A Guide to 5 Common Medications for Migraine Relief

If you suffer from migraines, you know they are much more than just a bad headache. Finding effective treatment is a top priority. Learn more about common medications used to manage migraines, and this guide will provide a clear overview of five key types of medication that doctors often prescribe or recommend.

Important: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before starting, stopping, or changing any medication or treatment plan.

Understanding Migraine Treatment Approaches

Before diving into specific medications, it’s helpful to know that migraine treatments generally fall into two categories:

1. Acute (or Abortive) Treatment: These medications are taken at the first sign of a migraine attack to stop it in its tracks and relieve symptoms like pain, nausea, and sensitivity to light and sound.
2. Preventive (or Prophylactic) Treatment: These medications are taken regularly, often daily, to reduce the frequency, severity, and duration of migraine attacks. They are typically recommended for people who experience frequent or debilitating migraines.

Here are five common classes of medications used to treat migraines, covering both acute and preventive strategies.

1. Triptans (Acute Treatment)

Triptans are a class of drugs specifically designed to stop a migraine attack after it has started. They are one of the most common and effective types of acute migraine medication prescribed by doctors.

How They Work: Triptans work by binding to serotonin receptors in the brain. This action helps to narrow blood vessels that have dilated during a migraine and block pain pathways. They target the underlying processes of a migraine attack rather than just masking the pain.

Common Examples:

• Sumatriptan (Brand names: Imitrex, Onzetra, Sumavel)
• Rizatriptan (Brand name: Maxalt)
• Eletriptan (Brand name: Relpax)
• Zolmitriptan (Brand name: Zomig)
• Naratriptan (Brand name: Amerge)

Triptans are available in various forms, including tablets, nasal sprays, and injections, which can be helpful if a migraine causes severe nausea and vomiting. They are most effective when taken as soon as you feel a migraine starting. A doctor will help determine which triptan and dosage form is right for you, as they are not suitable for people with certain cardiovascular conditions.

2. NSAIDs (Acute Treatment)

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a familiar group of pain relievers that can be effective for mild to moderate migraine attacks. Many are available over the counter, while others require a prescription.

How They Work: NSAIDs reduce pain and inflammation by blocking the production of enzymes called prostaglandins. During a migraine, prostaglandin levels can increase, contributing to pain and inflammation.

Common Examples:

• Ibuprofen (Brand names: Advil, Motrin)
• Naproxen Sodium (Brand name: Aleve)
• Aspirin
• Diclofenac (Prescription, brand name: Cambia)

For many people, combining an NSAID with caffeine can increase its effectiveness. This is why some over-the-counter products, like Excedrin Migraine, combine aspirin, acetaminophen, and caffeine. While helpful, overusing NSAIDs can lead to medication-overuse headaches, a condition where frequent use of pain relievers actually starts causing more headaches.

3. CGRP Antagonists (Acute and Preventive)

Calcitonin gene-related peptide (CGRP) antagonists are a newer class of migraine medications that have provided new hope for many sufferers. CGRP is a protein in the brain and nervous system that is known to play a key role in causing migraine pain and inflammation.

How They Work: These drugs work by blocking the CGRP protein or its receptor. By doing so, they can either stop a migraine attack that is already underway or, when taken preventively, stop one from ever starting.

This class includes two main types:

• Gepants (Acute Treatment): These are small-molecule drugs taken as oral tablets to stop an active migraine. They offer an alternative for people who cannot take triptans or do not respond to them. Examples include Ubrogepant (Ubrelvy) and Rimegepant (Nurtec ODT).
• Monoclonal Antibodies (Preventive Treatment): These are biologic drugs given as an injection or infusion on a monthly or quarterly basis to prevent migraines. Examples include Erenumab (Aimovig), Fremanezumab (Ajovy), and Galcanezumab (Emgality).

4. Beta-Blockers (Preventive Treatment)

Originally developed to treat high blood pressure and heart conditions, beta-blockers were found to be effective at preventing migraine attacks in many people. They are one of the most widely used and well-studied classes of preventive migraine medication.

How They Work: The exact way beta-blockers prevent migraines isn’t fully understood, but it’s believed they help calm overactive nerve cells in the brain and stabilize blood vessels. They essentially help raise the threshold for a migraine attack to be triggered.

Common Examples:

• Propranolol (Brand name: Inderal)
• Metoprolol (Brand name: Lopressor)
• Timolol

Because they also lower blood pressure and heart rate, they may not be suitable for everyone, particularly those with asthma or low blood pressure. A doctor prescribes these for daily use to reduce the overall frequency of migraines over time. It can take several weeks or even a couple of months to see the full preventive benefit.

5. Antidepressants (Preventive Treatment)

Certain types of antidepressants have also been proven to be effective in preventing migraine attacks, even in people who do not have depression. The two main classes used for migraine prevention are tricyclic antidepressants (TCAs) and SNRIs.

How They Work: These medications are thought to prevent migraines by increasing the levels of certain neurotransmitters in the brain, like serotonin and norepinephrine. These chemical messengers play a role in how the brain processes pain signals, and stabilizing their levels can make you less susceptible to migraines.

Common Examples:

• Amitriptyline: This is one of the most commonly prescribed tricyclic antidepressants for migraine prevention.
• Venlafaxine (Brand name: Effexor XR): This is a serotonin and norepinephrine reuptake inhibitor (SNRI) that is also used for prevention.

Like beta-blockers, these medications are taken daily and can take several weeks to become effective. They are often started at a low dose and gradually increased to find the right balance between effectiveness and potential side effects.

Frequently Asked Questions

What is a medication-overuse headache? This is a chronic daily headache that develops from the frequent use of acute pain medications (more than 10-15 days per month). The best way to avoid it is to limit the use of acute medications and talk to your doctor about preventive options if you have frequent headaches.

Can I combine different types of migraine medications? In some cases, yes, but this must be done under the strict guidance of a healthcare professional. For example, a doctor might prescribe a triptan and an NSAID to be taken together for a severe attack. Never combine medications without consulting your doctor first.

When should I consider preventive medication? You might be a candidate for preventive medication if you experience four or more migraine days per month, if your attacks are particularly severe and don’t respond well to acute treatment, or if migraines are significantly impacting your quality of life. A conversation with your doctor can help you decide if this is the right path for you.