Migraine Treatment: A Complete Guide

Contents

Over-the-Counter (OTC) Ache Relievers Triptans Triptan Plus NSAID Ergots Gepants 5-HT1F Receptor Agonists (Ditans)Antiemetics Antihypertensive Medicines Antidepressants Antiseizure Medication Botox CGRP Monoclonal Antibodies Corticosteroids (Steroids)Nerve Blocks for Acute Migraine Ache Aid Emergency Treatment for Intractable Migraine

Acute migraine therapies relieve migraine assaults which might be in progress, easing ache, nausea, and lightweight sensitivity. These embrace over-the-counter ache relievers, triptans, ditans, gepants, dihydroergotamine, steroids (often for assaults that don’t reply to different remedy), and antinausea medicines.

Others are preventive, that means that individuals taking them goal to scale back what number of assaults they’ve and the way extreme they’re. Individuals who have frequent or extreme migraine assaults that disrupt every day life could also be candidates for preventive migraine medicines.

Preventive medicines embrace antiseizure medicines, beta-blockers, calcium channel blockers, CGRP monoclonal antibodies, and sure antidepressants.

Individuals could have to attempt completely different choices to decide on a preventive drug that works for them, and it could take a number of months to start out decreasing migraine assaults.

Low doses will help folks restrict uncomfortable side effects whereas discovering a remedy that works for them.

Over-the-Counter (OTC) Ache Relievers

This class contains nonsteroidal anti-inflammatory medication (NSAIDs), akin to ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin, in addition to acetaminophen (Tylenol). A mixture drug containing aspirin, acetaminophen, and caffeine (Excedrin Migraine) could also be efficient at decreasing the ache related to delicate to average migraine. Nevertheless it’s not as efficient for extreme assaults.

In case your physician recommends NSAIDs or merchandise containing aspirin, these medication have hyperlinks to uncomfortable side effects like ulcers and gastrointestinal bleeding. Every day use would possibly result in medication-overuse complications.

Triptans

Triptans are also called 5-HT1B/1D receptor agonists as a result of they block the ache pathways within the mind by binding to particular serotonin receptors on neurons.

Docs usually prescribe them if different migraine therapies haven’t been profitable. Seven triptans can be found, together with:

eletriptan (Relpax)
rizatriptan (Maxalt)
zolmitriptan (Zomig)
frovatriptan (Frova)
naratriptan (Amerge)
sumatriptan (Imitrex)
almotriptan

Based on On a regular basis Well being community web site Migriane Once more, triptans are available in many varieties, together with oral tablets, nasal sprays, nasal powder, and injections. Non-oral strategies (nasal sprays and injections) might be simpler for folks experiencing the migraine symptom of nausea or vomiting as a result of the digestive system tends to sluggish throughout an assault.

Frequent uncomfortable side effects of triptans embrace nausea, dizziness, drowsiness, muscle tingling, numbness, and weak point. As a result of one in all their actions is to constrict blood vessels, medical doctors don’t advocate triptans for folks at excessive danger for a stroke or coronary heart assault.

Triptan Plus NSAID

In January 2025, the U.S. Meals and Drug Administration (FDA) authorised a mixture drug for the acute remedy of migraine containing the triptan rizatriptan and the NSAID meloxicam, a drug primarily used for arthritis ache.

The brand new mixture drug is called Symbravo and is taken as a pill.

Whereas combining triptans and NSAIDs for migraine reduction isn’t new, Symbravo makes use of a brand new formulation of meloxicam that will get absorbed — and begins working — quick, inside one hour. Rizatriptan acts rapidly, too, but it surely additionally stops working comparatively rapidly. In distinction, the results of the brand new formulation of meloxicam final for about 18 hours.

Collectively, the 2 medication promise fast ache reduction that lasts many hours.

Ergots

Ergots work together with the identical mind receptors as triptans. Nevertheless, medical doctors usually prescribe triptans as an alternative of ergots as a result of extra analysis helps the effectiveness of triptans for treating migraine assaults.

An ergot referred to as dihydroergotamine (Migranal, Trudhesa) could also be used when triptans aren’t having the specified impact on ache.

Dihydroergotamine is best when delivered intravenously (IV), which requires a medical skilled to manage the dose. It’s additionally accessible as a self-injection and as a nasal spray.

Gepants

CGRP is a peptide (or quick chain of amino acids) within the mind and nervous system that causes blood vessel dilation and performs a job in transmitting ache. Analysis exhibits that blood and saliva ranges of CGRP improve throughout migraine assaults.

CGRP antagonists, typically known as “gepants,” forestall CGRP from binding to receptors in varied cell sorts within the mind.

FDA-approved gepants embrace:

atogepant (Qulipta)
rimegepant (Nurtec ODT)
ubrogepant (Ubrelvy)
zavegepant (Zavzpret)

Completely different medication require completely different dosages. For instance, atogepant is out there in 10-milligram (mg), 30 mg, and 60 mg doses.

Zavgepant is a nasal spray accessible as a single spray (10 mg) in a single nostril, as wanted. The utmost dose in 24 hours is one 10 mg spray.

In 2023, atogepant additionally obtained approval as a preventive remedy for continual migraine primarily based on a research wherein members had roughly seven fewer migraine days over 12 weeks on both 30 mg twice a day or 60 mg as soon as a day in contrast with a placebo.

5-HT1F Receptor Agonists (Ditans)

Also called ditans, 5-HT1F receptor agonists selectively bind to sure serotonin receptors on trigeminal neurons, blocking the transmission of ache within the trigeminal nerve system.

The trigeminal nerve is a posh nerve liable for sensation within the face and motion of the jaw muscle mass.

Activation of the trigeminal nucleus, situated within the mind stem, is likely to be a key stage in a migraine assault’s improvement.

Lasmiditan (Reyvow) is the one drug on this class, and it has approval as an acute migraine remedy.

Antiemetics

In case your migraine assaults embrace nausea and vomiting, your physician could prescribe an oral antinausea drug, also called an antiemetic, to take together with a pain-relieving remedy. Antiemetics used for migraine reduction embrace:

chlorpromazine
prochlorperazine (Compro)
metoclopramide (Reglan)
droperidol (Inapsine)

Metoclopramide will increase muscle contractions within the higher digestive tract to hurry up the speed at which meals within the abdomen strikes to the small gut.

Chlorpromazine, droperidol, and prochlorperazine, in distinction, management nausea by blocking chemical substances within the mind linked to vomiting.

Antihypertensive Medicines

Individuals sometimes use beta-blockers to handle hypertension and coronary artery illness, however medical doctors additionally generally prescribe them to stop migraine assaults.

Examples of beta-blockers which will assist deal with migraine embrace:

propranolol (Inderal LA or Innopran XL)
metoprolol tartrate (Lopressor)
timolol (Betimol)

Extra analysis is important to grasp how beta-blockers work for folks with migraine.

Unwanted side effects would possibly embrace melancholy, insomnia, nausea, and excessive tiredness.

Calcium channel blockers are one other blood stress remedy which will assist forestall migraine assaults.

One frequent instance is verapamil (Calan, Verelan).

Antidepressants

Tricyclic antidepressants work by altering the degrees of serotonin and different chemical substances in your mind. So far, amitriptyline (Elavil) is the one tricyclic antidepressant confirmed to stop migraine assaults. Unwanted side effects can embrace dry mouth, constipation, weight achieve, sexual dysfunction, and others.

Antiseizure Medication

Sure antiseizure or antiepileptic medication, together with divalproex sodium (Depakote) and topiramate (Topamax), have been proven to scale back the frequency of migraine assaults. They’re accessible as tablets, capsules, and sprinkle capsules (capsules filled with small beads of remedy designed to be sprinkled over comfortable meals).

The precise means wherein these medicines forestall migraine assaults is unclear. You’ll take them as a every day or twice-daily dose.

Antiseizure medication have vital uncomfortable side effects, together with nausea, fatigue, surprising weight modifications, hair loss, dizziness, diarrhea, and focus issues.

Docs advocate towards utilizing them for those who’re pregnant or plan to grow to be pregnant.

Botox

The FDA has authorised onabotulinumtoxinA (Botox) to deal with adults with continual migraine. Docs inject the drug into round 31 areas within the brow and neck, the place it reduces muscle contractions and blocks ache indicators within the nerves for round 12 weeks.

Botox injections can scale back the variety of migraine assaults by round half. They generally trigger neck soreness as a brief aspect impact, which can really feel higher after making use of an ice pack.

You’ll have injections about each three months, and you might not really feel the advantages till your second or third remedy. Within the meantime, you possibly can take different migraine medicines with out the danger of dangerous interactions.

CGRP Monoclonal Antibodies

CGRP monoclonal antibodies are lab-made proteins that particularly goal CGRP within the physique to scale back its impact on ache and irritation.

CGRP antibody medication embrace:

eptinezumab (Vyepti)
erenumab (Aimovig)
fremanezumab (Ajovy)
galcanezumab (Emgality)

CGRP monoclonal antibodies are a preventive migraine remedy.

A assessment of knowledge revealed in 2023 concluded that they lowered the variety of migraine days in contrast with placebo in each episodic and continual migraine.

Individuals obtain CGRP antibodies both as an intravenous (IV) infusion as soon as each three months or as a month-to-month injection.

Corticosteroids (Steroids)

Docs could prescribe steroid medicines, together with methylprednisolone and dexamethasone, to deal with a migraine headache that hasn’t responded to different therapies or that has lasted greater than 72 hours, often called standing migrainosus. Most research on steroids for migraine reduction have proven that these medication are most helpful for migraine prevention, resulting in milder migraine assaults.

Docs prescribe steroids, particularly dexamethasone, together with different kinds of migraine medication, akin to triptans, to enhance ache reduction. They might administer steroids by IV in a hospital or clinic.

Steroids are solely appropriate for short-term use as a result of they’ve a danger of uncomfortable side effects, together with insomnia and excessive blood sugar.

Nerve Blocks for Acute Migraine Ache Aid

A nerve block includes injecting small quantities of a numbing drugs, akin to lidocaine or bupivacaine, into the bottom of the cranium, over the eyes, or within the temple to dam ache indicators from the nerves. Nerve blocks can relieve ache inside minutes, and the results could final for days, weeks, and even months.

A health care provider can even inject a nerve block into myofascial set off factors, which can relieve ache in these hypersensitive areas. Myofascial set off factors are nodules in skeletal muscle which might be painful below stress that may additionally trigger ache in different areas of the physique.

Urgent on myofascial set off factors could provoke a migraine assault in some folks with migraine.

Emergency Treatment for Intractable Migraine

Docs often seek advice from a extreme migraine assault that lasts for greater than 72 hours and doesn’t reply to an individual’s typical acute therapies as an intractable migraine, or standing migrainosus. It’s usually obligatory to hunt further remedy within the emergency division in these instances, the place quite a few medication might be administered intravenously to assist break the headache cycle.

These medication could embrace:

Antiepileptics
Triptans
NSAIDs
Steroids
Muscle relaxants
Antipsychotic medicines

Intractable migraine might be debilitating and worrying, and also you won’t be capable to suppose clearly while you get to the ER. Contemplate asking your common physician to write down down and signal an emergency migraine remedy plan so that you can carry with you to the hospital or pressing care middle. This will help you entry the medicines which might be best for you.

Ideally, your emergency migraine remedy plan ought to embrace:

Your analysis
Any related details about your medical historical past
Your physician’s suggestions for the most secure and best medicines for you
Your physician’s signature and get in touch with data