Migraine medications fall into two broad categories.
When a migraine begins, you might turn to drugs that ease the pain (acute treatment).
An over-the-counter (OTC) pain reliever may ease mild to moderate migraines but can’t prevent them.
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Some prescription medications relieve the pain of an acute migraine, while others reduce or prevent future migraine attacks.
There are two classes of non-prescription painkillers: nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen.
You may need to try different medications to find the one that works best for you.
However, a study published inNeurologyin 2023 offers some guidance.
The researchers reviewed information from millions of people with migraines.
They found that ibuprofen was rated as the most effective and acetaminophen the least effective for relieving migraine pain.
However, ibuprofen was only helpful 42% of the time.
NSAIDs
NSAIDs relieve pain, lower a fever, and reduce inflammation.
These medications work by decreasing the production of hormone-like compounds that transmit pain signals calledprostaglandins.
Acetaminophen
This medication reduces a fever by affecting the heat-regulating area of your brain.
It also blocks the production of prostaglandins, but does it through different pathways in the body than NSAIDs.
As a result, it relieves pain but doesn’t affect inflammation.
There are numerous brand names for acetaminophen, with the most common beingTylenol.
There are also many generic and store-brand versions available.
It’s important to never mix acetaminophen with alcohol.
Talk to your healthcare provider if you are also taking any other medications, as drug interactions can occur.
When not taken properly, acetaminophen can causeliver damagein some people.
OTC Products Targeting Migraines
Several OTC medications are formulated to target migraine headaches.
Excedrin Migraine tablets contain aspirin, acetaminophen, and caffeine.Caffeine enhances the effect of the two pain relievers.
Advil Migraine and Motrin IB Migraine contain ibuprofen in a liquid form.
The liquid provides faster pain relief compared to other forms of ibuprofen.
They reduce your pain and may also shorten the duration of your headache.
They work by stimulating receptors for serotonin (a brain chemical).
As a result, they reduce the inflammatory cascade that leads to migraine.
Triptans may also lower levels of a protein called calcitonin gene-related peptide (CGRP).
CGRP levels increase during a migraine, resulting in dilated blood vessels, inflammation, and pain.
Triptan medications
There are seven triptans available for the acute treatment of migraine headaches.
As with any medication, triptans have potential side effects.
People who have heart disease or high blood pressure that isn’t under control shouldn’t take triptans.
These drugs can increase blood pressure by tightening blood vessels.
CGRP Inhibitors
CGRP inhibitorswork by blocking CGRP receptors in the brain.
This activity minimizes blood vessel dilation and nerve inflammation.
However, they may cause nausea, dry mouth, and constipation.
Dihydroergotamine
Dihydroergotamine, which is available as D.H.E.
45 or Migranal, is in a class of drugs known as ergot alkaloids.
The most common side effects of this medication include upset stomach, dizziness, weakness, and fatigue.
Some rare but potentially serious problems associated with dihydroergotamine require immediate medical attention.
In addition to treating pain, steroids may also prevent a migraine from recurring within 72 hours.
Medications to Treat Nausea
Many people who have migraines are plagued withnausea and vomitingalong with head pain.
For this reason,antiemeticsto reduce vomiting are often part of the pharmacologic arsenal for treating migraines.
Antiemetics are in a class of drugs called dopamine-receptor antagonists.
Antiemetics may be prescribed for use at home and can be administered orally or rectally.
In the ER, they may be given intravenously or by injection into a muscle.
Your healthcare provider may recommend this treatment if you have four or more migraine days per month.
These injections are safe and seldom cause side effects.
However, they may increase blood pressure and cause constipation.
You may also have temporary soreness at the injection site.
There are currently four of these medications:
The first three in this list are self-injected at home.
You inject them once a month or every three months, depending on the medication.
Eptinezumab is administered through an intravenous infusion once every three months.
Botox
Botox injectionsare used for people withchronic migraines.
it’s crucial that you have Botox injections every three months to maintain your results.
These medications include:
These medications come with the risk of side effects.
A few examples include weight gain, dizziness, constipation, memory problems, and low blood pressure.
There are numerous migraine medication options for relieving the pain when a headache begins.
OTC medications may help mild to moderate migraines.
However, many people need prescription medications to achieve significant pain relief.
Preventive migraine medications reduce the number and severity of future migraines.
This group includes Botox and advanced medications like CGRP inhibitors and CGRP monoclonal antibodies.
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