There are many types of medications for people with migraine headaches. Some help to reduce symptoms as they occur. Others prevent episodes from occurring. Taking any drug can have side effects, but some are safer than others.
There are two primary ways that medications work to treat migraine headaches.
Acute medications aim to treat symptoms of migraine headaches as they occur. Preventive medications reduce the risk of migraine headaches occurring in the first place.
This article will discuss the different types of migraine headache medications and their possible risks.
There are several medications for migraine headaches that do not require a prescription from a doctor.
Many of these analgesic medications are nonsteroidal anti-inflammatory drugs (NSAIDs). This means they also reduce inflammation, which may help with symptoms.
It is best to take these medications as the first signs of an episode occur. The medicines will take time to enter the bloodstream, and taking them as the headache worsens may mean that the person is in pain for longer.
When over-the-counter (OTC) medications do not work, a doctor may recommend stronger prescription drugs. There are several different types, including:
Triptans act on the symptoms of a migraine headache in its early stages. They will not stop the migraine headache, but they can help with symptoms, such as:
- light sensitivity
According to the National Headache Foundation, the Food and Drug Administration (FDA) approved triptans to treat moderate to severe migraines. Moderate to severe migraine are migraine headaches where the symptoms interfere with the ability to perform daily tasks.
Several triptan medications exist, such as:
- sumatriptan (Imitrex)
- zolmitriptan (Zomig)
- rizatriptan (Maxalt)
A person should take these drugs as soon as migraine symptoms start. They may not work if taken during a migraine aura. They are available as a pill, orally disintegrating tablet, nasal spray, or injection.
The American Migraine Foundation point out that while doctors do not commonly prescribe ergot alkaloids, a doctor may recommend them if someone does not respond to other analgesics.
The two main types of ergot alkaloids are dihydroergotamine (DHE) and ergotamine (Ergomar). They can help to treat symptoms in severe cases, where other drugs have not worked.
However, ergot alkaloids may cause blood vessels to narrow, which can have serious side effects.
Antinausea medications, also known as antiemetic drugs, can help people with migraine headaches, even if they do not feel nauseous. Antiemetics do not reduce pain, so some people take them alongside pain relief medication.
Examples of antinausea drugs include:
- chlorpromazine (Thorazine)
- metoclopramide (Reglan)
- prochlorperazine (Compazine)
- promethazine (Phenergan)
CGRP receptor antagonists
The FDA have recently approved several drugs that block calcitonin gene-related peptide (CGRP) receptors. CGRP is a molecule typically involved in migraine episodes.
Doctors may recommend OnabotulinumtoxinA (Botox) for people with chronic migraine headaches. According to the Journal of Headache and Pain, a doctor might prescribe Botox if a person has experienced at least 15 headaches per month for 3 months — eight of these headaches must have included migraine symptoms.
Doctors tend to recommend two or three other types of medication before Botox.
Botox comes as an injection and can have many side effects. Doctors monitor progress carefully and may stop the treatment if there is no response after 8–12 weeks.
Doctors may also stop treatment if migraine episodes fall to less than 10 per month, for 3 months.
Some people experience migraine headaches after certain triggers. Identifying what these triggers are can help to reduce the episodes of migraine without medication.
Examples of migraine triggers can include:
- certain drinks, such as red wine or coffee
- strong stimulation of the senses, such as loud noises or flashing lights
- certain foods, such as cheese or smoked fish
Triggers for a migraine will differ from person to person. It can be helpful to keep a diary of when a migraine occurs to work out what the triggers might be.
Migraine headaches can cause oversensitivity to light. Some people find it helpful to lie down in a darkened room during an episode. An icepack on the head might also reduce some pain.
It is better to avoid taking most migraine medications while pregnant or breastfeeding. For moderate to severe migraine, a person should talk to their doctor to discuss the safest treatment options.
The Migraine Trust indicate that migraine headaches often reduce during pregnancy.
For people who get migraine headaches regularly, some medications can help to reduce the number and severity of episodes. The American Migraine Foundation list four categories of these medications, including:
Antihypertensive drugs lower blood pressure, usually in people with high blood pressure. There are many types of antihypertensive drugs that might help to prevent migraine headaches, such as:
Anticonvulsant drugs treat seizures in people with epilepsy. They work by reducing activity in the brain, which can reduce the risk of a migraine headache.
Examples of anticonvulsants for treating migraines include topiramate (Topamax) or valproic acid (Depakene).
Antidepressants often work to increase the availability of serotonin in the brain. Some of these drugs could also help to prevent migraine headaches, such as amitriptyline (Elavil).
4. CGRP inhibitors
The FDA recently approved erenumab (Aimovig) for preventing migraine headaches. It blocks the activity of calcitonin gene-related peptide (CGRP), which is a molecule typically involved in migraine episodes.
Other CGRP inhibitors include galcanezumab (Emgality) and remanezumab (Ajovy).
In 2020, the FDA approved the use of eeptinezumab-jjmr (VYEPTI) for migraine prevention in adults. Treatment with this medication would involve a doctor administering this drug intravenously for 30 minutes every 3 months.
The Cefaly transcutaneous electrical nerve stimulation device is a relatively new form of preventive treatment for migraine. The device uses an electrical current to stimulate the trigeminal nerve, which is involved in migraine.
Early research suggests that the device may help reduce the number of days that people experience a migraine.
According to the American Migraine Foundation, the device is currently available on prescription.
SPG nerve block
The sphenopalatine ganglion (SPG) is a group of nerve cells linked to the trigeminal nerve. Applying local anesthetics to this group of nerve cells can reduce sensations of pain related to migraines.
Doctors can apply medication to this area through the use of small tubes called catheters. They can place these tubes inside the person’s nose, then insert numbing medication through the tube using a syringe.
The risks associated with using OTC analgesics are relatively low. However, they may cause mild side effects in some people, such as rashes.
Triptans can cause side effects that include:
- nausea and vomiting
- pain in the throat, chest, or head
- dry mouth
- burning or prickly feeling on the skin
- hot flashes
Other prescription medications for treating migraines have more risks. For example, ergot alkaloids can cause vision problems, confusion, and unconsciousness. This is why doctors avoid using ergot alkaloids where possible.
Botox can also have many possible side effects, such as numbness or mild nausea. Some of the side effects of Botox are more serious, such as gallbladder dysfunction, visual problems, and bleeding.
Most drugs for preventing migraine headaches are relatively low risk. However, they may cause side effects, such as constipation, muscle spasms, and cramps.
There are many possible drugs for treating migraine headaches. These broadly include medications for treating symptoms as they occur and those for preventing them from happening.
OTC medications for treating acute migraine headaches can work for many people. In moderate to severe cases, doctors may recommend prescription drugs, such as triptans. It is also possible to prevent migraine headaches with anticonvulsants.
All drugs have risks and side effects. OTC medications or triptans are generally safe for most people but can cause some side effects. Other drugs, such as Botox, have more severe side effects.