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Treatments and drugs
By Mayo Clinic staffSeveral drugs are available to treat migraines. These range from over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) to prescription medications. Your doctor can help you decide which medications are best for your situation.
Medications that can be used to treat your migraine pain include:
- Analgesics. Over-the-counter pain relievers — such as acetaminophen (Tylenol, others), a combination of acetaminophen, aspirin and caffeine (Excedrin), ibuprofen (Advil, Motrin, others), and naproxen (Aleve, others) — may be all you need to relieve your headache pain. Prescription-strength analgesics also are available. Don't take analgesic drugs for more than 10 days in a month, because these medications can lead to what's known as a medication-overuse headache.
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Triptans. When taken early in the course of a migraine, these drugs can quickly relieve migraine symptoms by acting on the nerves and blood vessels. This class of medications includes sumatriptan (Imitrex), zolmitriptan (Zomig), almotriptan (Axert), rizatriptan (Maxalt), naratriptan (Amerge), eletriptan (Relpax), frovatriptan (Frova), and a combination drug that includes sumatriptan plus naproxen (Treximet). Side effects of triptans include nausea, dizziness, drowsiness and, rarely, heart attack. People with a history of heart disease, stroke and high blood pressure and women who are pregnant should not take these medications.
Additionally, people who take the antidepressant medications known as selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs) should use these medications with caution, as there's a small risk of developing serotonin syndrome when these drugs are combined.
- Ergots. Ergotamine (Ergomar) is an older migraine treatment that tends to have more side effects than do triptan medications. It's also not recommended for people who have migraines with auras. Dihydroergotamine (D.H.E. 45, Migranal) works in a similar manner to ergotamine, but is more commonly prescribed because it's more effective and has fewer side effects.
- Anti-nausea drugs. Because nausea with or without vomiting is a common symptom of migraine, anti-nausea medications may be prescribed along with other migraine drugs. Drugs in this class include chlorpromazine, prochlorperazine and metoclopramide.
Preventive medications
Because overuse of analgesics can cause medication-overuse headaches, doctors recommend preventive drugs to reduce the frequency and severity of migraine attacks. Your doctor may recommend preventive medications if you're having more than four headaches a month, your headaches last more than 12 hours, or you're disabled by your migraines. Preventive medication options include:
- Cardiovascular medications. Certain classes of heart and blood pressure medications, including beta blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARB) may be prescribed to help prevent your migraines. Of these treatments, beta blockers, such as propranolol (Inderal LA) and timolol, are the most well-studied. It may take several weeks to months before these medications are effective, and they're not recommended for people with low blood pressure.
- Antidepressants. Tricyclic antidepressants, such as amitriptyline, can help prevent migraines. Side effects of these medications include drowsiness, dry mouth, constipation, heart palpitations and weight gain.
- Anti-seizure drugs. Certain anticonvulsants are effective in reducing the frequency of migraine, though the reason they work on migraine isn't clear. Divalproex sodium (Depakote), topiramate (Topamax) and gabapentin (Neurontin) — drugs normally used to treat the seizure disorder epilepsy — help prevent migraines. These medications can't be used by pregnant women, and they may cause weight gain.
Previously, some research had suggested that botulinum toxin type A (Botox) might be an effective treatment for migraine. However, more recent studies have failed to find a benefit, and botulinum toxin isn't recommended for migraine treatment.
Stress management
Cognitive behavioral therapy, a technique that teaches you more appropriate ways to deal with stressful situations, may help reduce the number of migraines you have.
- Bajwa ZH, et al. Pathophysiology, clinical manifestations, and diagnosis of migraine in adults. http://www.uptodate.com/home/index.html. Accessed Jan. 9, 2009.
- Headache: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/headache/detail_headache.htm?css=print. Accessed Jan. 11, 2009.
- Pelak VS. Approach to the patient with visual hallucinations. http://www.uptodate.com/home/index.html. Accessed Jan. 9, 2009.
- Ramzan M, et al. Headache, migraine, and stroke. http://www.uptodate.com/home/index.html. Accessed Jan. 9, 2009.
- Bajwa ZH, et al. Acute treatment of migraine in adults. http://www.uptodate.com/home/index.html. Accessed Jan. 9, 2009.
- Migraine - What are the treatments? American Academy of Neurology. http://www.thebrainmatters.org/index.cfm?key=1.9.6 1/. Accessed Jan. 12, 2009.
- Bajwa ZH, et al. Preventive treatment of migraine in adults. http://www.uptodate.com/home/index.html. Accessed Jan. 9, 2009.
- Swanson JW (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 15, 2009.
- Tinel D, et al. Vertebrobasilar ischemia after cervical spine manipulation: A case report. Annales de readaptation et de medecine physique 208;51:403.
- Haldeman S, et al. Stroke, cerebral artery dissection, and cervical spine manipulation therapy. Journal of Neurology. 2002;249:1098.
