A variety of drugs have been specifically designed as one of Migraine Treatment. In addition, some drugs commonly used to treat other conditions also may help relieve or prevent migraines. Medications used to combat migraines fall into two broad categories:
- Pain-relieving medications. Also known as acute or abortive treatment, these types of drugs are taken during migraine attacks and are designed to stop symptoms that have already begun.
- Preventive medications. These types of drugs are taken regularly, often on a daily basis, to reduce the severity or frequency of migraines.
Choosing a strategy to manage your migraines depends on the frequency and severity of your headaches, the degree of disability your headaches cause, and your other medical conditions.
Some medications aren’t recommended if you’re pregnant or breastfeeding. Some aren’t used for children. Your doctor can help find the right medication for you.
For best results, take pain-relieving drugs as soon as you experience signs or symptoms of a migraine. This Migraine Treatment may help if you rest or sleep in a dark room after taking them:
- Pain relievers. These medications, such as ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others) may help relieve mild migraines. Drugs marketed specifically for migraines, such as the combination of acetaminophen, aspirin, and caffeine (Excedrin Migraine), also may ease moderate migraine pain but aren’t effective alone for severe migraines. If taken too often or for long periods of time, these medications can lead to ulcers, gastrointestinal bleeding and rebound headaches. The prescription pain reliever indomethacin may help thwart a migraine headache and is available in suppository form, which may be helpful if you’re nauseous.
- Triptans. For many people with migraine attacks, triptans are the drug of choice. They are effective in relieving the pain, nausea, and sensitivity to light and sound that are associated with migraines. Medications include sumatriptan (Imitrex), rizatriptan (Maxalt), almotriptan (Axert), naratriptan (Amerge), zolmitriptan (Zomig), frovatriptan (Frova) and eletriptan (Relpax). Side effects of triptans include nausea, dizziness and muscle weakness. They aren’t recommended for people at risk for strokes and heart attacks. A single-tablet combination of sumatriptan and naproxen sodium (Treximet) has proved more effective in relieving migraine symptoms than either medication on its own.
- Ergot. Ergotamine and caffeine combination drugs (Migergot, Cafergot) are much less expensive, but also less effective, than triptans. They seem most effective in those whose pain lasts for more than 48 hours. Dihydroergotamine (D.H.E. 45, Migranal) is an ergot derivative that is more effective and has fewer side effects than ergotamine. It’s also available as a nasal spray and in injection form.
- Anti-nausea medications. Because migraines are often accompanied by nausea, with or without vomiting, medication for nausea is appropriate and is usually combined with other medications. Frequently prescribed medications are metoclopramide (Reglan) or prochlorperazine (Compro).
- Opiates. Medications containing narcotics, particularly codeine, are sometimes used to treat migraine headache pain when people can’t take triptans or ergot. Narcotics are habit-forming and are usually used only as a last resort.
- Dexamethasone. This corticosteroid may be used in conjunction with other medication to improve pain relief. Because of the risk of steroid toxicity, dexamethasone should not be used frequently.
You may be a candidate for preventive therapy if you have two or more debilitating attacks a month, if pain-relieving medications aren’t helping, or if your migraine signs and symptoms include a prolonged aura or numbness and weakness.
Preventive medications can reduce the frequency, severity, and length of migraines and may increase the effectiveness of symptom-relieving medicines used during migraine attacks. Your doctor may recommend that you take preventive medications daily, or only when a predictable trigger, such as menstruation, is approaching.
In most cases, preventive medications don’t eliminate headaches completely, and some cause serious side effects. If you have had good results from preventive medicine and have been migraine-free for six months to a year, your doctor may recommend tapering off the medication to see if your migraines return without it.
For best results, take these medications as your doctor recommends:
- Cardiovascular drugs. Beta-blockers — commonly used to treat high blood pressure and coronary artery disease — can reduce the frequency and severity of migraines. The beta blocker propranolol (Inderal La, Innopran XL, others) has proved effective for preventing migraines. Calcium channel blockers, another class of cardiovascular drugs, especially verapamil (Calan, Verelan, others), also may be helpful in preventing migraines and relieving symptoms from the aura. In addition, the antihypertensive medication lisinopril (Zestril) has been found useful in reducing the length and severity of migraines. Researchers don’t understand exactly why these cardiovascular drugs prevent migraine attacks. Side effects can include dizziness, drowsiness or lightheadedness.
- Antidepressants. Certain antidepressants are good at helping to prevent some types of headaches, including migraines. Tricyclic antidepressants, such as amitriptyline, nortriptyline (Pamelor) and protriptyline (Vivactil) are often prescribed for migraine prevention. Tricyclic antidepressants may reduce migraine headaches by affecting the level of serotonin and other brain chemicals, though amitriptyline is the only one proved to be effective for migraine headaches. You don’t have to have depression to benefit from these drugs. Other classes of antidepressants called selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) haven’t been proved as effective for migraine headache prevention. However, preliminary research suggests that one SNRI, venlafaxine (Effexor, Venlafaxine HCL), may be helpful in preventing migraines.
- Anti-seizure drugs. Some anti-seizure drugs, such as valproate (Depacon), topiramate (Topamax) and gabapentin (Neurontin), seem to reduce the frequency of migraines. Lamotrigine (Lamictal) may be helpful if you have migraines with aura. In high doses, however, these anti-seizure drugs may cause side effects, such as nausea and vomiting, diarrhea, cramps, hair loss, and dizziness.
- Cyproheptadine. This antihistamine specifically affects serotonin activity. Doctors sometimes give it to children as a preventive measure.
- Botulinum toxin type A (Botox). The FDA has approved botulinum toxin type A for treatment of chronic migraine headaches in adults. During this procedure, injections are made in muscles of the forehead and neck. When this is effective, the treatment typically needs to be repeated every 12 weeks.
There are several precautions that should be observed with OTC analgesics:
- Children and teenagers should not use aspirin for the treatment of headaches, other pain, or fever, because of the risk of developing Reye’s Syndrome, a life-threatening neurological disease that can lead to coma and even death.
- People with balance disorders or hearing difficulties should avoid using aspirin because aspirin may aggravate these conditions.
- People taking blood thinners such as warfarin (Coumadin) should not take aspirin and non-aspirin NSAIDs without a doctor’s supervision because they add further to the risk of bleeding that is caused by the blood thinner.
- People with active ulcers of the stomach and duodenum should not take aspirin and non-aspirin NSAIDs because they can increase the risk of bleeding from the ulcer and impair healing of the ulcer.
- People with the advanced liver disease should not take aspirin and non-aspirin NSAIDs because they may impair kidney function. Deterioration of kidney function in these patients can lead to failure of the kidneys.
- OTC or prescription analgesics should not be overused. Overuse of analgesics can lead to the development of tolerance (increasing ineffectiveness of the analgesic) and rebound headaches (return of the headache as soon as the effect of the analgesic wears off, usually in the early morning hours). Thus, overuse of analgesics can lead to a vicious cycle of more and more analgesics for headaches that respond less and less to treatment.
Keeping a migraine diary, particularly when you first begin to experience migraines, can help identify the triggers for your headaches so you can avoid them. When a migraine occurs, write down the date and time it began. Note what you ate for the preceding 24 hours, how long you slept the night before, what you were doing just before a headache, any unusual stress in your life, how long the headache lasted, and what you did to make it stop.
Other lifestyle measures that may reduce the number of migraines include:
- Exercising regularly
- Getting enough sleep each night
- Relaxing and reducing stress in your life (see Mind/Body Medicine section)
- Eating regular meals
- Avoiding cigarettes, caffeine, and alcohol
Once a headache or associated migraine symptoms begin, it helps to:
- Rest in a quiet, darkened room
- Drink fluids to avoid dehydration (especially if you have vomited)
The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a healthcare practitioner.
- Butterbur (Petasites hybridus, 50 – 75 mg of a standardized extract 2 times per day) — A few studies suggest that butterbur may help reduce both the frequency and duration of migraine attacks. The studies used a standardized extract that lowered the number of alkaloids in the herb, which might potentially harm the liver. If you want to try butterbur for your migraines, ask your doctor about a safe extract and dose. Women who are pregnant or breastfeeding should not take butterbur.
- Feverfew (Tanacetum parthenium, 50 – 80 mg per day) — Feverfew has been used traditionally to treat headaches, and several well-designed studies have found that it may help prevent and treat migraines (not all studies agree, however). In one study of people with migraines, those who took feverfew capsules every day for 4 months saw a substantial drop in the number of attacks as well as far fewer symptoms, such as nausea and vomiting, compared to those who received placebo. Feverfew can increase the risk of bleeding, and should not be taken with anticoagulants (blood thinners). Women who are pregnant or breastfeeding should not take feverfew.
Although there are no scientific studies showing that these herbs work, they are sometimes suggested to treat migraines and other types of headaches. Note: people who take blood-thinning medications or who have bleeding disorders should not take these herbs:
- Dong Quai (Angelica Sinensis)
- Devil’s claw (Harpagophytum procumbens)
- Ginger (Zingiber officinale)
- Ginkgo biloba (Ginkgo biloba)
- Willow bark (Salix spp.)