Migraine Medications: So many choices

There are so many options today when it comes to migraine medications.  Many people don't realize this because most often there are very few medications that are "officially approved" for migraine.  But there are many other medications prescribed by specialists that have helped migraine patients.  Also, there are many combinations, leaving us with more options than we will ever try.

Using Migraine Medications

Migraine medications
First, a quick introduction.  There are many migraine treatments that don't involve medication at all.  Many people don't need medication at all, and have success using other therapies, alternative treatments, and making lifestyle adjustments.

Very often a doctor will prescribe a medication as a "short term" measure.  The drugs will help you get out of the "migraine cycle".  Then you will be able to ease off the medication and use other treatments to maintain your health.

The two types

Migraine medications are usually split into two categories.  First, there are abortive medications.  This is what you take when you feel a migraine attack coming on, to stop the migraine chain reaction.

Second, there are preventatives.  These are medications that you take regularly to keep migraine attacks from coming in the first place.

Let's take a quick look at some of the medications that are used in each of these categories.  Now remember, not all of these are for everyone - you need to talk to your doctor, a doctor who knows your medical history, to find the migraine medications that have the best chance of working for you.  Some of these are better for children, or better for people with certain symptoms, etc.

Also remember that, depending on what country you're in, not all of these are officially approved for migraine (or are even available).  That doesn't mean that you're not allowed to use them for migraine, it just means that the research on them is still being done.  A qualified doctor or migraine specialist will know what has a good chance of helping you.

Finally, keep in mind that we're just talking about medications here, and won't be covering herbal treatments, supplements, etc, many of which are very helpful (often more helpful than the drugs).

These are not exhaustive listings, just an introduction.  Remember that often these are used in combinations with one another or with other treatments or supplements, which means there are hundreds of options.  All the brand names for each are not listed, just an example or two.

Abortives

The most commonly prescribed abortives (also called acute migraine medications) today are triptan drugs.  They are not painkillers - in other words, they won't help you when you have a broken arm or a stomach ache.  They are specifically for migraine, and will stop your pain by stopping the migraine chain reaction.

People react to triptans differently - so if one doesn't work for you, another may.

Here are some of the common abortives, including triptans:

  • Triptans: including Maxalt (rizatriptan), Zomig (zolmitriptan), Axert (almotriptan), Amerge (naratriptan), Frova (frovatriptan), Imitrex (Sumatriptan) and others.  (more on triptans)
  • Ergotamine:  for example DHE-45 or Migranal (dihydroergotamine), Ergomar, Wigraine, Gravergol and Cafergot (these last three contain caffeine)
  • Some abortives are especially for nausea.  These include metoclopramide (Reglan), prochlorperazine (Compazine) and rochlorperazine promethazine(Phenergan).
  • Others (often given by injection for severe cases) include antihistamines such as Benadryl and other medications such as droperidol (Dropletan) (which also fights nausea).  Valproate sodium (Depacon) may be injected as well.  Sometimes drugs such as narcotics, barbiturates, and steroids are used in extreme situations.  Due to concerns such as toxicity these are being used less and less as better options become available.
  • Over the counter:  Sometimes over the counter medication is used for migraine, including acetaminophen/paracetamol (Tylenol), ibuprofen (Advil), and aspirin.  There are many combination drugs available such as Excedrin Migraine.  Though sometimes used for ocassional migraine, most of these are not actually migraine medications and don't work as well as more specialized drugs.  If taken too often, they can make matters worse by causing rebound headache (although even specialized drugs like triptans can do the same).

Preventatives

Many migraine medications are taken regularly to either cut down on migraine attacks, or make the ones that come less severe.  Here's a sampling of drugs used to prevent migraine:

  • Antiseizure medications:  This includes valproic acid (Depakote), valproate sodium (Depacon), topiramate (Topamax), gabapentin (Neurontin), levetiracetam (Keppra), oxcarbazepine (Trileptal) and many more.
  • Methylergonovine (Methergine), an ergot psychedelic alkaloid.
  • Beta blockers:  There are many, including propranolol (Inderal, Dociton), nadolol (Corgard) and metoprolol (Toprol-XL, Minax)
  • Calcium Channel blockers:  These include verapamil (Isoptin, Verelan), flunarizine (Sibelium) and nimodipine (Nimotop)
  • Antidepressants:  This is a huge category; there are many types of antidepressants that are used.  These include tricyclic antidepressants, SSRIs, and MAOIs, to name a sample.  Some common ones would be amitriptyline (Elavil, Endep), desipramine (Norpramin, Pertofrane), phenelzine (Nardil), sertraline (Zoloft, Lustril), paroxetine (Paxil, Seroxat), duloxetine (Cymbalta) and venlafaxine (Effexor, Efexor)
  • Alpha-2 adrenergic agonists:  Such as clonidine (Catapres) and guanfacine (Tenex)
  • Cox-2 inhibitors:  celecoxib (Celebrex, Celebra) - more about cox-2 inhibitors.
  • Antihistamines:  pizotifen (Sandomigran) and cyproheptadine (Periactin)
  • ACE inhibitors:  Or inhibitors of Angiotensin-Converting Enzyme.  This is a big category including drugs such as fosinopril (Monopril), benazepril (Lotensin) and enalapril (Renitec, Vasotec)
  • Angiotensin II receptor antagonists:  including losartan (Cozaar) and irbesartan (Avapro, Karvea)
  • Leukotriene blockers:  such as zyleuton (Zyflo) and montelukast (Singulair)
  • Others:  There are always new preventative migraine medications under investigation.  One of the most well known today is Botox (read more about using Botox for migraine).  Another is a GABA agonist known as baclofen (Kemstro, Lioresal).  Sometimes NSAIDs (anti-inflammatory drugs) are recommended as migraine preventatives as well.  However, some are avoided because of the dangers of long term use.
Migraine medication


For highlights, check out what the National Headache Foundation (USA) has to say about migraine medications.