Find your way through the maze of Headache Painkillers & Abortives . . .

There are so many headache painkillers out there! What really works and what's the difference? Let this page be your guide as we try to make the world of painkillers and abortives simple and clear, so that you can get to the END of your pain!

In this article we're going to look at medications designed to stop your headache or migraine after it starts. These are called abortive or acute medicines, and they include headache painkillers. (Click here for preventative meds...) Some of these are specifically for migraine, others are used for various types of headache. Some are specifically headache painkillers, but there are other types of abortives.

For more on headache and migraine, read:  Have a slight headache? Might be migraine

Designer Migraine Medicine - The TRIPTANS

These include brand names such as Maxalt (rizatriptan), Zomig (zolmitriptan), Amerge (naratriptan), Frova (frovatriptan) and Imitrex (sumatriptan). These were designed specifically for migraine, although we're still not sure exactly why they work.  For more on the history and function of triptan medications, read Triptan and Migraine answers.

Triptans have been called miracle drugs, and they do seem to work very well for most people. Not only can they kill the pain, but they also get rid of many of the other migraine symptoms, such as nausea and drowsiness. Many brands can be administered orally, through a nasal spray, and using a needle.

The side effects are usually minor, and the relief is fairly quick. However, it is important to make sure your doctor knows your complete medical history before giving you a prescription. If there are concerns about heart disease, for example, these would not be the drugs for you.

What else do you need to know about triptans?  Read 10 Triptan Facts You Need to Know Now.

Ergotamine Tartrate

This includes brands such as Ergomar, and Wigraine (which includes caffeine as well). Before the Triptans came along this was the most commonly used migraine drug. It decreases serotonin activity, and also narrows the blood vessels.

This type of drug needs to be taken when the migraine first begins to appear. As with all these painkillers, it is not to be taken on a regular basis. Becaus of the way it effects blood vessels it can cause serious side effects. It can also start causing headaches if taken too often.

Migranal (dihydroergotamine mesylate)

Migranal works in much the same was as the Triptans. It's generally not quite as effective, but in some patients that can't take the triptans it may be the answer. Again, be sure to tell your doctor your medical history and all other drugs that you are taking.

It can also be effective as a short term replacement for Ergotamine Tartrate if someone becomes dependant. However since it effects the blood vessels as well your doctor should watch you carefully for side effects.

For more in-depth information on Migranal, read DHE Migraine Treatment: Why some people still use it.

Headache painkillers and more – NSAIDs

This includes band names such as Advil, Motrin, Aspirin, and Naproxen. NSAID stands for nonsteroidal anti-inflammatory drugs. These drugs are designed to cut down inflammation and raise your pain threshold so that you can cope better.

The main cautions regarding these (besides checking with your doctor about your medical history and other drugs – did I mention that?) is that only one type should be taken at a time and also that they can cause rebound headache. That means that your body can become used to them and you can start getting headaches just because you didn't take a painkiller. NSAIDs are also not to be taken during pregnancy, due to an increased risk of miscarriage. Some of these can also cause stomach problems if taken long term. Don't take these any more than 2 days a week without checking with your doctor (of course you should be checking with your doctor anyway, right?).

The possible exception to the stomach problems are cox-2 inhibitors, such as Celebrex, but they have risks of their own. Read this article for more on the cox2 inhibitor drug family.

Due to its popularity, we now have an article online specifically about ibuprofen (Advil).

More headache painkillers – Acetaminophen / Paracetamol

This includes drugs like Tylenol and Excedrin. Acetaminophen's main aim is to raise your pain threshold. It should not be taken regularly with NSAIDs without a doctor's supervision. There is danger as well that acetaminophin (also called paracetamol) can cause rebound headaches (see above), so avoid taking more than a couple days a week.

Because of their popularity as headache painkillers, we've included a special page on Tylenol and Acetaminophin.

The heavyweights – Narcotics

This includes things like codeine (Tylenol #1-3), Demerol, Dolophine and Stadol. Most often these are given as injections, though tablets and nasal sprays are also available.

These are the heavy-hitters, given to counteract extreme pain. They should only be taken with extreme caution and with the supervision of a doctor.

Your body can get accustomed to these drugs, requiring more and more to relieve your headache and doing serious damage to your body. These are best used by those who get occasional and severe migraine, or who are hospitalized due to migraine. However, they are being used much less often today because of better alternatives and the high risks.

Barbiturates

This is a substance included in drugs such as Fioricet, Butisol and Luminal. As with narcotics, your body can get used to these drugs, causing worse problems down the road. They work on the nervous system to slow things down and sedate. They are not for long term use.

Steroids

Steroids are generally given intravenously for patients who have severe ongoing migraine and who are hospitalized. They are prescribed when all other measures have failed.

Drs Kandel and Sudderth write in Migraine - What Works! : Although steroids have received generally bad press in recent times, we feel that short-term use of steroid medications is reasonable in the context of intractable [stubborn, violent] migraine.

Migraine meds and Headache painkillers – Combinations

Some drugs are combinations of several of these, often adding caffeine. Caffeine can cure a headache itself, but it's often used to enhance the effect of the other drugs. Excedrin Migraine is one of these.


Talk to your doctor about these options, and don't give up! There are many variations even within each category of headache painkillers and abortives. The best use of these is with an all around lifestyle treatment of migraine or other headache.

Special thanks to Seymour Diamond, MD, for his book Conquering Your Migraine which offers a good variety of treatments. To go beyond headache painkillers to more treatments take a look at the rest of this website.

For more here's a summary of headache painkillers, migraine abortives and preventatives.