Common Migraine Medications and Treatments

When you struggle with migraines whether they’re chronic migraines or not, there are a wide variety of medications that might be used. The type of medication you use can vary depending on the type of migraines you have, your health history, and what you’ve previously tried among other factors. Common migraine medications include over-the-counter and prescription options.

There are also migraine medications that are preventative and others that are taken when the migraine is starting or is occurring for acute relief. Along with medications for migraines specifically, there are some treatments that are for symptoms that occur along with migraines such as nausea.

The following covers some of the most common types of migraine medications and what they do for migraine patients. The list isn’t exhaustive, but it does cover the more frequently used medications for migraines and common symptoms associated with migraines.

What is a Migraine?

A migraine is a type of headache that is often accompanied by other symptoms such as nausea and sensitivity to light and sound. Contrary to what people may think, a migraine is more than a bad headache.

A migraine is actually a neurological disorder. Migraines create symptoms related to levels of chemicals in the brain and the nerve pathways in the brain.

Migraines often occur because of a combination of genetic and environmental factors.

Common features and symptoms of migraines include:

  • Attacks lasting anywhere from 4 to 72 hours
  • May occur on one side of the head, but sometimes on both
  • Can cause visual disturbances
  • Nausea and vomiting
  • Sensitivity to light, sound, touch, and smell
  • Numbness or tingling in the face or extremities

How Are Migraines Treated?

In the past, before more was known about migraines, the primary goal of medication and treatment was treating the pain. Now that researchers see migraines as a neurological disorder, medications for migraines attempt not just to address the pain, but the other symptoms and causes as well.

Acute Migraine Treatment and Preventative Migraine Treatment

The two broadest categories of migraine medications are acute treatment and preventative treatment.

For many people, treating migraines requires a combination of both types of medicines.

Acute migraine treatment is one that works to reverse or stop symptoms of a migraine that are already occurring.

Preventative medication is one that is intended to help reduce how often someone has migraine attacks and how severe the symptoms are. Preventative medications are long-term treatments almost always taken daily.

The Goals of Acute Migraine Treatments

The goals of acute migraine medications and treatments are different from preventative and long-term treatments. According to the U.S. Headache Consortium, the goals of acute or as-needed migraine treatments include:

  • To quickly treat migraine attacks and provide pain relief
  • Help someone experiencing a migraine attack function better
  • Reduce the need for other types of back-up medications
  • Help promote self-care
  • Minimize side effects of migraine attacks

The Goals of Preventative Migraine Treatments

The goals of preventative migraine treatments according to the U.S. Headache Consortium include:

  • To reduce migraine severity and how frequently they occur
  • Reduce disability
  • Improve quality of life
  • Prevent headaches
  • Avoid the need for escalating use of migraine medications
  • Help patients more effectively manage their migraine disorder

What Are the Different Types of Migraine Treatments?

Along with breaking migraine treatments into the categories of acute and preventative, there are other ways to group them as well. The three primary types of migraine treatments are over-the-counter migraine medication, prescription medicines for migraines, and natural treatments for migraines.

Over-the-Counter Medications for Migraines

There are different over-the-counter medications for migraines, some of which are more potent than others. There are reasons a person might prefer OTC migraine medicine over prescription options, including the fact they are typically less expensive and have fewer side effects.

Acetaminophen

Acetaminophen is a pain reliever that people may use for migraines and other types of headaches. It’s a generic drug found in brand-names like Tylenol. The following are some important things to know about using acetaminophen for a migraine:

  • Acetaminophen, when combined with an anti-nausea medicine, can be an extremely effective headache treatment
  • Acetaminophen on its own is excellent for treating tension headaches, but not necessarily migraines
  • This OTC migraine medicine works by reducing pain (and also fever) by reducing chemicals called prostaglandins
  • Acetaminophen tends to be very well-tolerated by most people, making it a good option for someone who can’t take nonsteroidal anti-inflammatories (NSAIDs)
  • While acetaminophen is a commonly used OTC pain medication, one of the biggest risks is liver damage
  • No one should take more than 4000 mg of acetaminophen in a day or use it with alcohol
  • You can’t use acetaminophen if you have liver damage
  • Too much acetaminophen can cause liver or kidney damage and can be deadly

Ibuprofen

Ibuprofen is the generic name of an OTC pain reliever found in brand-name medications like Advil and Motrin. Ibuprofen can be useful for treating tension headaches and migraines ranging in severity from mild to moderate.

The following are some of the things to know about this OTC migraine medication:

  • Ibuprofen may be somewhat more effective than acetaminophen for relieving headache pain
  • Since ibuprofen is an NSAID, it also reduces inflammation
  • The maximum dose of ibuprofen is meant to be no more than 1200 mg a day
  • Ibuprofen can cause stomach problems and can increase bleeding
  • Someone with a history of stomach bleeding, or kidney or heart disease shouldn’t use ibuprofen

Naproxen

Naproxen is also an NSAID like ibuprofen. It works in mostly the same ways and has the same risks and potential side effects. When naproxen is used with sumatriptan, which is a prescription migraine medicine, it can be helpful for refractory migraines. It may also allow the user to take a lower dose of the sumatriptan than they would if they took that alone.

Naproxen is found in brand-name, OTC pain medicines like Aleve.

Aspirin

Aspirin is one of the most commonly used NSAIDs. It has pain relieving characteristics, and it’s also an anti-inflammatory and a blood thinner.

While aspirin, which is in several brand-name OTC medicines, may be effective at helping reduce migraines and tension headaches, it can also cause other side effects. The following are some things to know about aspirin:

  • Aspirin is more likely to cause bleeding than other NSAIDs
  • Other side effects can include ringing in the ears or a rash
  • Aspirin can lead to a severe allergic reaction in some users
  • Aspirin shouldn’t be used with other NSAIDs unless a doctor specifically instructs a patient to

Excedrin

Excedrin is a brand-name, prescription medication often used by people who struggle with different types of headaches and migraines. There are four different types of Excedrin, including Excedrin and Excedrin Extra Strength.

The following are some things to know about Excedrin for migraines:

  • Excedrin contains a combination of acetaminophen, aspirin, and caffeine
  • Caffeine is included in Excedrin to help narrow blood vessels in the brain
  • Specific formulations are: Excedrin Migraine, Excedrin Extra Strength, Excedrin Tension Headache and Excedrin PM Headache
  • There are side effects including upset stomach, dizziness, and nervousness

Prescription Migraine Medications for Acute Symptom Relief

Prescription migraine medications can fall into one of two categories, as was touched on. They are either acute, abortive migraine medications or they are preventative migraine medications.

Acute Migraine Medications

Acute migraine medications are taken when symptoms begin. A prescription acute migraine medicine is meant to help stop an attack and provide relief from symptoms right away.

Acute migraine medications should be taken ideally as soon as someone feels a migraine could be coming and before it reaches its full strength and severity.

Triptans

Triptans are a type of prescription medication for migraines that are agonists of certain serotonin receptor sites. The following are facts about triptans:

  • Triptans are most often used for the acute treatment of migraines ranging from moderate to severe
  • Triptans are available in many different forms including oral medications, nasal sprays, injections, and transdermal patches
  • Triptans bind to serotonin receptors and reduce the swelling of blood vessels
  • Sometimes these prescription medications for migraines are combined with something else like an NSAID
  • Triptans can reduce pain in around two hours, but they don’t prevent migraines

DHE 45

DHE 45 is a brand-name injectable prescription migraine drug. The generic name is dihydroergotamine mesylate. This acute migraine medicine can be used to treat migraines with or without aura and cluster headaches. Things to know about this injection migraine medicine include:

  • DHE 45 is believed to constrict blood vessels in the brain to provide migraine symptom relief
  • DHE 45 may also prevent inflammatory chemicals from being released in the brain
  • This prescription medicine for migraines has a black box warning from the FDA because it can cause something called peripheral ischemia, which is insufficient blood flow to the arms and legs and the condition can be deadly
  • Other serious possible side effects include rapid heart rate, stroke or ergotism which is a type of poisoning

Ergotamine

Ergotamine is a generic drug sold under the trade name Ergomar. This drug constricts blood vessels in the brain to help reduce pain. This prescription migraine drug isn’t a pain reliever, and it has side effects that aren’t desirable, so it’s not a favorite among most doctors when it comes to prescribing treatments for migraine headaches. There are other brand names for ergotamine and many of the available brand names include caffeine. Side effects can include:

  • Extreme constriction of vessels that block blood flow and can lead to stroke or gangrene
  • High blood pressure
  • Irregular heartbeat
  • Nausea and vomiting
  • Dizziness
  • Weakness
  • Potential allergic reactions

Opioid (Narcotic) Pain Medications

Opioid medications are also known as narcotics, and these are especially controversial ways to treat migraines. Opioids like codeine may be prescribed to a patient who can’t use other medications or for whom they aren’t effective. Opioids are highly addictive, however. Narcotics can also lead to overdose. Some of the opioids that might be given for migraine headache relief can include:

  • Codeine
  • Hydrocodone
  • Meperidine
  • Oxycodone
  • Hydromorphone
  • Butorphanol
  • Tramadol

Nasal Spray

Nasal sprays can work to alleviate migraine headache pain because they’re absorbed into the blood vessels found inside the nose. Nasal sprays often work quickly to relieve pain, and they are helpful for people who have nausea and vomiting with migraines because they don’t have to be taken orally.

There are different types of nasal spray medicines for migraines which include:

  • Nasal triptans which narrow blood vessels
  • Nasal DHE which is a type of ergotamine
  • Nasal ketorolac which is an NSAID that helps prevent pain

Preventative Migraine Medications

Preventative medications are usually taken daily, and they are meant to help reduce how often people have migraine attacks and how severe those attacks are. There are more than 100 migraine medications and supplements geared toward prevention. All of these were originally formulated for other conditions.

Currently, only four medicines are FDA-approved for the prevention of migraines and others that may be prescribed to a patient are done so off-label. The FDA-approved migraine prevention medications are:

  • Divalproex Sodium available in brand names Depakote and Depakote ER is an anticonvulsant medication originally used for the treatment of seizures.
  • Propranolol which is available under the brand names Inderal and Inderal LA is a beta blocker that was intended to be used for the treatment of hypertension and heart disease.
  • Timolol is also a beta blocker available under the brand name Blocadren.
  • Topiramate is the generic name for Topamax which is classified as a neuronal stabilizing agent and is also used to treat seizure disorders.

Off-Label Migraine Prescription Medications

Other migraine medications may be prescribed off-label to prevent attacks. Off-label means the use isn’t approved by the FDA for that specific purpose. The medications that are off-label migraine medications include the following:

  • Antihistamines
  • Antihypertensive medications used to help with blood pressure. These include ACE inhibitors, alpha-2 antagonists like clonidine, beta blockers, and calcium channel blockers.
  • Antidepressants including MAOIs, SNRIs, SSRIs, and tricyclic antidepressants
  • Cox-2 enzyme inhibitors like Celebrex
  • Muscle relaxants
  • Neuronal stabilizing agents which are anticonvulsants
  • Leukotriene blockers
  • ADD medications like Adderall and Strattera
  • Dementia medications

Also, certain dietary supplements may be used to help prevent migraines including Coenzyme Q10, vitamin B2, and magnesium.

Summing Up—Migraine Medications

The above list includes common migraine medications such as migraine medications that are OTC, prescription migraine medications and migraine prevention medications. If you have specific questions about your migraines or your treatment needs, see your health care provider.

Sources

American Migraine Foundation. “Preventative Treatments.” Accessed February 26, 2019.

Migraine.com. “OTC Medicine.” Accessed February 26, 2019.

Doherty, Colleen MD. “Medications for Treating Migraine Headaches.” Verywell Health. January 29, 2019. Accessed February 26, 2019.

Robert, Teri. “Over-the-Counter Meds for Migraine or Tension Headaches.” Verywell Health. February 15, 2019. Accessed February 26, 2019.

WebMd. “Migraine Headache Treatment.” Accessed February 26, 2019.

Robert, Teri. “Migraine Preventative, Abortive and Rescue Medications.” Migraine.com. August 4, 2013. Accessed February 26, 2019.