effects include pain or a burning sensation where the injection was given.

Finding the right treatment

With the variety of effective treatments available today, there’s a good chance you and your doctor will find an effective migraine treatment for you.

There’s no single treatment that works for everyone, so be prepared to try different treatment plans until you find the right one. Good communication with your doctor will help you find the best solution for your migraine episodes.