Types of Migraine Headache Medications

Medications for migraine relief include NSAIDs, tricyclic antidepressants, calcitonin gene-related peptide (CGRP) inhibitors, botulinum toxin type A (Botox), ergot alkaloids, triptans, antinausea medications, and other pain relievers.

Migraine medications are for treating migraine headaches and associated symptoms. Migraine medications do not cure migraines, but relieve migraine symptoms and reduce the frequency and intensity of the migraines.

Medications for migraine relief include NSAIDs, tricyclic antidepressants, calcitonin gene-related peptide (CGRP) inhibitors, botulinum toxin type A (Botox), ergot alkaloids, triptans, antinausea medications, and other pain relievers. Some migraine medications are available over the counter, but most are prescription medicines.

Migraine is a neurovascular disorder marked by physiological changes in the brain that cause a collection of symptoms including intense, debilitating headaches, that may last from several hours to days. The cause of migraine is not fully clear. Migraines are possibly hereditary, and the majority of sufferers are women. In some women, migraines may be cause by hormone fluctuations during the menstrual cycle.

Current research suggests that migraine pain may be initiated by overactive nerve cells (neurons) triggering the trigeminal nerve, which provides sensation to the head and face. This leads to an imbalance in certain chemical messengers (neurotransmitters) in the brain resulting in a migraine headache.

The two neurotransmitters involved in migraines are:

• Serotonin: A hormone that plays many roles, including mood regulation, sleeping and digestion. Serotonin constricts blood vessels, and a sudden fall in serotonin levels at the start of a migraine makes blood vessels in the brain swell, resulting in inflammation and pain.
• Calcitonin gene-related peptide (CGRP): CGRP is a small protein involved in transmission of pain signals. CGRP is released by the trigeminal nerve during a migraine headache.

In some people, migraine headaches may be preceded by warning signs known as auras, the symptoms of which may vary from flashing lights, transient blindness, to weakness or numbness on one side of the body. Migraine headaches may be triggered by many factors such as hormone fluctuations, certain foods or drinks, and stress.

Common symptoms of migraine include:

• Throbbing or pounding pain, usually on one side of the head
• Nausea and/or vomiting
• Sensitivity to sound, light and/or smells
• Visual disturbances and eye pain

Migraine medications are of two major types (some medications are both types): abortive medications and preventive medications.

Abortive medications

Abortive medications relieve the symptoms of acute migraines. Abortive medications are taken at the first sign of a migraine attack. Acute migraine attacks not relieved by abortive therapy and lasting longer than 72 hours should be treated in the emergency department.

Types of abortive medications include:

• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Ergot alkaloids
• Triptans (serotonin receptor agonists)
• Ditans
• CGRP antagonists
• Antinausea medications
• Other pain relievers

Preventive medications

Preventive medications are usually taken daily by people with chronic migraine. Migraine is considered chronic when a person has migraine headaches 15 or more times in a month. Preventive medications reduce the frequency and severity of migraines, but may take up to six months to produce maximal effects.

Most preventive medications are not specifically migraine-targeted, but medications that treat other conditions, which clinical trials have found to be effective for migraines. Women who have menstrual migraines may respond to hormone therapy, in addition to preventive or abortive therapy.

The American Headache Society and the American Academy of Neurology recommend the following types of medications for treating chronic migraine:

• NSAIDs
• Tricyclic antidepressants
• Selective serotonin reuptake inhibitor (SSRI) antidepressants
• Serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressants
• High blood pressure medications (antihypertensives)
• Anticonvulsants
• CGRP inhibitors
• Botulinum toxin type A

NSAIDs

NSAIDs block the production of the chemicals that cause inflammation and pain. NSAIDs only relieve pain and do not address the changes in the brain that cause migraine. Most NSAIDs are available over the counter. Following are some of the NSAIDs used for migraines:

• Aspirin
• Ibuprofen (Advil, Motrin) -- dosage of 400 mg and above require prescription
• Acetaminophen, paracetamol (Tylenol)
• Naproxen sodium (Aleve, Anaprox DS [prescription] and Naprosyn [prescription])
• Combination of aspirin, acetaminophen, caffeine (Excedrin migraine)

Ergot alkaloids

• Ergot alkaloids provide pain relief by constricting blood vessels. Ergot alkaloids include:
• Ergotamine tartrate (Ergomar sublingual tablet)
• Dihydroergotamine mesylate (D.H.E. 45 injection, Migranal nasal spray)
• Ergotamine tartrate/caffeine (Cafergot)

Triptans

Triptans are serotonin receptor agonists which boost serotonin activity. Triptans constrict blood vessels, reduce inflammation and relieve pain. Triptans include the following:

• Sumatriptan succinate (Imitrex, Zembrace, Onzetra inhaled, Tosymra nasal spray)
• Sumatriptan/naproxen (Treximet)
• Zolmitriptan (Zomig)
• Rizatriptan benzoate (Maxalt)
• Naratriptan hydrochloride (Amerge)
• Almotriptan malate
• Frovatriptan succinate (Frova)
• Eletriptan hydrobromide (Relpax)

Ditans

Ditans are a new type of medication for acute migraines. Ditans also works on serotonin receptors, but bind to a specific subtype of serotonin receptors which block the release of CGRP by the trigeminal nerve. Ditans may be a better option for people with cardiovascular disease because it does not constrict blood vessels. The FDA-approved ditan is:

• Lasmiditan succinate (Reyvow)
• CGRP antagonists
• Calcitonin gene-related peptide antagonists work by preventing CGRP from transmitting pain signals. CGRP antagonists include:
• Rimegepant sulfate (Nurtec ODT)
• Ubrogepant (Ubrelvy)

Antinausea medications

Antinausea medications relieve nausea and vomiting caused by migraines. These symptoms may be relieved with migraine medications, but for some people they may be severe enough to prevent them from taking migraine medications.

Antinausea medications are available in the form of injections, tablets, capsules, syrup, and as rectal suppositories for people unable to ingest them orally.

Antinausea medications for migraines include the following:

• Promethazine hydrochloride
• Chlorpromazine hydrochloride
• Prochlorperazine (Compro)
• Trimethobenzamide hydrochloride (Tigan)
• Metoclopramide hydrochloride (Reglan)

Other pain relievers

• Barbiturate, a sedative, may be prescribed in combination with an NSAID, with or without an opioid (narcotic). A barbiturate combination often used for migraine is:
• Butalbital/acetaminophen/caffeine with or without codeine (opioid)
• Opioids are more potent painkillers but sparingly prescribed because they carry a serious risk of addiction.

NSAIDs

NSAIDs used for migraine prevention include:

• Diclofenac potassium (Cambia)
• Ibuprofen (Advil, Motrin)
• Naproxen sodium (Aleve, Anaprox DS, Naprosyn)

Tricyclic antidepressants

Antidepressants are medication that treat depression. Tricyclic antidepressants increase the level of serotonin. Commonly prescribed tricyclic antidepressant for migraine is:

• Amitriptyline hydrochloride
• Nortriptyline hydrochloride
• Imipramine hydrochloride
• Doxepin hydrochloride (Silenor)
• Protriptyline hydrochloride (Vivactil)

SSRI antidepressants

Selective serotonin reuptake inhibitors maintain normal levels of serotonin by preventing their reuptake. Reuptake refers to the normal reabsorption of neurotransmitters by neurons after the completion of nerve signal transmission.

• Paroxetine hydrochloride (Paxil)
• Fluoxetine hydrochloride (Prozac)
• Sertraline hydrochloride (Zoloft)

SNRI antidepressants

Serotonin-norepinephrine reuptake inhibitors prevent reuptake of both serotonin and norepinephrine, another hormone which helps reduce the intensity of the headache. SNRI antidepressants used for migraine include:

• Venlafaxine hydrochloride (Effexor XR)
• Duloxetine hydrochloride (Cymbalta)

High blood pressure medications

High blood pressure (HBP) medications work in various ways to relax the smooth muscles around the heart and blood vessels to reduce blood pressure. Types of HBP medications prescribed for migraines include:

• Beta-blockers
  • Atenolol (Tenormin)
  • Metoprolol (Lopressor, Toprol-XL)
  • Nadolol (Corgard)
  • Propranolol (Inderal)
  • Timolol (Betimol)
• ACE inhibitors
  • Lisinopril (Zestril)
  • Angiotensin II receptor inhibitors
  • Candesartan cilexetil (Atacand)
• Calcium channel blockers
  • Diltiazem hydrochloride (Cardizem LA)
  • Nimodipine
  • Verapamil (Calan SR)

Anticonvulsants/antiepileptics

Anticonvulsant medications reduce the electrical activity in the brain and bring down the pain. Anticonvulsants prescribed for migraines include:

• Sodium valproate
• Divalproex sodium (Depakote)
• Topiramate (Topamax)
• Gabapentin (Neurontin)

CGRP inhibitors

Calcitonin gene-related peptide inhibitors bind to CGRP receptors and block their activity. CGRP inhibitors are the newest preventive medications specifically developed for treating chronic migraines. CGRP inhibitors are monoclonal antibodies administered as monthly or quarterly injections.

CGRP inhibitors include:

• Erenumab (Aimovig)
• Fremanezumab (Ajovy)
• Galcanezumab (Emgality)
• Eptinezumab (Vyepti)

Botulinum toxin type A

Botulinum toxin type A is a purified enzyme produced from the bacteria Clostridium botulinum. Botulinum toxin type A is used to treat a number of muscle disorders and relax overactive muscles by blocking a neurotransmitter known as acetylcholine.

It is not fully understood how Botulinum toxin type A works in relieving migraine pain, but it is thought to inhibit the pain pathways of the trigeminal nerve. Botulinum toxin type A injections are given quarterly and the medication prescribed for migraine is:

• OnabotulinumtoxinA (Botox)

Though scientific evidence of efficacy is not established with quality studies for may of the following remedies, some migraine patients may find benefit from complementing medications with alternative therapies such as:

• Yoga and meditation
• Acupressure/acupuncture
• Chiropractic therapy
• Massages
• Craniosacral therapy
• Biofeedback

Nutritional/herbal supplements

There is some evidence that some herbal supplements may help in managing migraines, though scientific evidence is limited. Supplements that may help with migraines include:

• Feverfew
• Butterbur
• Magnesium
• Melatonin
• Coenzyme Q10 (CoQ10)
• Vitamin B12 (riboflavin)

Lifestyle changes

In addition to medications, migraines can be managed by adopting lifestyle habits such as:

• Eating nutritious food and avoiding migraine triggers
• Getting sufficient sleep
• Managing/reducing stress
• Regular exercise
• Adequate hydration

Warning: Triptans should not be taken with SSRI or SNRI antidepressants, it may lead to a life-threatening condition called serotonin syndrome.

• Please visit our medication section of each drug within its class for more detailed information.
• If your prescription medication isn’t on this list, remember to look at MedicineNet.com drug information or discuss with your healthcare provider and pharmacist.
• It is important to discuss all the drugs you take with your doctor and understand their effects, possible side effects and interaction with each other.
• Never stop taking your medication and never change your dose or frequency without consulting with your doctor.