What are Migraine Medications?

A Summary of Abortive Migraine Medications

There are Effective Medications to Treat Migraines
There are Effective Medications to Treat Migraines. Frank and Helena/Getty Images

Whether you have recently been diagnosed with migraines or are a chronic migraineur, you may find yourself dreaming of a medication that could instantly treat all your attacks. Unfortunately, for many of you, this "dream" medication does not exist.

Nevertheless, there are lots of good migraine medications out there, and it is often the combination of both medication and behavioral changes that allows us to gain some control over our migraine attacks.

 

Abortive Migraine Medications

Abortive medications are taken at the start of a migraine to provide headache relief, stop the attack from progressing, and/or diminish its severity.

NSAIDS

Most people first treat their migraines with over-the-counter medications. This is reasonable as non-steroidal anti-inflammatories (NSAIDs), like ibuprofen or naproxen sodium (Aleve), are generally considered first-line treatments for migraines. Even though NSAIDs may be purchased over-the-counter, they are not for everyone—be sure to talk with your doctor before taking one to ensure it is safe for you. 

Triptans

If an NSAID does not work, or if a person's initial migraine is moderate to severe, a triptan like Imitrex (sumatriptan) or Maxalt (rizatriptan) can be useful. The nice aspect of triptans is that they are available in non-oral forms. For instance, sumatriptan is available in subcutaneous or intranasal form, and rizatriptan is available in an absorbable wafer, known as Maxalt MLT.

Triptans though, unlike NSAIDs, are not available over-the-counter and require a prescription from your doctor. 

Your doctor may also consider a combination NSAID/triptan, like Treximet (sumatriptan/naproxen sodium). In a 2007 study in JAMA, sumatriptan/naproxen sodium was found to be more effective than sumatriptan or naproxen sodium alone.

Triptans though have potential side effects including nausea, paresthesias, fatigue and chest or throat tightness. They also should be avoided in patients with heart disease and uncontrolled hypertension due to their mechanism of action, which is to constrict blood vessels. In terms of other migraine types, triptans are also not used to treat hemiplegic migraines or basilar migraines.

Antiemetics

An antiemetic or anti-nausea medications like intravenous (through the vein) metoclopramide (Reglan) is another reasonable migraine abortive medication—this is commonly given in the emergency department. Antiemetics given by mouth are sometimes used to treat the nausea that accompanies migraines, but have not been shown to be effective for the migraine itself.

One potentially dangerous side effect of antiemetics is that these medications can cause a heart arrhythmia.

Dihydroergotamine

Dihydroergotamine (D.H.E. 45, Migranal) is another migraine therapy. This medication is injected (intravenous, subcutaneous, intramuscular) or administered intranasally (through the nose).

Intravenous administration (through the vein) in combination with antiemetics is sometimes given in the emergency room for migraine treatment.

Dihydroergotamine cannot be used in conjunction with triptans and is contraindicated in pregnancy, and in people with poorly controlled blood pressure and/or heart disease.

Other Medications

Other treatment alternatives include an intravenous steroid, like dexamethasone, which is usually given in addition to other migraine therapies. Intranasal lidocaine may provide relief for migraines. It is administered by a doctor or the patient themselves, but often only provides short-term relief. Migraine recurrence is common.

A Word from Verywell

In summary, NSAIDs are considered first-line therapy for mild to moderate migraines. If a migraine persists despite an NSAID, or if a migraine is moderate to severe in intensity to start, a triptan or a triptan/NSAID combination drug is often prescribed by a doctor. 

Other alternative migraine therapies that are used mainly in an emergency room are intravenous antiemetics, dihydroergotamines, or steroids.

In addition to potential side effects, be cautious of developing a medication overuse headache or rebound headache when taking abortive migraine medications. Always discuss your migraine treatment plan with your doctor.

Sources:

Aukerman G, Knuston D, Miser WF; Department of Family Medicine, Ohio State University College of Medicine and Public Health, Columbus Ohio. Management of the acute migraine headache. Am Fam Physician. 2002 Dec 1;66(11):2123-30.

Bajwa Z, Sabahat A. Acute treatment of migraine in adults. In: UpToDate, Basow DS (Ed), UpToDate, Waltham, MA, 2013.

Brandes JL, Kudrow D, Stark SR, et al. Sumatriptan-naproxen for acute treatment of migraine: a randomized trial. JAMA. 2007;297(13):1443–1454.

Gilmore B & Michael M. Treatment of Acute Migraine Headache. Am Fam Physician. 2011 Feb 1;83(3):271-280.

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