Migraine medications can help decrease the frequency, duration and intensity of headaches by using medications like acetaminophen, nonsteroidal anti-inflammatory drugs, triptans or antiemetics.
Triptans – pills, nasal sprays and injections – work quickly to stop migraines. Injections containing the CGRP antagonists rimegepant (Nurtec) or ubrogepant (Zavzpret) block the receptor that dilates blood vessels, and could provide relief within 60 minutes.
Over-the-counter (OTC) painkillers
Many headache sufferers utilize over-the-counter (OTC) painkillers to manage migraines. Your best choice may depend on your symptoms and any existing health conditions you may have.
Dihydroergotamine (Migranal, Trudhesa) can be effective treatment for certain people. Available as both nasal spray or injection form, dihydroergotamine works to block pain pathways in the brain while providing temporary relief from migraine. Unfortunately it may cause side effects like vomiting and should not be taken by those with coronary artery disease or high blood pressure.
Ergotamines
Ergot alkaloids such as ergotamine and dihydroergotamine have proven highly effective at relieving migraine symptoms by narrowing blood vessels and modulating certain chemicals that help nerve cells communicate and cause inflammation.
Migraine medications come in pill, nasal spray or injection form and work quickly to provide pain relief, pairing well with antinausea drugs for maximum effect.
These medications should not be taken by individuals who have had liver issues in the past or who are currently taking medications known to be toxic to liver cells. Some ergotamines contain caffeine which will ensure more efficient absorption if taken with food.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs such as aspirin and acetaminophen are among the most frequently prescribed treatments for migraine pain, both over-the-counter (OTC) and with valid valid prescription. They can be taken either orally or rectal sublingually; and can even form part of combined therapies recommended for migraine.
NSAIDs can be quickly absorbed following oral administration, reaching their peak concentration within two hours of being taken orally. Even when used alongside prokinetic medications like metoclopramide, they can still provide effective relief.
Triptans
Migraine medication can provide significant relief, both physically and psychologically. Triptans (sumatriptan [Imitrex], frovatriptan [Frova], and naratriptan [Amerge]) have proven particularly useful.
These medications work by stimulating a brain chemical that sends signals to your nerves to relax overactive pain nerves and decrease any changes to blood vessels that occur during migraine attacks. As such, this class of medication should be considered first-line treatment option when there are no contraindications or risk factors present.
Beta-blockers
Beta-blockers were originally developed to treat cardiovascular diseases; now used to alleviate migraine pain by blocking adrenaline’s effects. Doctors may prescribe atenolol, metoprolol or nadolol for this purpose.
Amitriptyline (Elavil) and anticonvulsants like topiramate (Qudexy XR, Topamax) are common prescriptions used to combat migraines; however they should not be taken by those with coronary artery disease or high blood pressure; additionally they may not work effectively for children and adolescents. Antidepressants may help by increasing serotonin levels and altering how pain signals reach the brain.
Calcium channel blockers
Calcium channel blockers such as Procardia(r), Verapamil(r) (Calan) and Diltiazem(r) (Cardizem(r)) can help alleviate migraine symptoms by keeping blood vessels from contracting. They may also be prescribed to treat arrhythmias.
Flunarizine appears to have similar effectiveness at treating migraines as beta blockers without their cardiovascular risks, however it should still be discussed with your healthcare provider prior to taking these medicines as they could interact negatively with existing medications or cause unwanted side effects.
Antidepressants
Most antidepressant medication works by altering neurotransmitters – chemicals in your brain that carry signals between nerve cells – in order to treat depression. Many doctors often recommend selective serotonin reuptake inhibitors (SSRIs) first as these usually produce the least side effects.
Tricyclic antidepressants like Amitriptyline and Nortriptyline may also help to prevent migraines, although evidence for this claim remains limited. Selective serotonin reuptake inhibitors like Venlafaxine may also prove helpful in managing migraine and TTH symptoms; however, when combined with certain other drugs they could increase your risk of serotonin syndrome.
Anticonvulsants
Anticonvulsant medications – including topiramate, timolol, propranolol, nadolol, and metoprolol — have strong evidence for treating migraines.
New preventive drugs that target the CGRP molecule and receptor include erenumab, fremanezumab and galcanezumab.
Other medications treat only the symptoms of headaches, including pain and auras. This includes over-the-counter analgesics like acetaminophen and prescription narcotics or barbiturate combinations. But taking too many of these medicines could cause medication overuse headaches (also called rebound headaches).
