Migraine Headaches: Medications

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Medications

Drugs are used to treat migraine symptoms after they have started (abortive drugs) as well as to prevent future attacks (preventive drugs). You may have to try several different drugs or types of drugs before you find the one that is right for you. Good communication with your doctor is important in this process.

Usually, your doctor will first prescribe a drug that causes the fewest side effects. Drugs may be prescribed based on the type of migraine that you experience. If your migraines are mild to moderate, you may need only a nonprescription drug to relieve your symptoms. However, if your migraines are moderate to severe and disabling, you may need a prescription migraine drug to treat your symptoms. If you experience frequent migraine attacks, your doctor may suggest a preventive drug.

Medication Choices

Abortive drugs—used to stop a migraine attack—include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, which may be tried first to reduce migraine symptoms.
• Triptans (serotonin receptor agonists). These are usually the first type of prescription medicine tried to quickly stop acute migraine attacks.
• Ergotamine derivatives, such as Cafergot, although these medications may not be as effective as triptans for treating migraines.
• Midrin, which is a combination of the drugs isometheptene, acetaminophen, and dichloralphenazone.
• Antinausea drugs (such as Compazine or Reglan) may also be prescribed alone to treat migraine symptoms.

Preventive drugs—used to avoid or reduce the frequency of migraine attacks—include:

• Beta-blockers, which relax blood vessels.
• Calcium channel blockers, which reduce the amount of narrowing (constriction) of the blood vessels.
• Antidepressants, such as amitriptyline, a tricyclic antidepressant, which has been shown to be effective in preventing migraines.⁵
• Some anticonvulsants (such as topiramate) that are approved by the U.S. Food and Drug Administration (FDA) for preventing migraines.

Some small studies suggest that the angiotensin-converting enzyme (ACE) inhibitor lisinopril and the angiotensin receptor blocker (ARB) candesartan reduce the frequency of migraine headaches. However, more research is needed.⁶

Antinausea drugs (such as Compazine or Reglan) are prescribed along with abortive drugs. Antinausea drugs may also be prescribed alone to treat migraine symptoms.

What To Think About

It may take several attempts with different drugs before the right one or combination of drugs is found. Researchers now recommend taking a nonsteroidal anti-inflammatory drug (NSAID), such as aspirin or ibuprofen, to reduce headache pain before trying a prescription migraine drug, which may have more side effects than an NSAID.⁵

Because many people who have migraines also have depression, taking prescription medicines for both problems is common. In very rare cases, when a triptan such as sumatriptan (Imitrex) for migraines is taken with an SSRI (selective serotonin reuptake inhibitor) or SNRI (selective serotonin/norepinephrine reuptake inhibitor) such as fluoxetine (Prozac) or duloxetine (Cymbalta) for depression, these medicines can cause a very rare but serious condition called serotonin syndrome. But most people take these two types of medicines together and have no problems. If you are worried about serotonin syndrome, talk to your doctor.

If you experience increased nausea or vomiting as a side effect of a migraine drug, your doctor may also prescribe an antinausea drug, such as prochlorperazine (Compazine) or metoclopramide (for example, Reglan), to reduce these symptoms.

Overuse of migraine drugs or pain relievers can cause rebound headaches. Rebound headaches are different from migraine headaches. They are usually triggered after pain medicine has worn off, prompting you to take another dose. Eventually you get a headache whenever you stop taking the drug. Be sure to take your migraine medicine only as prescribed by your doctor.

The U.S. Food and Drug Administration (FDA) has issued a warning on anticonvulsants and the risk of suicide and suicidal thoughts. The FDA does not recommend that people stop using these medicines. Instead, people who take anticonvulsant medicine should be watched closely for warning signs of suicide. People who take anticonvulsant medicine and who are worried about this side effect should talk to a doctor.

For more information, see:

Should I take medicine to prevent migraines?

Last updated:	July 03, 2007
Author:	Monica Rhodes
Reviewed By:	Anne C. Poinier, MD - Internal Medicine, Colin Chalk, MD, CM, FRCPC - Neurology
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC