Medications for Treating Migraine Headaches

There are two main categories of drugs for managing migraine headaches: those taken to prevent them from happening and those used for the acute treatment of a migraine that's already underway. Healthcare providers often refer to the latter as "abortive" medications.

Under the umbrella of abortive migraine treatments are drugs ranging from over-the-counter (OTC) analgesics (painkillers) to prescription medications that treat not only the headache but also other migraine symptoms.

Finding what works best for you can take some time and requires the guidance of your healthcare provider.

Over-the-Counter Medications

For most people who experience migraines, the first line of defense against an impending headache is an over-the-counter (OTC) analgesic. There are two classes of non-prescription painkillers: acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs).

Acetaminophen

This medication works by blocking chemical messengers that help transmit pain signals to the brain. There are dozens of brand names for acetaminophen, with the most common being Tylenol. There are also many generic and store brand versions available.

It's important to never mix acetaminophen with alcohol and to talk to your healthcare provider if you are also taking any other medications, as drug interactions can occur. When not taken properly, acetaminophen has been found to cause liver damage in some people.

NSAIDs

NSAIDs relieve pain by decreasing the production of hormone-like compounds called prostaglandins that send pain messages to the brain. They include:

• Aspirin (the most common brand is Bayer)
• Advil, Motrin (ibuprofen)
• Aleve (naproxen)

NSAIDs are associated with stomach pain and gastrointestinal bleeding. In addition, aspirin is linked to a potentially fatal condition in children called Reye's syndrome, so it should not be prescribed for kids under 19.

Prescription Analgesics

For some people, an OTC pain medication isn't potent enough to bring relief. Stronger versions of both acetaminophen and NSAIDs are available by prescription. In addition, an NSAID called Cambia (diclofenac) is often effective. Cambia comes as a powder that's mixed with water.

Other prescription NSAIDs that have been studied for treating migraine are:

• Diclofenac epolamine
• Ketorolac
• Celecoxib

Triptans

Triptans are a class of prescription medication often used to stop a migraine attack that's already underway from getting worse. They also are used to help prevent migraines in people who menstruate who tend to get them when they have their periods (a.k.a. menstrual migraines).

Triptans are most effective for moderate to severe migraines and work best when taken at the earliest sign of an impending attack.

These drugs fend off pain and also help to alleviate nausea and sensitivity to light and sound, which are common symptoms of migraine attacks. They do this by stimulating receptors for the neurotransmitter (brain chemical) serotonin, thereby reducing the inflammatory cascade that leads to migraine. Triptans also may lower levels of a protein called calcitonin gene-related peptide (cGRP), which is elevated during migraine attacks.

Available Options

There are seven triptans available for the acute treatment of migraine headaches. Unless otherwise noted, they're available only as tablets. They are:

• Axert (almotriptan)
• Relpax (eletriptan)
• Frova (frovatriptan)
• Amerge (naratriptan)
• Maxalt, Maxalt-MLT (rizatriptan), which comes as a tablet or as a wafer that melts on the tongue
• Imitrex (sumatriptan), which is available as a tablet, nasal spray, or subcutaneous (under-the-skin) injection
• Zomig (zolmitriptan), available as a tablet, nasal spray, or wafer

In addition to these single-ingredient triptans, there is a medication called Treximet that combines sumatriptan with the NSAID naproxen.

As with any medication, triptans have potential side effects. The most common ones include nausea, paresthesias, fatigue, and chest or throat tightness. People who have heart disease or high blood pressure that isn't under control shouldn't take triptans, since the drugs can cause constriction of blood vessels.

Lasmiditan (Reyvow)

Lasmiditan, currently sold under the brand name Reyvow, is a prescription medication approved for the acute treatment of migraines with or without aura in adults. Similar to the triptans, lasmiditan can block a number of the processes that lead to the development of a full-blown headache by stimulating serotonin (5 HT) - but this medication is different in that it does not bond to cardiac arteries. This means lasmiditan does not cause blood vessels to narrow and is therefore safer for use in patients with cardiac issues.

Dihydroergotamine

Dihydroergotamine, which is available as D.H.E. 45 or Migranal, is in a class of drugs known as ergot alkaloids. It provides pain relief by inducing vasoconstriction (narrowing of blood vessels in the brain), and inhibiting the release of cGRP, thereby reducing inflammation.

Dihydroergotamine is formulated in a way that makes it more tolerable for people who are prone to the nausea and vomiting that can sometimes accompany other medications. It is taken as a subcutaneous injection, usually in the thigh, or as a nasal spray.

The most common side effects of this medication include upset stomach, dizziness, weakness, and fatigue; the nasal spray can cause a stuffy or dry nose, tingling or pain in the nose or throat, and nosebleed.

Some unusual but potentially serious problems associated with dihydroergotamine require immediate medical attention: numbness, tingling, or changes in the color of your fingers or toes; muscle pain or weakness; chest pain; changes in heart rate; and swelling, itching, dizziness, or faintness.

You should not take dihydroergotamine if you are taking a triptan, have poorly controlled blood pressure and/or heart disease, or you're pregnant.

Antiemetics

Many people who have migraines are plagued with nausea and vomiting along with head pain. Not only are these symptoms unpleasant, they can lead to dehydration and make it difficult to keep medication down. For this reason, drugs called antiemetics often are part of the pharmacologic arsenal for treating migraine.

Antiemetics are in a class of drugs called dopamine-receptor antagonists. Antiemetics may be prescribed for use at home and can be administered orally or rectally. In the ER they may be given intravenously or by injection into a muscle. These drugs include:

• Chlorpromazine
• Compro, Procomp (prochlorperazine)
• Haldol (haloperidol)
• Metoclopramide

Corticosteroids

Steroids can relieve pain from a migraine, and may also prevent a headache from coming back. This is important.

This research, which reviewed 25 studies in which corticosteroids were used to treat migraine headaches, found that when a patient received a single steroid shot as part of emergency treatment for migraine (usually along with a triptan), they were less likely to have another migraine within 72 hours.

What's more, headaches that did recur tended to be milder. Similarly, in research cited by the National Headache Foundation, an injection of dexamethasone given with a triptan reduced the recurrence of headache within 72 hours by 26%.

CGRP Antagonists

CGRP antagonists work by blocking the binding of CGRP to receptors in the brain, thereby minimizing vasodilation and neurogenic inflammation. Unlike other acute migraine medications, these drugs do not induce vasoconstriction, which means they may be a safer option for people who have increased cardiovascular risk.

The FDA has approved three CGRP antagonists for the acute treatment of migraine with or without aura:

• Nurtec ODT (rimegepant)
• Ubrelvy (ubrogepant)
• Zavzpret (zavegepant)

Nurtec ODT and Ubrelvy are taken by mouth in pill form, while Zavzpret is a nasal spray. In most cases, CGRP antagonists can relieve migraines as quickly as one hour after ingestion. The most common side effects include dizziness, sleepiness, numbness, and nausea.

Although rare, severe allergic reactions can occur. If you begin to develop symptoms of an allergic reaction, such as rashes, hives, or swelling in the face, tongue, throat, or lips, you should seek medical attention right away.

A Word From Verywell

There's no one-size-fits-all approach to treating migraine headaches. People respond differently to different types of medications, doses, and combinations of drugs—and there are many, many options. This can be overwhelming and frustrating, but trust that even if takes a bit of trial and error, you and your healthcare provider will hit upon an effective way to manage your migraines.