Medications for Treating Migraine Headaches

Drugs That Stop Pain, Nausea, and Other Symptoms in Their Tracks

There are Effective Medications to Treat Migraines
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There are two main categories of drugs for managing migraine headaches: Those taken to prevent them from happening and those used for the acute treatment of a migraine that's already underway, which often are referred to by doctors as "abortive" medications.

Within the latter category of migraine treatments are drugs ranging from over-the-counter (OTC) analgesics (painkillers) to prescription medications that treat not only the headache but also other migraine symptoms.

Finding what works best for you can take some time and requires the guidance of your physician.

Pain Medications

For most people who get migraines, the first line of defense against an impending headache is an over-the-counter (OTC) analgesic (pain-relief medication). There are two classes of non-prescription painkillers—acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs).

Acetaminophen

This medication works by blocking chemical messengers that help transmit pain signals to the brain. There are dozens of brand names for acetaminophen; the most common is Tylenol. There also are many generic and store brand versions available.

When not taken properly, acetaminophen has been found to cause liver damage in some people.

NSAIDs

NSAIDs relieve pain by decreasing the production of hormone-like compounds called prostaglandins that send pain messages to the brain. They include:

  • Aspirin (the most common brand is Bayer)
  • Advil, Motrin (ibuprofen)
  • Aleve (naproxen)

NSAIDs are associated with stomach pain and gastrointestinal bleeding. In addition to this, aspirin is linked to a potentially fatal condition in children called Reye's syndrome, so it should not be prescribed for kids under 19.

Prescription Analgesics

For some people, an OTC pain medication isn't potent enough to bring relief. Stronger versions of both acetaminophen and NSAIDs are available by prescription. In addition, an NSAID called Cambia (diclofenac) is often effective. Cambia comes as a powder that's mixed with water.

Other prescription NSAIDs that have been studied for treating migraine are:

Triptans

Triptans are a class of prescription medication often used to stop a migraine attack that's already underway from getting worse. They also are used to help prevent migraines in women who tend to get them when they have their periods (a.k.a. menstrual migraines).

Triptans are most effective for moderate to severe migraines and work best when taken at the earliest sign of an impending attack.

These drugs not only fend off pain, they also help to alleviate nausea and sensitivity to light and sound that are common symptoms of migraine attacks. They do this by stimulating the production of the neurotransmitter (brain chemical) serotonin, thereby reducing inflammation and constricting blood vessels. Triptans also may lower levels of a protein called calcitonin gene-related peptide (CGRP) that is elevated during migraine attacks.

Available Options

There are seven triptans available for heading off migraine headaches. Unless otherwise noted, they're available only as tablets. They are:

  • Axert (almotriptan)
  • Relpax (eletriptan)
  • Frova (frovatriptan)
  • Amerge (naratriptan)
  • Maxalt, Maxalt-MLT (rizatriptan), which comes as a tablet or as a wafer that melts on the tongue
  • Imitrex (sumatriptan), which is available as a tablet, nasal spray, or subcutaneous (under-the-skin) injection
  • Zomig (zolmitriptan), available as a tablet, nasal spray, or wafer

In addition to these single-ingredient triptans, there is a medication called Treximet that combines sumatriptan with the NSAID naproxen.

Research suggests that taking sumatriptan and naproxen together as a single tablet may be more effective for some people than taking them separately.

As with any medication, triptans have potential side effects. The most common ones include nausea, paresthesias, fatigue, and chest or throat tightness. People who have heart disease or high blood pressure that isn't under control shouldn't take triptans, since the drugs work by constricting blood vessels.

Dihydroergotamine

Dihydroergotamine, which is available as D.H.E. 45 or Migranal, is in a class of drugs known as ergot alkaloids. It helps head off emergent migraines by tightening blood vessels in the brain and preventing the release of substances in the brain that cause swelling.

This medication can be injected subcutaneously, usually in the thigh well above the knee, or taken as a nasal spray.

If you're prescribed dihydroergotamine, the doctor may give you your first dose to monitor how you react and also to make sure you understand how to give yourself the shot or use the spray.

The most common side effects of this medication include upset stomach, dizziness, weakness, and fatigue; the nasal spray can cause a stuffy or dry nose, tingling or pain in the nose or throat, and nosebleed.

Among the more unusual and potentially serious problems associated with dihydroergotamine are those that require immediate medical attention: numbness, tingling, or changes in the color of your fingers or toes; muscle pain or weakness; chest pain; changes in heart rate; and swelling, itching, dizziness, or faintness.

You should not take dihydroergotamine if you are taking a triptan, have poorly controlled blood pressure and/or heart disease, or you're pregnant.

Antiemetics

Many people who have migraines are plagued with nausea and vomiting along with head pain. Not only are these symptoms unpleasant, they can lead to dehydration and make it difficult to keep medication down. For this reason, drugs called antiemetics often are part of the pharmacologic arsenal for treating migraine, particularly when someone is in so much pain they seek emergency treatment.

Antiemetics usually are given intravenously or by injection into a muscle and are in a class of drugs called dopamine-receptor antagonists. Among those sometimes used to treat migraine-related nausea in the ER are:

  • Chlorpromazine
  • Compro, Procomp (prochlorperazine)
  • Haldol (haloperidol)
  • Metoclopramide

Corticosteroids

Steroids don't relieve pain from a migraine, but they may prevent a headache from coming back. This is important.

According to research published in 2015 in the journal Cephalagia, "headaches recur in up to 87 percent of migraine patients visiting the emergency department."

This research, which reviewed 25 studies in which corticosteroids were used to treat migraine headaches, found that when a patient received a single steroid shot as part of emergency treatment for migraine (usually along with a triptan), they were less likely to have another migraine within 72 hours. What's more, headaches that did recur tended to be milder. Similarly, in research cited by the National Headache Foundation, an injection of dexamethasone given with a triptan reduced the recurrence of headache within 72 hours by 26 percent.

A Word From Verywell

There's no one-size-fits-all approach to treating migraine headaches. People respond differently to different types of medications, doses, and combinations of drugs—and there are many, many options. This can be overwhelming and frustrating, but trust that even if takes a bit of trial-and-error, you and your doctor will hit upon an effective way to manage your migraines.

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