Migraine medication and tips for migraine relief

While there is no cure for migraines, it is possible to decrease the severity, frequency and duration of these headaches with a combination of medication and lifestyle changes. Here we examine the different types of medications you may be prescribed by your healthcare provider, as well as some tips to help prevent migraines or reduce their severity.

If you experience severe headaches, make an appointment with your medical provider, who will evaluate your medical and headache history to determine whether your headaches are migraines and, if so, whether a preventive or acute migraine medication, or both, may be appropriate.

Additionally, you may be asked to keep a detailed headache calendar to help pinpoint any triggers or situational factors that may contribute to your migraines. With this information, your medical provider will work with you to create a prevention and treatment plan. 

Some medications for migraines are specifically intended to alleviate the pain of a migraine during an attack. Known as acute migraine medications, these are taken at the first sign of symptoms. Typically, acute migraine medicine is more effective if taken within two hours of headache onset. The following are some over-the-counter and prescription acute migraine pain medications.

Healthcare providers often begin migraine treatment with over-the-counter migraine medications, such as:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin, ibuprofen or naproxen
• Acetaminophen
• Combination products that contain caffeine and acetaminophen or caffeine, aspirin and acetaminophen

Although you can purchase over-the-counter pain relievers without a prescription, you should still talk to your healthcare provider before using them to treat migraine pain, since these drugs can cause side effects and drug interactions in some people.

Some prescription and over-the-counter migraine medicines can cause medication overuse headaches, known as “rebound headaches,” so your provider will urge caution when taking them. People with certain health conditions, including kidney, gastrointestinal or cardiovascular issues may be advised to avoid specific medications as they may worsen their condition.

Triptans

For moderate to severe migraines, triptans may be more effective than over-the-counter medicine at alleviating pain. These drugs attach to receptors in the brain and constrict arteries that are vasodilated. These medications include:

• Sumatriptan (Imitrex)
• Rizatriptan (Maxalt)
• Zolmitriptan (Zomig)
• Almotriptan (Axert)
• Frovatriptan (Frova)
• Naratriptan (Amerge)
• Eletriptan (Relpax)

While these are common migraine-specific medications for acute migraine treatment, a medical professional will evaluate whether a triptan is appropriate. Triptans may not be appropriate for those with uncontrolled high blood pressure or vascular disease.

Lasmiditan

Sold under the brand name Reyvow, lasmiditan can relieve not only migraine headache pain but also some of the symptoms of migraine aura. The main downside to this drug is that it may cause drowsiness and other sedative-like side effects, making it unsafe to drive or operate heavy machinery for eight hours after taking it.

CGRP antagonists

A newer migraine treatment option, CGRP antagonists alleviate migraine pain, as well as nausea, sensitivity to light and other symptoms. These drugs typically take two hours to work, and they may cause side effects like drowsiness and dry mouth. The FDA has approved two oral CGRP antagonists for acute migraine treatment: ubrogepant (Ubrelvy) and rimegepant (Nurtec ODT).

Opioids

Rarely, opioids like hydrocodone or codeine may be considered for limited use for chronic, severe refractory migraine treatment. This is a last resort due to the risk of dependence, and it’s limited to select clinical scenarios.

Migraines can cause a variety of symptoms beyond pain, so medical providers may prescribe more than one medication for when a migraine attack begins. This combination of medications is sometimes called a migraine cocktail. What’s in a migraine cocktail varies, but it often includes an NSAID, a triptan and an anti-nausea drug like prochlorperazine or metoclopramide.

In addition to acute migraine headache medications, your migraine treatment plan may include other drugs that are taken on a scheduled basis to reduce the frequency of migraine attacks. Some drugs that may be prescribed for preventing migraines include:

Blood pressure medications

Some drugs used to treat hypertension have been shown to reduce the frequency of migraine attacks. These include:

• Propranolol (Inderal, InnoPran XL)
• Metoprolol tartrate (Lopressor)
• Verapamil (Verelan)

These drugs may cause side effects, such as weight gain, fatigue and coldness of the hands and feet.

Antidepressants

Some drugs used to treat symptoms of depression have been shown to also reduce the frequency of migraines for some people. Antidepressants used for migraine prevention include:

• Amitriptyline
• Nortriptyline
• Doxepin
• Duloxetine
• Venlafaxine

Some of these medications may cause drowsiness and shouldn’t be taken when you need to drive or operate heavy machinery.

Antiseizure drugs

Valproate and topiramate are two anticonvulsant medications that may reduce the frequency of migraine attacks if taken daily. Common side effects of these drugs include nausea and dizziness. Valproate may also cause weight gain.

Botox

Injections with Botox can be very successful for preventing migraines. Injections are administered by a trained medical provider every three months in sites around the face, head and neck.

CGRP antagonists

Aimovig, Emgality and Ajovy are injectables you administer yourself once a month or every three months. These medications decrease the severity and frequency of migraines. Occasional nausea or constipation are infrequent side effects. This category has the benefit of less frequent dosing rather than taking a daily pill.

Injection medications for sudden-onset migraines

Some people have sudden onset, severe migraine head pain or nausea and vomiting as a significant component of their migraine. In these cases, a migraine injection medication for acute migraine may be prescribed, such as:

• Sumatriptan: This triptan medication is available as an injection as well as a nasal spray and an oral drug.
• Dihydroergotamine: This medication is usually prescribed for migraines that last for 24 hours or more and is available as a nasal spray or an injection.

In addition to prescribing medication, your healthcare provider may recommend a few ways to help prevent or reduce the severity of migraines at home.

Self-care measures

Some tips for managing migraines at home include these self-care measures:

• Find relaxation techniques that work for you: Stress can trigger or worsen migraines, making it important that you find ways to relax, especially when you’re dealing with stress at home or work. Deep-breathing exercises, yoga and mindfulness meditation may benefit you. Enjoying hobbies and spending time with friends and family while engaging in activities you enjoy may also be beneficial.
• Develop a routine and stick to it: Changes in the amount of sleep you get and skipping meals may trigger a migraine attack. Create a daily schedule that includes regular meals, a set bedtime and an established wake time.
• Stay hydrated: Ask your medical provider what level of fluid intake is right for you, and strive to meet that goal daily by drinking water and other hydrating beverages.
• Exercise regularly: For many people, physical activity improves the outcome of migraine treatment. However, your medical provider should approve any new exercise program before you begin.

Keep a headache journal

Many migraine sufferers experience migraine attacks in response to triggers like certain foods or beverages, strong smells or changes in the weather. Identifying your specific triggers can give you an opportunity to alter your diet or lifestyle to avoid them. To do so, write down your schedule, diet and activities every day, and keep track of migraine symptoms. Share the information with your medical provider so they can help you identify patterns.

Mental health interventions may help improve migraine control in some people. One option is biofeedback, which teaches you how to detect tension and stress in your body and actively relieve it. Another option is cognitive behavioral therapy, or CBT, which focuses on helping you uncover how your behaviors and thoughts may impact your headache pain. CBT then focuses on developing coping strategies to better manage symptoms.

Anytime migraines affect your quality of life, see your medical provider. If you don't have an official diagnosis, your provider can conduct tests and an examination to rule out other possible causes of your symptoms and then develop a treatment plan tailored to your unique needs. In the event you are already being treated for migraines but they haven’t improved or they’ve gotten worse, your provider can reassess your treatment plan and make changes to better manage your symptoms.

Published January 2023.