Overview

Migraines are severe, debilitating headaches that are usually characterized by an intense throbbing or pulsing in one area of your head.

They can include sensitivity to light, sound, and smell, create visual disturbances such as auras, and can even cause nausea or vomiting. Migraines are more than a headache and can affect your everyday life.

Migraines are commonly treated with medication. There are two categories of drugs used to treat migraines:

acute treatment, for pain and other symptoms during a migraine headache
preventive treatment, to reduce the frequency and severity of migraines

Drugs for acute treatment

These drugs are taken at the onset of migraine symptoms or auras to relieve a headache or reduce its severity.

Taking any of these drugs too often can lead to a rebound headache, headaches that arise from the overuse of medication, which then necessitates additional medication.

If you need to use acute migraine drugs more than 9 times per month, talk to your doctor about possible preventive treatments.

Painkillers

Some over-the-counter (OTC) painkillers are commonly used for migraines, but many are only available in prescription strength.

Aside from acetaminophen, an analgesic that only relieves pain, these drugs are nonsteroidal anti-inflammatory drugs (NSAIDs), which relieve pain and reduce inflammation:

acetaminophen (Excedrin, Tylenol)
aspirin
diclofenac (Cataflam)
ibuprofen (Advil, Motrin)
ketorolac (Toradol)
naproxen (Aleve)

Many OTC drugs marketed specifically for migraine or headaches in general combine one or more of the drugs above with a small amount of caffeine, which can make them work more quickly and effectively, especially for mild migraine headaches.

Possible side effects of long-term NSAID use include:

heart attack
stroke
kidney damage
stomach ulcers

Ergotamines

Ergotamines were the first class of drugs used specifically for migraines. They cause blood vessels around your brain to contract and can relieve a migraine within a few minutes.

Ergotamines are available as pills, tablets that dissolve under your tongue, nasal sprays, suppositories, and injections. They’re generally taken at the first sign of headache symptoms, and some have the option to take additional doses every 30 minutes if the headache continues.

Some ergotamines are:

dihydroergotamine (DHE-45, Migranal)
ergotamine (Ergomar)
ergotamine and caffeine (Cafatine, Cafergot, Cafetrate, Ercaf, Migergot, Wigraine)
methysergide (Sansert)
methylergonovine (Methergine)

Ergotamines can have dangerous side effects. They can cause birth defects and heart problems, and are toxic in high doses.

If you’re pregnant or breastfeeding or have heart disease, you shouldn’t take ergotamines. Ergotamines can also interact negatively with other drugs, including antifungal and antibiotic medications.

Triptans

Triptans are a newer class of drug that increases serotonin levels in your brain, reducing inflammation and constricting blood vessels, effectively ending a migraine.

Triptans are available as pills, nasal sprays, injections, and tablets that dissolve under your tongue, and work quickly to stop a migraine.

Some triptans are:

almotriptan (Axert)
eletriptan (Relpax)
frovatriptan (Frova)
naratriptan (Amerge)
rizatriptan (Maxalt, Maxalt-MLT)
sumatriptan (Imitrex)
sumatriptan and naproxen (Treximet)
zolmitriptan (Zomig)

Possible side effects of triptans include:

tingling or numbness in your toes
drowsiness
dizziness
nausea
tightness or discomfort in your chest or throat

People with heart problems or who are at risk for stroke should avoid triptans.

Triptans can also cause the potentially fatal serotonin syndrome if taken with other drugs that increase serotonin, such as antidepressants.

Antinausea drugs

These drugs reduce nausea and vomiting that can accompany severe migraines. They’re usually taken along with a painkiller, as they don’t reduce pain.

Some include:

dimenhydrinate (Gravol)
metoclopramide (Reglan)
prochlorperazine (Compazine)
promethazine (Phenergan)
trimethobenzamide (Tigan)

These drugs may make you drowsy, less alert, or dizzy, and have other possible side effects.

Opioids

If migraine pain doesn’t respond to other painkillers and you can’t take ergotamines or triptans, your doctor may prescribe opioids - much more powerful painkillers.

Many migraine drugs are a combination of opioids and painkillers. Some opioids are:

codeine
meperidine (Demerol)
morphine
oxycodone (OxyContin)

Opioids carry a serious risk of addiction, so they’re usually prescribed sparingly.

Drugs for preventive treatment

If you experience migraines frequently, your doctor may prescribe a preventive drug to reduce the frequency and intensity of your migraines.

These drugs are taken on a regular basis, usually daily, and may be prescribed alone or in combination with other drugs.

It may take several weeks or months for them to become effective. These drugs are commonly used for other conditions and are also effective for migraines.

CGRP antagonists

CGRP antagonists are the newest group of medications approved for prevention of migraines.

They work on the calcitonin gene-related peptide (CGRP), a protein that’s found around the brain. CGRP is involved in the pain associated with a migraine.

This class of medications is expected to grow over the next year. Current ones include:

erenumab (Aimovig)
fremanezumab (Ajovy)

Beta-blockers

Commonly prescribed for high blood pressure, beta-blockers decrease the effects of stress hormones on your heart and blood vessels, and can help reduce both the frequency and intensity of migraines.

Some include:

atenolol (Tenormin)
metoprolol (Toprol XL)
nadolol (Corgard)
propranolol (Inderal)
timolol (Blocadren)

Side effects of beta-blockers may include:

fatigue
nausea
dizziness when standing
depression
insomnia

Calcium channel blockers

Calcium channel blockers are blood pressure drugs that moderate the constriction and dilation of your blood vessels, which plays a role in migraine pain.

Some calcium channel blockers include:

diltiazem (Cardizem, Cartia XT, Dilacor, Tiazac)
nimodipine (Nimotop)
verapamil (Calan, Covera, Isoptin, Verelan)

Side effects of calcium channel blockers may include:

low blood pressure
weight gain
dizziness
constipation

Antidepressants

Antidepressants affect levels of various brain chemicals, including serotonin. An increase of serotonin can reduce inflammation and constrict blood vessels, helping alleviate migraines.

Some antidepressants used to treat migraines are:

amitriptyline (Elavil, Endep)
fluoxetine (Prozac, Sarafem)
imipramine (Tofranil)
nortriptyline (Aventyl, Pamelor)
paroxetine (Paxil, Pexeva)
sertraline (Zoloft)
venlafaxine (Effexor)

Some of the side effects of antidepressants include weight gain and decreased libido.
Anticonvulsants

Anticonvulsants prevent seizures caused by epilepsy and other conditions. They may also alleviate migraine symptoms by calming overactive nerves in your brain.

Some anticonvulsants include:

divalproex-sodium (Depakote, Depakote ER)
gabapentin (Neurontin)
levetiracetam (Keppra)
pregabalin (Lyrica)
tiagabine (Gabitril)
topiramate (Topamax)
valproate (Depakene)
zonisamide (Zonegran)

Side effects of anticonvulsants may include:

nausea
vomiting
diarrhea
weight gain
sleepiness
dizziness
blurred vision

Botulinum toxin type A (Botox)

The FDA has approved Botox (Botulinum toxin type A) injections in your forehead or neck muscles for the treatment of chronic migraine.

Generally, they’re repeated every three months, and can be costly.

Outlook

Many drugs are available to treat pain from migraines. Be cautious of the overuse of medication to avoid rebound headaches.

If pain is consistent, talk to your doctor about taking preventive medication.