Getting to Know Migraine Medications
When looking at migraine pain relief options, migraine medications fall into one of two categories — preventatives and abortives.
Preventative migraine medications are taken daily to help prevent migraine attacks from occurring. Abortive migraine medications are taken when a migraine presents itself in order to stop the migraine. The earlier these are taken the better they work at stopping the migraine.
Which Medications Are Used as Preventatives?
Prevention is key when someone with migraine experiences frequent and disabling attacks. For instance, someone with chronic migraine who has 15 or more migraines a month would benefit from taking a preventative medication.
There are no drugs on the market that specifically target and prevent migraines, however, certain blood pressure medications, anti-seizure drugs, antidepressants, and some herbals have been shown to help in migraine prevention.
There are numerous medications that have been used off-label as a preventative for migraine. Divalproex sodium/sodium valproate, topiramate (Topamax), metoprolol (Lopressor, Toprol XL), propranolol (Inderal), and timolol (Blocadren, Betimol) have been recommended by the American Headache Society and American Academy of Neurology (AAN) based on their proven effectiveness in controlled clinical trials.
Other medications that have been used to prevent migraine include the following:
- ACE inhibitors, like lisinopril (Prinivil/Zestril)
- Angiotensin II receptor antagonists (ARBS), like candesartan (Atacand)
- Beta-blockers, like atenolol(Tenormin) and nadolol
- Calcium channel blockers, like Diltiazem (Cardizem LA), nimodipine (Nimotop) and verapamil (Isoptin, Calan)
- Tricyclic antidepressants, like amitriptyline(Elavil), nortriptyline (Nortriptyline Hydrochloride, Nortriptyline Hydrochloride Oral Solution, Pamelor), imipramine, doxepin (Silenor), and protriptyline (Vivactil)
- Other antidepressants, like paroxetine (Paxil), fluoxetine (Prozac), and sertraline (Zoloft)
- Anti-seizure medications, like topiramate (Topamax), gabapentin (Neurontin), and divalproex sodium (Depakote)
- Herbals, like feverfew, butterbur, coenzyme Q10(CoQ10), and magnesium supplements
Which Medications Are Used as Abortives?
Common medications used as an abortive for migraine include over-the-counter (OTC) medications such as NSAIDS, analgesics, and caffeine, including Aspirin, naprosyn (Naproxen, Anaprox, Anaprox DS), acetaminophen (Tylenol), and ibuprofen (Motrin).
Ergot alkaloids are strong medications that constrict blood vessels, something that OTC drugs do not do. The most commonly prescribed ergots are Cafergot (ergotamine tartrate) and D.H.E. 45 injection or Migranal nasal spray (dihydroergotamine mesylate).
Triptans target serotonin receptors, cause constriction of blood vessels, and interrupt the chain of chemical events that lead to a migraine. These include:
- Almotriptan (Axert)
- Eletriptan (Relpax)
- Frovatriptan (Frova)
- Naratriptan (Amerge)
- Rizatriptan (Maxalt, Maxalt—MLT)
- Sumatriptan (Imitrex, Zecuity)
- Zolmitriptan (Zomig, Zomig-ZMT)
Next page: side effects of migraine medications.