Medication may help ease the throbbing pain associated with migraines, but it’s essential that they only be taken when needed or else you risk medication-overuse headache.
An anti-migraine medication such as Tylenol(r)/NSAIDs may provide effective relief. Other drugs available for treatment may include ergotamines – available as pill, nasal spray, suppository and injection forms. Triptans increase serotonin levels to decrease inflammation while constricting blood vessels to stop migraine pain.
Over-the-counter (OTC) pain relievers
Six out of ten migraine sufferers can effectively manage their headaches with OTC medicines such as aspirin or ibuprofen (Advil, Motrin IB). Both products reduce pain by blocking enzymes that produce prostaglandins; long-term or high dose use may increase stomach bleeding risk however; other non-steroidal anti-inflammatory drugs (NSAIDs), such as naproxen (Naprosyn) or celecoxib (Erythromycin, Elyxyba), also inhibit COX enzymes; other medicines combine aspirin/ibuprofen with acetaminophen (Excedrin Migraine, Vanquish).
Triptans, or prescription painkillers, may help ease some symptoms of migraine by blocking pain pathways in the brain. Triptans include eletriptan (Relpax), naratriptan (Amerge), sumatriptan (Imitrex XR, Sumavel, Onzetra Xsail Tosymra) and rizatriptan (Maxalt). All three drugs can be taken either orally or via injection.
Antidepressants
Antidepressants are a class of drugs designed to treat depression. They work by altering neurotransmitters that transport messages between brain cells. Antidepressants can also help prevent migraines; specific examples include selective serotonin reuptake inhibitors (SSRIs) which increase serotonin in your brain; while selective norepinephrine reuptake inhibitors (SNRIs), which increase both serotonin and norepinephrine levels simultaneously may prove more successful than their predecessors; examples include Pristiq (desvenlafaxine), Cymbalta (duloxetine), and Effexor XR (venlafaxine).
Migraine and depression are often closely interconnected; according to the American Migraine Foundation, those living with migraine are twice as likely to also suffer from psychiatric disorders than their counterparts without migraine. Medication may help ease anxiety and stress levels which in turn reduce headache frequency; combination therapies should also be considered.
Calcium channel blockers
Your doctor may suggest anticonvulsant medications to either help prevent headaches from starting or stop them once they occur, including topiramate (Qudexy XR/Topamax) and valproic acid (Depakene/Depakote).
These medications block calcium ions in blood vessel cell membranes to keep blood vessels from narrowing, thus preventing constriction. Commonly prescribed for high blood pressure and angina patients, they may also prove beneficial in mitigating migraine. [3]
Your doctor may suggest cognitive behavioral therapy (CBT) to identify triggers and devise ways of coping when they occur. You could also try noninvasive solutions like spring TMS (Spring eNeura sTM) or the vagus nerve stimulator gammaCore which send magnetic pulses directly to the vagus nerve in your neck to ease pain.
Angiotensin-converting enzyme (ACE) inhibitors
ACE inhibitors are prescription medications used to lower blood pressure and may also help prevent migraine headaches, according to Dr. Shadbehr. However, further research must be conducted in order to understand how these drugs work to treat migraines; additionally they are usually not advised for pregnant women.
There is limited evidence that beta-blockers – including nebivolol, bisoprolol, pindolol, atenolol and carbamazepine – can effectively prevent migraines; however, they may increase your risk for other medical issues, including heart attack and stroke.
Newer treatments that target the serotonin system to stop or prevent migraines include atogepant (Qulipta), lasmiditan (Reyvow), and rimegepant (Nurtec). All three were approved by the FDA in 2021-2022 and require regular monitoring by your physician to detect blood pressure fluctuations and drug interactions; some can cause dry cough, dizziness or dryness if taken with nonsteroidal anti-inflammatory painkillers (NSAIDs).
Triptans
Triptans drugs such as sumatriptan (Imitrex), naratriptan (Amerge), frovatriptan (Frova) and zolmitriptan (Maxalt), cause blood vessels around your brain to contract, decreasing inflammation while blocking pain receptors and relieving discomfort. They’re available as tablets, nasal sprays or injections.
These medications work best if taken as soon as the first sign of migraine begins, and may be repeated every 30 minutes if symptoms resurface. Unfortunately, they should not be used by individuals with uncontrolled high blood pressure, hepatic impairment, renal impairment or coronary artery disease as they could potentially lead to severe side effects.
Ergot alkaloid medications like dihydroergotamine (Migranal and Trudhesa), promethazine (Phenergan), can provide effective relief from nausea associated with migraine. When OTC drugs, triptans or other remedies fail to ease your symptoms, these prescription may provide temporary respite.
