Migraine medications & treatments
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Do you have recurring headaches on one side of the head that can be described as a pulsing or throbbing pain that lasts for hours or even several days? Is it accompanied by nausea, vomiting, and sensitivity to light? Well, according to the American Migraine Foundation, you may be 1 of the estimated 39 million Americans, or 12% of the adult population who suffer from migraines.
What is a migraine?
A migraine is a common neurological disorder that affects 1 out of every 5 women and 1 out of every 15 men. The causes of migraines are not known but genetics are thought to play a big role. If one parent has a history of these types of headaches, their child has a 50% chance of getting them. If both parents experience migraines, the risk jumps to 75%. Imbalances in brain chemicals are also thought to be a contributing factor.
Other risk factors that can be migraine triggers include:
- Hormonal changes in women, which can be related to their menstrual cycle, menopause, birth control, or hormone replacement therapy
- Skipping meals
- Too much or not enough sleep
- Bright lights or flashing lights
- Loud noises
- Certain foods or drinks such as alcohol, aged cheeses, and chocolate
- Changes in weather or barometric pressure
- Overuse of medications
- Too much physical activity
There are several types of migraines which include:
- Migraine with aura (complicated migraine)
- Migraine without aura (common migraine)
- Migraine without head pain (silent migraine)
- Hemiplegic migraine (typically have temporary paralysis on one side of your body)
- Basilar migraine (migraine with brainstem aura, which can affect coordination, vision, and speech)
These different types of migraines can be classified as episodic or chronic. People with episodic migraine have 14 or fewer headache days per month. People with chronic migraine experience more than 15 headache days per month for three or more months.
How are migraines diagnosed?
If you have migraines or a family history of migraines, your health care professional will diagnose migraines based on your medical history and symptoms. They may also do a blood test, MRI, or CAT scan to rule out other possible causes of your headaches.
Symptoms of migraines will depend on which phases you experience. There are four different phases of migraines although you may not go through every phase when you have a migraine attack:
- Prodrome. This phase starts up to 24 hours before you get the migraine. You have early signs and symptoms, such as food cravings, unexplained mood changes, constipation, yawning, fluid retention, and increased urination.
- Aura. This phase can happen before or during a migraine. You might have visual disturbances such as seeing flashing or bright lights and blind spots. You may also have muscle weakness on one side of the body and difficulty speaking.
- Headache. This phase can last from 4 to 72 hours. It typically causes throbbing or pulsing pain, which is often on one side of your head. Some other symptoms you may have include nausea, vomiting, insomnia, neck pain, stiffness, and increased sensitivity to light, noise, and smell.
- Postdrome. This phase follows a migraine attack and can last a day or two. You can feel exhausted, weak, depressed, and confused. Migraines are more common in the morning; people often wake up with them. Some people have migraines at predictable times, such as before menstruation or on weekends following a stressful week of work.
What are some migraine treatment options?
There is no cure for migraines. The treatment of migraines is aimed at reducing the severity of symptoms, reducing the pain during a migraine attack, decreasing the frequency of your migraines, and preventing them from occurring.
The two main types of medications used to treat migraines are abortive or acute treatment and preventative treatment.
Abortive medications are taken during migraine attacks and are designed to relieve your headache pain. These meds are most effective when taken at the onset of your headache.
- Triptans. These prescription meds such as Imitrex (sumatriptan) and Zomig (zolmitriptan) come in tablets, nasal sprays, and injections. They treat migraines by constricting the blood vessels around the brain. This reverses the painful dilation of blood vessels during a migraine attack. Triptans should not be used by those at risk of a stroke or heart attack.
- Ergotamines. These prescription meds such as Migranal/DHE 45 (dihydroergotamine) are available in tablets, nasal sprays, and injections. They work by narrowing the blood vessels as well as reducing inflammation. Ergotamines should not be used by anyone with heart disease or high blood pressure.
- Pain relievers. These over-the-counter and prescription meds include Aleve (naproxen sodium) and Excedrin Migraine (acetaminophen, aspirin, caffeine). If you take these analgesics more than a couple of days a week, they can trigger medication overuse headaches or rebound headaches.
Preventive medications won’t stop every headache but will greatly reduce how often you get a migraine, how severe the attacks are, and how long they last.
- Blood pressure medications. These include beta-blockers such as propranolol (Inderal, InnoPran XL, others) and metoprolol tartrate (Lopressor). Calcium channel blockers such as verapamil (Verelan) can help prevent migraines with aura.
- CGRP monoclonal antibodies. These newer medications include Aimovig (erenumab), Ajovy (fremanezumab), and Emgality (galcanezumab). They are injected under the skin monthly or every 3 months.
- Antidepressants. These prescription meds include Elavil (amitriptyline) and Effexor XR (venlafaxine).
- Anticonvulsants. Depakote (divalproex sodium) and Topamax (topiramate) are commonly used as a prevention of migraines. They should not be taken if you are pregnant or are trying to get pregnant.
- Botox. Under the NICE guidelines, botulinum toxin type A should be given by injection to between 31 and 39 sites around the head and back of the neck every 12 weeks.
If these medications do not help prevent migraines, you may want to consider acupuncture. There is evidence that acupuncture reduces the frequency of headaches and that the effect may be similar to that observed with preventive medications. A course of up to 10 sessions over a 5- to 8-week period may be beneficial.
What is the best medication for migraine?
The best medication for migraine will depend on the individual’s medical condition, medical history, medications that the individual is already taking that may potentially interact with migraine medications, and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare provider about the best medication for you. The table below includes a list of the most prescribed or over-the-counter migraine medications approved by the Food and Drug Administration (FDA).
Best medications for migraine
|Drug name||Drug class||Administration route||Standard dosage||Common side effects|
|Aimovig (erenumab)||CGRP antagonist||Injection||70mg to 140mg under the skin once monthly.||Injection site pain, constipation, cramps|
|Ajovy (fremanezumab)||CGRP antagonist||Injection||225mg under the skin once monthly or 675mg every 3 months.||Injection site pain, constipation, cramps|
|Emgality (galcanezumab)||CGRP antagonist||Injection||240mg under the skin for 1 dose, then 120mg once monthly.||Injection site reactions|
|Vyepti (eptinezumab-jjmr)||CGRP antagonist||Injection||100mg intravenously (IV) every 3 months.||Stuffy nose, runny nose, sore throat, injection site reactions|
|Ubrelvy (ubrogepant)||CGRP antagonist||Oral||50-100mg for acute migraine. May take a second dose at least 2 hrs after the initial dose for a max of 200mg/24 hrs.||Nausea, drowsiness, dry mouth|
|Nurtec ODT (rimegepant)||CGRP antagonist||Oral||75mg as needed. Max of 1 dose per 24 hours.||Nausea, rash, hypersensitivity|
|Amerge (naratriptan)||Serotonin 5-HT receptor antagonist (Triptan)||Oral||1mg to 2.5mg at the onset of headache; may repeat once after 4 hours. Max of 5mg/day.||Dizziness, drowsiness, fatigue, nausea|
|Frova (frovatriptan)||Triptan||Oral||2.5mg at the onset of headache; may repeat after 2 hours. Max of 7.5mg/day.||Dizziness, chest pain, fatigue, dry mouth, nausea|
|Imitrex (sumatriptan)||Triptan||Oral, injection||Max 200mg oral per day; 12mg under the skin per day||Injection site reactions, dizziness, tingling, warm/hot sensation, chest tightness|
|Onzetra Xsail (sumatriptan)||Triptan||Nasal spray||5mg to 20mg via nasal spray in 1 nostril. May repeat once after 2hrs if needed. Max of 40mg per day.||Bad/unusual taste, nausea, vomiting, nasal cavity discomfort|
|Treximet (sumatriptan)||Triptan/NSAID||Oral||85mg/500mg at the onset of headache; may repeat in 2hrs if needed. Max of 2 tablets per 24hrs.||Dizziness, tingling, nausea, vomiting|
|Maxalt (rizatriptan benzoate)||Triptan||Oral||5mg to 10mg at the onset of headache; may repeat dose after 2 hours. Max of 30mg/24 hrs||Drowsiness, dizziness, fatigue, nausea, dry mouth|
|Relpax (eletriptan hydrobromide)||Triptan||Oral||20mg to 40mg at the onset of headache; may repeat the dose in 2 hours. Max of 80mg/day||Drowsiness, dizziness, nausea, chest pain|
|Zomig (zolmitriptan)||Triptan||Oral, nasal spray||2.5mg to 5mg at the onset of headache; may repeat in 2 hours. Max of 10mg/24hrs||Dizziness, neck/throat/jaw pain, nausea, tingling, drowsiness|
|Trokendi XR (topiramate)||Anticonvulsant||Oral||Titrate over 4 weeks up to 100mg/day.||Decrease in sodium bicarb, dizziness, fatigue, reduced appetite, tingling, confusion|
|Depakote ER (divalproex sodium)||Anticonvulsant||Oral||250mg to 1000mg daily.||Nausea, headache, muscle weakness, confusion, drowsiness|
|Reyvow (lasmiditan)||Serotonin 5-HT1 agonist||Oral||50mg to 200mg as needed. Max of 1 dose per 24 hours.||Dizziness, drowsiness, fatigue, nausea, vomiting, muscle weakness|
|Innopran XL (propranolol)||Beta-blocker||Oral||80mg to 240mg per day divided every 6 to 8 hours.||Fatigue, low heart rate, hyper/hypoglycemia, nausea|
|Inderal LA||Beta-blocker||Oral||80mg to 240mg per day.||Fatigue, low heart rate, hyper/hypoglycemia, nausea|
|Migranal (dihydroergotamine)||Ergot alkaloid||Nasal spray||Max of 2 to 4 sprays per day separated by 15 to 30 minutes and 8 sprays per week.||Stuffy nose, nausea, altered taste, vomiting|
|Trudhesa (dihydroergotamine)||Ergot alkaloid||Nasal spray||Max of 2 to 4 sprays per day separated by 1 hour and 6 sprays per week.||Stuffy nose, nausea, altered taste, vomiting|
|Botox (onabotulinumtoxinA)||Botulinum toxin||Injection||A total dose of 155 units as IM injections divided across 7 head/neck muscles every 12 weeks.||Headache, neck pain, muscle stiffness|
|Elavil (amitriptyline)||Tricyclic antidepressant||Oral||10mg to 400mg at bedtime for migraine prevention.||Drowsiness, dry mouth, nausea, insomnia|
|Motrin/Advil (ibuprofen)||NSAID||Oral||OTC: 200mg to 400mg every 4 to 6 hours as needed. Max of 1200mg/day.|
Rx: 400mg to 800mg every 6 hours as needed. Max of 3200mg/day.
|Stomach pain, dizziness, heartburn, constipation, nausea|
|Aleve (naproxen sodium)||NSAID||Oral||750mg initially; may give 250mg to 500mg if needed. Max of 1250mg in 24 hours.||Abdominal pain, drowsiness, dizziness, heartburn, nausea|
|Excedrin Migraine (acetaminophen, aspirin, caffeine)||Pain reliever||Oral||1 to 2 tablets or capsules every 4 to 6 hours. Check individual products for specific dosages.||Nausea, stomach pain, insomnia, increased heart rate|
Your healthcare provider will determine the right dosage for you based on your response to the treatment, medical condition, weight, and age. Other possible side effects may exist; this is not a complete list.
What are the most common side effects of migraine medications?
As with all medicines, those used for migraine will have some side effects, depending on the class you are taking.
CGRP monoclonal antibodies side effects include:
- Injection site reactions
- Dry mouth
- Tingling or ”pins and needles” sensation
- Upper respiratory infections
Beta-blockers side effects include:
- Low blood pressure
- Cold hands or feet
Anticonvulsants side effects include:
- Tingling or burning sensations
Triptans side effects include:
- Dry mouth
- Injection site reactions
- Tingling, burning, or “pins and needles” sensation
- Chest pain or tightness
Ergot alkaloids side effects include:
- Stuffy nose
- Altered taste
- Stomach pain
Antidepressants side effects include:
- Dry mouth
- Decreased sex drive
What are some home remedies for migraine?
Home remedies will not prevent or decrease the number of migraines you have but can help relieve some of your symptoms. These include:
- Rest with your eyes closed in a quiet dark room.
- Use a cool cloth or ice on your forehead or neck.
- Stay hydrated.
There are also lifestyle changes that may help prevent migraines:
- Avoid triggers that cause your migraines
- Managing stress using relaxation techniques, yoga, and meditation
- Regular exercise
- Set a regular sleep routine
- Eat healthy meals
- Don’t skip meals
- Vitamins and supplements such as magnesium, vitamin B2 (riboflavin), and butterbur can help reduce the frequency and intensity of migraine.
Frequently asked questions about migraine
Is my headache a migraine?
Migraines are the most common type of headache but not all headaches are migraines. Migraines typically occur on one side of your head and can last up to 72 hours. The pain associated with a migraine is usually described as throbbing or pulsing. You might also experience nausea, vomiting, and sensitivity to light and/or sound.
Will my migraines get better or go away with time?
Although not typical, one-third of women will see their migraines disappear or drastically improve after menopause. Some men also see a decreased frequency when they reach their 50s or 60s.
Are migraines deadly?
Migraines are not typically life-threatening. However, some types can increase your risk of stroke. This will further be increased if you have other risk factors for stroke such as smoking, high blood pressure, and high cholesterol.
When should I see a doctor for my migraines?
You should see a doctor if:
- Your headaches interfere with your job, family, or school.
- OTC meds are no longer relieving the pain or you are taking them more than a couple of days a week.
- Your headaches are becoming more frequent or severe.
- Headaches that first develop after age 50
- If you see changes in your personality or mental function
Related resources for migraine
- What is migraine? American Migraine Foundation
- Migraine: Symptoms and Causes. MayoClinic
- Migraine Headaches. Cleveland Clinic
- What is migraine? WebMD
- Migraine overview. NHS
- Acupuncture and migraine: Finding a combination that sticks. American Migraine Foundation