An Overview of Medicine to Use for Migraine Treatment

Several medications help prevent and treat this headache disorder

ByMark Gurarie Mark Gurarie

Mark Gurarie is a freelance writer, editor, and adjunct lecturer of writing composition at George Washington University.

Learn about our editorial processPublished on October 14, 2021Medically reviewedVerywell Health articles are reviewed by board-certified physicians and healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more.byMary Choy, PharmD Medically reviewed byMary Choy, PharmD

Mary Choy, PharmD, is board-certified in geriatric pharmacotherapy. She currently serves as the director of pharmacy practice of the New York State Council of Health-System Pharmacists.

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Different types of medications are used to treat migraine headaches, depending on the level of pain you are experiencing. Some medicine can prevent migraines, while others treat current symptoms. Read more about the most common types of medicine used for migraine treatment.

What Is a Migraine?

Migraines are primary headache disorders, in which headaches arise independently of other illnesses or diseases. Lasting anywhere from four to 72 hours or more, migraine attacks are distinctive in that they cause a broader range of symptoms than just headaches.

Typically, migraine attacks come in phases, changing shape as they progress. Here’s a breakdown:

The frequency of migraine attacks can vary a great deal. However, people who experience 15 or more attacks a month are considered to have chronic migraine.

Causes of Migraine Headaches

Migraines are believed to arise from waves of increased activity in certain brain cells, which causes the release of the hormones serotonin and estrogen. As a result, blood vessels supplying the brain become narrowed, which leads to headache and the other symptoms.

While the exact reasons someone may develop migraines are unknown, several risk factors have been identified:

In addition, migraine attacks can be set off by triggers. Triggers can vary from person to person. The most common of these are:

In addition, other triggers include:

Medications Used to Prevent Migraines

Along with making certain lifestyle changes and working to prevent exposure to triggers, medications play a central role in migraine management. Broadly speaking, medicine for migraine can be divided into “prophylactic” medications that prevent and minimize attacks, and “abortive” medications, which manage symptoms after onset.

Several classes of drugs are prescribed as preventive migraine therapy; these are generally considered if migraines are occurring multiple times a month.

Among the most widely prescribed drugs for migraine are beta-blockers, which are also used for high blood pressure (hypertension), cardiac arrhythmia (irregular heartbeat), and other heart or circulation issues. Most common of these are Tenormin (atenolol), Inderal LA (propranolol), or Toprol XL (metoprolol), but there are many others.

Though effective, these can cause some side effects, including:

Another class of drugs used to prevent migraine are tricyclic antidepressants. Also used to treat depression and anxiety, Elavil (amitriptyline), Pamelor (nortriptyline), and Silenor (doxepin) are frequently considered options.

Common side effects of these medications include:

In addition, rare adverse effects are:

Typically used to treat seizures, antiepileptic drugs such as Depakote (valproic acid) and Topamax (topirimate) can help prevent migraine onset. As with other medications, antiepileptic use can lead to some side effects, including:

Guide to Anti-Epileptic Drugs

Calcium channel blockers are typically used to reduce blood pressure. However, they may also be considered for migraine, though evidence for efficacy is mixed. The calcium channel blocker verapamil, a generic or available as Calan or Veralan, is considered as an off-label treatment for this condition.

Adverse effects of this drug include:

A newer class of medication for migraine, calcitonin gene-related peptide (CGRP) monoclonal antibodies, like Vyepti (eptinezumab) and Ajovy (fremanezumab), have shown efficacy in reducing the frequency of monthly attacks. These medications are delivered via injection. While they are Food and Drug Administration (FDA) approved, they are still a relatively new treatment and research is ongoing.

An Overview of Medicine to Use for Migraine Treatment

Side effects are mild and rare with CGRP monoclonal antibodies, though use may cause irritation or infection at the site of injection. In addition, injections can cause a mild allergic reaction, leading to itchiness, hives, or a rash.

In particularly challenging chronic migraine cases—especially those in which other treatments haven’t yielded results—some doctors may recommend Botox injection. Basically, doctors inject a toxin made by the botulinum bacteria into specific nerves in your forehead, temples, neck, and head. This prevents their activity, reducing the prevalence and severity of attacks.

Though they can be effective, Botox injection treatments are needed once every three months.

When used to treat migraine, the most common side effects of this treatment are:

Medicine for Migraine Onset

If migraines have already begun, it’s important to treat them as soon as possible. Earlier intervention is generally better for the overall outcome, reducing the severity of pain and duration of the attacks.

Several classes of drugs, both prescribed and over-the-counter, may be used to help ease symptoms.

Depending on the case, doctors may suggest you first try OTC pain relievers. There are many that can help, though some are designed specifically for migraine, including:

However, using these too often or too many at a time can become problematic. In some cases, it can actually make headaches worse, a condition called medication overuse headache (MOH).

Often the first-line medications for migraine attacks, triptans bind to 5-HT receptors in brain cells, which binds to serotonin. Low levels of this hormone are associated with attacks causing blood vessels to narrow. Triptans like Zembrace SymTouch (sumatriptan) and Zomig (zolmitriptan), among others, cause blood vessels to dilate and open up.

Available as injections, patches, or tablets, there are some side effects associated with these drugs, including:

Generally used to take on nausea and vomiting, some dopamine antagonist antiemetic drugs may be indicated for migraine cases. Compazine (prochlorperazine), Thorazine (chlorpromazine), and Reglan (metoclopramide) are among the medications that may be considered.

With a solid track record in managing migraine cases, these drugs do cause some side effects. The most common of these are:

Prolonged use of these has been associated with neurological issues and effects on motor ability.

Stronger painkilling drugs may also be used to help with headache pain. For migraines, opioid medications like butorphanol, codeine, and Ultram (tramadol) may be considered. This approach is not recommended for chronic migraine cases.

That said, these can be highly addictive and cause many side effects, including:

Management and Prevention of Migraines

Luckily, there are several steps you can take to help manage your condition.

Those who often get a poor night's rest are more likely to experience migraines at a greater frequency. Here are some tips to improve your sleep quality:

Since stress, anxiety, and physical overexertion are all reliable migraine triggers, relaxation strategies can be instrumental in preventing attacks. Your doctor may recommend you do yoga, meditation, and get regular exercise.

Among the many benefits of a good fitness regimen is that it can reduce the severity and frequency attacks. Not only does this improve the quality of sleep, but it can help get at conditions that can bring on migraines, such as obesity and sleep apnea.

At minimum, you should aim for 150 minutes of light to moderate activity (such as walking or cycling), or about 30 minutes a day, five days a week.

Several other means may be attempted to help with migraines. One option, biofeedback, focuses on tracking your body’s signs of stress and tension using a specialized device worn on the body. Since spikes in stress response can bring on attacks, wearers can learn to sense them coming, making them better able to manage their condition.

There is also evidence that regular acupuncture treatment can reduce the frequency of migraine attacks. This traditional Chinese medical modality relies on the use of needles inserted into the skin at strategic spots. In turn, nerve pathways are stimulated, which may help with headaches and other symptoms.

When to Seek Professional Treatment

If you get regular and very debilitating headaches, it’s important to be proactive about getting help. According to the National Institutes of Health (NIH), make sure to call 911 and seek emergency care if:

If you’re living with migraine attacks, it’s also important to be vigilant of changes or other factors that can affect your treatment. Here’s a rundown of reasons to call your doctor or primary care provider:

A Word From Verywell

While medications shouldn’t be the only aspect of migraine management, they can play a significant role in helping you get a handle on this difficult condition. As with any medical treatment, there are some drawbacks to migraine medications and care needs to be taken.

Nonetheless, these medications help countless people handle and prevent attacks. It’s worth talking to your doctor about your migraine treatment options.

Talk to your doctor about the medications you're taking and be mindful of how well they are working.

  • What can you use in addition to medicine to treat a migraine?

    The chief nonmedical approaches to migraine include:

    Learn More:Top 10 Ways to Avoid or Reduce Headache and Migraine Pain
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