An Overview of Medicine to Use for Migraine Treatment

Different types of medications are used to treat migraine headaches, depending on the level of pain you are experiencing. Some medicine can prevent migraines, while others treat current symptoms. Read more about the most common types of medicine used for migraine treatment.

What Is a Migraine?

Migraines are primary headache disorders, in which headaches arise independently of other illnesses or diseases. Lasting anywhere from four to 72 hours or more, migraine attacks are distinctive in that they cause a broader range of symptoms than just headaches.

Typically, migraine attacks come in phases, changing shape as they progress. Here’s a breakdown:

• Prodrome: Before the onset of full-blown headaches, common symptoms of the first stage are confusion, speech difficulties, problems concentrating, nausea, light and or smell sensitivity, muscle stiffness, sleepiness, and insomnia. Prodrome can last a few hours or a few days.
• Aura: The aura phase can last anywhere from five to 60 minutes. Occurring in many—but not all—migraine cases, the aura stage immediately precedes the headache pain. It’s primarily characterized by visual disturbances, such as flashing dots, sparks, or lines, and it sometimes causes temporary blindness. Dizziness, changes in smell and taste, numbness, and tingling are among the other symptoms.   
• Headache: The headaches associated with migraines are moderate to severe and are throbbing or pulsing. In many cases, they affect only one side of the head. Headaches may be accompanied by severe nausea, vomiting, sweating, hot flashes and/or chills, loss of appetite, dizziness, and pale skin. This phase can last about four to 72 hours and also causes severe sensitivity to light, sounds, or odors.
• Postdrome: The postdrome phase following the headache attacks can cause depression, problems with concentration or comprehension, fatigue, and euphoria. This phase can last up to a day afterward.

The frequency of migraine attacks can vary a great deal. However, people who experience 15 or more attacks a month are considered to have chronic migraine.

Causes of Migraine Headaches

Migraines are believed to arise from waves of increased activity in certain brain cells, which causes the release of the hormones serotonin and estrogen. As a result, blood vessels supplying the brain become narrowed, which leads to headache and the other symptoms.

While the exact reasons someone may develop migraines are unknown, several risk factors have been identified:

• Genetics
• Menstruation
• Obesity
• Smoking   

Medications Used to Prevent Migraines

Along with making certain lifestyle changes and working to prevent exposure to triggers, medications play a central role in migraine management. Broadly speaking, medicine for migraine can be divided into “prophylactic” medications that prevent and minimize attacks, and “abortive” medications, which manage symptoms after onset.

Several classes of drugs are prescribed as preventive migraine therapy; these are generally considered if migraines are occurring multiple times a month.

Beta-Blockers

Among the most widely prescribed drugs for migraine are beta-blockers, which are also used for high blood pressure (hypertension), cardiac arrhythmia (irregular heartbeat), and other heart or circulation issues. Most common of these are Tenormin (atenolol), Inderal LA (propranolol), or Toprol XL (metoprolol), but there are many others.

Though effective, these can cause some side effects, including:

• Depression
• Fatigue and loss of energy
• Erectile dysfunction 
• Nightmares
• Slow heart rate (bradycardia)
• Low blood pressure (hypotension)

Tricyclic Antidepressants

Another class of drugs used to prevent migraine are tricyclic antidepressants. Also used to treat depression and anxiety, amitriptyline, Pamelor (nortriptyline), and Silenor (doxepin) are frequently considered options.

Common side effects of these medications include:    

• Sedation
• Blurry vision
• Constipation
• Dry mouth
• Heart palpitations or elevated heart rate (tachycardia)
• Urinary retention

In addition, rare adverse effects are:

• Changes in heart conductivity
• Low blood pressure
• Slowed heartbeat
• Weight gain

Antiepileptic Drugs

Typically used to treat seizures, antiepileptic drugs such as Depakote (valproic acid) and Topamax (topirimate) can help prevent migraine onset. As with other medications, antiepileptic use can lead to some side effects, including:

• Intestinal problems
• Nausea and vomiting
• Fatigue
• Tremors
• Alopecia (loss of hair)
• Weight loss
• Mental confusion

Calcium Channel Blockers

Calcium channel blockers are typically used to reduce blood pressure. However, they may also be considered for migraine, though evidence for efficacy is mixed. The calcium channel blocker verapamil, a generic or available as Calan or Veralan, is considered as an off-label treatment for this condition.

Adverse effects of this drug include:

• Headache
• Swelling in the lower limbs
• Constipation
• Dizziness
• Nausea
• Low blood pressure
• Fatigue

Calcitonin Gene-Related Peptide (CGRP) Monoclonal Antibodies

A newer class of medication for migraine, calcitonin gene-related peptide (CGRP) monoclonal antibodies, like Vyepti (eptinezumab) and Ajovy (fremanezumab), have shown efficacy in reducing the frequency of monthly attacks. These medications are delivered via injection. While they are Food and Drug Administration (FDA) approved, they are still a relatively new treatment and research is ongoing.

Side effects are mild and rare with CGRP monoclonal antibodies, though use may cause irritation or infection at the site of injection. In addition, injections can cause a mild allergic reaction, leading to itchiness, hives, or a rash.

Botox Injection

In particularly challenging chronic migraine cases—especially those in which other treatments haven’t yielded results—some doctors may recommend Botox injection. Basically, doctors inject a toxin made by the botulinum bacteria into specific nerves in your forehead, temples, neck, and head. This prevents their activity, reducing the prevalence and severity of attacks.

When used to treat migraine, the most common side effects of this treatment are:

• Headache
• Neck pain
• Muscle stiffness and pain
• Eye twitching
• Muscle spasms

Medicine for Migraine Onset

If migraines have already begun, it’s important to treat them as soon as possible. Earlier intervention is generally better for the overall outcome, reducing the severity of pain and duration of the attacks.

Several classes of drugs, both prescribed and over-the-counter, may be used to help ease symptoms.

Over-the-Counter (OTC) Options

Depending on the case, doctors may suggest you first try OTC pain relievers. There are many that can help, though some are designed specifically for migraine, including:

• Excedrin Migraine (a combination of aspirin, acetaminophen, and caffeine)
• Advil Migraine (ibuprofen, a nonsteroidal anti-inflammatory drug, NSAID)
• Tylenol Ultra Relief (acetaminophen plus caffeine)

However, using these too often or too many at a time can become problematic. In some cases, it can actually make headaches worse, a condition called medication overuse headache (MOH).

Triptans

Often the first-line medications for migraine attacks, triptans bind to 5-HT receptors in brain cells, which binds to serotonin. Low levels of this hormone are associated with attacks causing blood vessels to narrow. Triptans like Zembrace SymTouch (sumatriptan) and Zomig (zolmitriptan), among others, cause blood vessels to dilate and open up.

Available as injections, patches, or tablets, there are some side effects associated with these drugs, including:

• Flushing of the face or skin
• Tingling
• Hot or cold flashes
• Drowsiness and tiredness
• Muscle weakness
• Muscle cramps
• Dizziness
• Upset stomach, diarrhea, and/or nausea

Dopamine Antagonist Antiemetics

Generally used to take on nausea and vomiting, some dopamine antagonist antiemetic drugs may be indicated for migraine cases. Compazine (prochlorperazine), Thorazine (chlorpromazine), and Reglan (metoclopramide) are among the medications that may be considered.

With a solid track record in managing migraine cases, these drugs do cause some side effects. The most common of these are:

• Drowsiness
• Dizziness
• Amenorrhea (the absence of menstrual cycles)
• Blurred vision
• Skin reactions
• Hypotension

Opioids

Stronger painkilling drugs may also be used to help with headache pain. For migraines, opioid medications like butorphanol, codeine, and Ultram (tramadol) may be considered. This approach is not recommended for chronic migraine cases.

That said, these can be highly addictive and cause many side effects, including:

• Sleepiness
• Confusion
• Nausea
• Constipation
• Euphoria
• Slowed breathing

Management and Prevention of Migraines

Luckily, there are several steps you can take to help manage your condition.  

Get Good Sleep

Those who often get a poor night's rest are more likely to experience migraines at a greater frequency. Here are some tips to improve your sleep quality:

• Getting up and going to bed at consistent times, every day
• Ensuring you get at least seven to eight hours of sleep at night (eight to nine if you’re an adolescent)
• Ensuring you have a restful, quiet space for sleep
• Avoiding caffeine and alcohol at night
• Steering clear of screens or monitors in bed   
• Getting regular exercise

Try Relaxation Methods

Since stress, anxiety, and physical overexertion are all reliable migraine triggers, relaxation strategies can be instrumental in preventing attacks. Your doctor may recommend you do yoga, meditation, and get regular exercise.

Get Exercise

Among the many benefits of a good fitness regimen is that it can reduce the severity and frequency attacks. Not only does this improve the quality of sleep, but it can help get at conditions that can bring on migraines, such as obesity and sleep apnea.

At minimum, you should aim for 150 minutes of light to moderate activity (such as walking or cycling), or about 30 minutes a day, five days a week.

Other Methods

Several other means may be attempted to help with migraines. One option, biofeedback, focuses on tracking your body’s signs of stress and tension using a specialized device worn on the body. Since spikes in stress response can bring on attacks, wearers can learn to sense them coming, making them better able to manage their condition.

There is also evidence that regular acupuncture treatment can reduce the frequency of migraine attacks. This traditional Chinese medical modality relies on the use of needles inserted into the skin at strategic spots. In turn, nerve pathways are stimulated, which may help with headaches and other symptoms.

When to Seek Professional Treatment

If you get regular and very debilitating headaches, it’s important to be proactive about getting help. According to the National Institutes of Health (NIH), make sure to call 911 and seek emergency care if:

• Your headache is worse than any you’ve had.
• You’re also having problems speaking, with vision, or moving.
• You’ve lost your balance.
• The onset of the headache is very sudden.

If you’re living with migraine attacks, it’s also important to be vigilant of changes or other factors that can affect your treatment. Here’s a rundown of reasons to call your doctor or primary care provider:

• You’re finding changes in your general pattern of headaches.
• Preventive or abortive medications aren’t working anymore.
• You’re experiencing side effects from the drugs you’re taking.
• You have started taking birth control.
• You find you need pain medications three or more days a week.
• Your headaches get worse when you’re lying down or leaning over.

A Word From Verywell

While medications shouldn’t be the only aspect of migraine management, they can play a significant role in helping you get a handle on this difficult condition. As with any medical treatment, there are some drawbacks to migraine medications and care needs to be taken.

Nonetheless, these medications help countless people handle and prevent attacks. It’s worth talking to your doctor about your migraine treatment options.