A variety of drugs have been specifically designed to treat migraines. In addition, some drugs commonly used to treat other conditions also may help relieve or prevent migraines. Medications used to combat migraines fall into two broad categories:
Some medications aren't recommended if you're pregnant or breast-feeding. Some aren't used for children. Your doctor can help find the right medication for you.
Pain-relieving medications
For best results, take pain-relieving drugs as soon as you experience signs or symptoms of a migraine. It may help if you rest or sleep in a dark room after taking them:
All FDA-approved migraine treatments are approved only for adults. No migraine products have officially been approved for use in children.
PAIN RELIEVERSSome patients with mild migraines respond well to over-the-counter (OTC) painkillers, particularly if they take a full dose of the medicine at the very first sign of an attack. OTC pain relievers, also called analgesics, include:
NSAID Side Effects . High dosages and long-term use of NSAIDs can increase the risk for heart attack, stroke, kidney problems, and stomach bleeding. Aspirin does not increase the risk for heart problems, but it can cause other NSAID-related side effects.
TRIPTANSTriptans (also referred to as serotonin agonists) were the first drugs specifically developed for use against migraine. They are the most important migraine drugs currently available. They help maintain serotonin levels in the brain, and so specifically target one of the major components in the migraine process.
Triptans are recommended as first-line drugs for adult patients with moderate-to-severe migraines when NSAIDs are not effective. Triptans have the following benefits:
Other Triptans . Newer triptans include almotriptan (Axert), zolmitriptan (Zomig), naratriptan (Amerge), rizatriptan (Maxalt), frovatriptan (Frova), and eletriptan (Relpax). Treximet combines in one pill both sumatriptan and the anti-inflammatory pain reliever naproxen (Aleve, Naprosyn). Triptans are also being investigated for prevention under certain circumstances, such as menstrual migraines, but benefits appear limited.
Although triptans, (like all migraine medications), are approved only for adults, researchers are investigating zolmitriptan for treating migraines in adolescents.
Side Effects . Side effects of triptans may include:
- Pain-relieving medications. Also known as acute or abortive treatment, these types of drugs are taken during migraine attacks and are designed to stop symptoms that have already begun.
- Preventive medications. These types of drugs are taken regularly, often on a daily basis, to reduce the severity or frequency of migraines.
Some medications aren't recommended if you're pregnant or breast-feeding. Some aren't used for children. Your doctor can help find the right medication for you.
Pain-relieving medications
For best results, take pain-relieving drugs as soon as you experience signs or symptoms of a migraine. It may help if you rest or sleep in a dark room after taking them:
- Pain relievers. These medications, such as ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others) may help relieve mild migraines. Drugs marketed specifically for migraines, such as the combination of acetaminophen, aspirin and caffeine (Excedrin Migraine), also may ease moderate migraine pain but aren't effective alone for severe migraines. If taken too often or for long periods of time, these medications can lead to ulcers, gastrointestinal bleeding and rebound headaches. The prescription pain reliever indomethacin may help thwart a migraine headache and is available in suppository form, which may be helpful if you're nauseous.
- Triptans. For many people with migraine attacks, triptans are the drug of choice. They are effective in relieving the pain, nausea, and sensitivity to light and sound that are associated with migraines. Medications include sumatriptan (Imitrex), rizatriptan (Maxalt), almotriptan (Axert), naratriptan (Amerge), zolmitriptan (Zomig), frovatriptan (Frova) and eletriptan (Relpax). Side effects of triptans include nausea, dizziness and muscle weakness. They aren't recommended for people at risk for strokes and heart attacks. A single-tablet combination of sumatriptan and naproxen sodium (Treximet) has proved more effective in relieving migraine symptoms than either medication on its own.
- Ergot. Ergotamine and caffeine combination drugs (Migergot, Cafergot) are much less expensive, but also less effective, than triptans. They seem most effective in those whose pain lasts for more than 48 hours. Dihydroergotamine (D.H.E. 45, Migranal) is an ergot derivative that is more effective and has fewer side effects than ergotamine. It's also available as a nasal spray and in injection form.
- Anti-nausea medications. Because migraines are often accompanied by nausea, with or without vomiting, medication for nausea is appropriate and is usually combined with other medications. Frequently prescribed medications are metoclopramide (Reglan) or prochlorperazine (Compro).
- Opiates. Medications containing narcotics, particularly codeine, are sometimes used to treat migraine headache pain when people can't take triptans or ergot. Narcotics are habit-forming and are usually used only as a last resort.
- Dexamethasone. This corticosteroid may be used in conjunction with other medication to improve pain relief. Because of the risk of steroid toxicity, dexamethasone should not be used frequently.
- Non-prescription drugs. Excedrin Migraine, Advil Migraine, and Motrin Migraine Pain
- Prescription drugs. Triptans and ergotamine
All FDA-approved migraine treatments are approved only for adults. No migraine products have officially been approved for use in children.
PAIN RELIEVERSSome patients with mild migraines respond well to over-the-counter (OTC) painkillers, particularly if they take a full dose of the medicine at the very first sign of an attack. OTC pain relievers, also called analgesics, include:
- Nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin. The FDA-approved migraine products Advil Migraine and Motrin Migraine Pain both contain ibuprofen.
- Acetaminophen (Tylenol). The FDA-approved migraine product Excedrin Migraine contains acetaminophen, as well as aspirin and caffeine.
NSAID Side Effects . High dosages and long-term use of NSAIDs can increase the risk for heart attack, stroke, kidney problems, and stomach bleeding. Aspirin does not increase the risk for heart problems, but it can cause other NSAID-related side effects.
TRIPTANSTriptans (also referred to as serotonin agonists) were the first drugs specifically developed for use against migraine. They are the most important migraine drugs currently available. They help maintain serotonin levels in the brain, and so specifically target one of the major components in the migraine process.
Triptans are recommended as first-line drugs for adult patients with moderate-to-severe migraines when NSAIDs are not effective. Triptans have the following benefits:
- They are effective for most patients with migraine, as well as patients with combination tension and migraine headaches.
- They do not have the sedative effect of other migraine drugs.
- Withdrawal after overuse appears to be shorter and less severe than with other migraine medications
Other Triptans . Newer triptans include almotriptan (Axert), zolmitriptan (Zomig), naratriptan (Amerge), rizatriptan (Maxalt), frovatriptan (Frova), and eletriptan (Relpax). Treximet combines in one pill both sumatriptan and the anti-inflammatory pain reliever naproxen (Aleve, Naprosyn). Triptans are also being investigated for prevention under certain circumstances, such as menstrual migraines, but benefits appear limited.
Although triptans, (like all migraine medications), are approved only for adults, researchers are investigating zolmitriptan for treating migraines in adolescents.
Side Effects . Side effects of triptans may include:
- Tingling and numbness in the toes
- Sensations of warmth
- Discomfort in the ear, nose, and throat
- Nausea
- Drowsiness
- Dizziness
- Muscle weakness
- Heaviness, pain, or both in the chest. (About 40% of patients taking sumatriptan experience these symptoms, and they are major factors in discontinuing the drug. Newer drugs, such as almotriptan, produce fewer chest symptoms.)
- Rapid heart rate
- Complications of heart and circulation. Triptans narrow (constrict) blood vessels. Because of this effect, spasms in the blood vessels may occur and cause serious side effects, including stroke and heart attack. Such events are rare, but patients with an existing history or risk factors for these conditions should generally avoid triptans.
- Serotonin syndrome. Serotonin syndrome is a life-threatening condition that occurs from an excess of the brain chemical serotonin. Triptan drugs used to treat migraine, as well as certain types of antidepressant medications, can increase serotonin levels. These antidepressant drugs include serotonin reuptake inhibitors (SSRIs) -- such as fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft) -- and selective serotonin/norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta) and venlafaxine (Effexor). It is very important that patients not combine a triptan drug with a SSRI or SNRI drug. Serotonin syndrome is most likely to occur when starting or increasing the dose of a triptan or antidepressant drug. Symptoms include restlessness, hallucinations, rapid heartbeat, tremors, increased body temperature, diarrhea, nausea, and vomiting. You should seek immediate medical care if you have these symptoms.
- Anyone with a history or any risk factors for stroke, uncontrolled diabetes, high blood pressure, or heart disease.
- People taking antidepressants that increase serotonin levels.
- Children and adolescents. They may be safe, but controlled studies are needed to confirm this. (Triptans should not, in any case, be the first-line treatment for children.)
- People with basilar or hemiplegic migraines. (Triptans are not indicated for these migraineurs.)
- There is no evidence to date of any higher risk for birth defects in pregnant women who take triptans. Still, women should be cautious about taking any medications during pregnancy and discuss any possible adverse effects with their doctors.