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.

If you experience severe headaches, it is best to talk about your symptoms with your healthcare provider. They will evaluate your medical and headache history to determine if the headaches you are experiencing are migraines. If they are determined to be migraines, 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. Using this information, your healthcare provider can work with you to establish a preventive and treatment plan that works best for you.

Some migraine medications are specifically intended to alleviate the pain of a migraine as it occurs. 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:

1. Over-the-counter migraine 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 discuss your symptoms with your healthcare provider before using them to treat migraine pain. That’s because these drugs can cause side effects and interactions in some people.

Some prescription and over-the-counter migraine medicines can lead to medication overuse headaches, known as “rebound headaches.” As a result, your healthcare provider may recommend you use caution when taking them. Also, people with certain health conditions, such as kidney, gastrointestinal or cardiovascular issues, may be advised to avoid specific medications as they may worsen the condition.

2. Prescription medications

Healthcare providers may prescribe medication for migraines in some cases, including:

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 healthcare provider can evaluate whether a triptan is appropriate for you. For example, 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. However, this medication may cause drowsiness and other sedative-like side effects. This makes it unsafe to drive or operate heavy machinery for eight hours after taking the medication.

CGRP antagonists: A newer migraine treatment option, CGRP antagonists alleviate migraine pain, as well as nausea, sensitivity to light and other symptoms associated with migraines. These drugs typically take approximately two hours to take effect. 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 on a limited basis for chronic, severe refractory migraine treatment. This is a last resort due to the risk of dependence and the limitation to select clinical scenarios.

Migraines can cause a variety of symptoms beyond pain, so healthcare providers may prescribe more than one medication 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 regular basis to reduce the frequency of migraine attacks. Some drugs that may be prescribed for preventing migraines include:

1. Blood pressure medications: Some medications 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 medications may cause side effects, such as weight gain, fatigue and coldness of the hands and feet.

2. Antidepressants: Some medications used to treat symptoms of depression have been shown to also reduce the frequency of migraines in 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.

3. 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 medications include nausea and dizziness. Valproate may also cause weight gain.

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

5. 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. Side effects can include occasional nausea or constipation. These medications require less frequent dosing and may be more convenient than medications that require a daily pill.

6. Injection medications for sudden-onset migraines: Some people can experience sudden 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:

7. Sumatriptan: This triptan medication is available as an injection as well as a nasal spray and an oral drug.

8. Dihydroergotamine: This medication is usually prescribed for migraines that last 24 hours or more. It’s available as a nasal spray or an injection.

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

1. 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, so it’s important to find effective ways to manage stress at home and work. Deep-breathing exercises, yoga and mindful meditation may be beneficial for 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 a consistent wake time.
• Stay hydrated: Ask your healthcare provider how much fluid you should be taking in. 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, it’s important to discuss any new exercise routine with your healthcare provider before you begin.

2. Keep a headache journal

Many people who suffer from migraines may experience migraine attacks in response to triggers like certain foods or beverages, strong smells or changes in the weather. Identifying your specific triggers can allow you to adjust your diet or lifestyle to help avoid migraines. Write down your schedule, diet and activities every day, and keep track of migraine symptoms. Share the information with your healthcare 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 and actively relieve tension and stress in your body. Another option is cognitive behavioral therapy (CBT), which focuses on helping you understand how your behaviors and thoughts may impact your headache pain. CBT then focuses on developing coping strategies to better manage symptoms.

Talking to your healthcare provider about how your migraines are affecting your quality of life is an important step toward developing the best care plan for you. If you don’t have an official diagnosis, your healthcare provider can conduct tests and an examination to rule out other possible causes of your symptoms. They can 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 healthcare provider can reassess your treatment plan and make changes to better manage your symptoms.

Updated by Rebeca Thomas, RN, BSN, April 2025.