Medication Options to Treat Migraines
Migraine headaches are a type of headache characterized by recurrent episodes of moderate to severe throbbing or pulsating pain. These headaches can last anywhere from four to 72 hours if left untreated. Individuals with migraines may also experience other symptoms such as increased sensitivity to light, noise, and odors, as well as nausea and vomiting.
There are several types of medications used to treat migraine headaches. Each medication type has a different effect in helping to treat migraines, and they also come with precautions and potential side effects. Medications for migraine may be for acute treatment or preventive treatment.
The goal of acute migraine treatment is to stop a migraine that has started, alleviate symptoms such as pain and nausea and vomiting, and restore function. Medication options for acute treatment of migraine include:
- Over-the-counter (non-prescription) pain relievers such as acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs): These medications are generally considered first-line treatments for mild-to-moderate migraines.
- Side effects of pain relievers include stomach upset, indigestion, and nausea.
- It is important to know that overusing over-the-counter pain relievers may cause rebound headaches (also called medication overuse headaches). Consult a healthcare professional if these pain relievers are needed more than two or three times per week.
- Triptans: These drugs stimulate serotonin receptors in the brain to block the pain pathway and help to narrow (constrict) the blood vessels in the brain. Triptans are available as pills, nasal sprays, and injections.
- Side effects include dizziness, drowsiness, flushing, and nausea. Rarely, triptans may cause chest pain.
- Calcitonin gene-related peptides (CGRP) receptor antagonists: These drugs block the effect of CGRP, a protein that causes migraines when released in the brain. The type of CGRP used for acute treatment of migraine are called gepants. Gepants are available as pills and a nasal spray.
- Side effects include nausea, dizziness, dry mouth and drowsiness. Less common side effects include chest tightness.
- Ditans: These medications bind to a serotonin receptor in the brain to prevent the release of CGRP that leads to migraine headache. These medications may come as a tablet.
- Side effects include dizziness, fast heartbeat, sleepiness, and diarrhea.
- Ergotamines: These drugs narrow blood vessels in the brain to help relieve a migraine headache. These medications come as a nasal spray or injection.
- Side effects include nausea and vomiting
- Antinausea medications may also be used to help stop the nausea and vomiting symptoms of a migraine. In addition, antinausea medications have been shown in many cases to actually stop the headache.
The goal of preventive treatment for migraines is to reduce the frequency, severity, and duration of attacks. These medications work by targeting the disease mechanisms of migraines and include:
- Beta-blockers: Beta-blockers like propranolol work by reducing stress and have different actions on the brain that help prevent migraine attacks.
- Side effects may include fatigue, headache, and changes in blood pressure.
- Antidepressants: Some types of antidepressant medications may be used migraine prevention. They regulate neurotransmitters in the brain to prevent certain migraine symptoms. Antidepressants may be helpful for people with both mood disorders and migraines.
- Side effects can include nausea, constipation, dizziness, and weight changes.
- Anticonvulsants (antiseizure medications): These medications work by reducing the frequency and severity of migraine attacks.
- Side effects can include dizziness, drowsiness, and nausea.
- Calcium channel blockers: These medications work by relaxing blood vessels and reducing the frequency and severity of migraine attacks.
- Side effects include dizziness, fatigue, low blood pressure, constipation, and fluid retention.
- Calcitonin-gene-related peptide (CGRP) antagonists or inhibitors can also be used for preventative treatment.
- Onabotulinum toxin A (botulinum neurotoxin): Onabotulinum toxin A is a biological treatment that has been shown to be effective for chronic migraine patients. It works by blocking the release of certain chemicals involved in pain transmission.
- Side effects of neurotoxin injections include neck pain or stiffness at the injection site, muscle weakness or paralysis in nearby muscles, and flu-like symptoms.
Each medication type has its own set of precautions and potential side effects. It's best to consult with a doctor before starting any medication for migraines to discuss the benefits and risks specific to your situation. They can provide more information about each medication type and help determine which one may be best for you based on your individual needs and medical history.