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Understanding the Types of Migraine Medications: A Guide for Migraineurs

If you ask me, medications can be one of the most confusing parts of any health condition. However, migraine medications can be especially confusing because there are different types of medications for different reasons, and sometimes people take multiple medications depending on the day. Plus, as more doctors spend time researching migraine, more medications hit the market, which throws everything off-kilter.

Whether you are new to your migraine diagnosis or a veteran who is looking for better options, you may want to know how migraine medications work and what options are available to you. Well, luckily for you, this list breaks down the most common types of migraine medications based on whether they help with prevention, acute treatment, or can be purchased over-the-counter.

Preventative Migraine Medications

Many people with migraine use preventative medications to reduce the frequency and severity of migraine attacks. People who are prescribed these medications take them daily or receive them as injections monthly or quarterly. While there are many different preventative medications available to migraineurs, they fall under four main types of preventative medications: antihypertensives, anticonvulsants, antidepressants, and CGRP inhibitors.

Antihypertensives typically treat high blood pressure, but can also help prevent migraine attacks. Common antihypertensives used for migraine treatment include lisinopril (an angiotensin-converting enzyme inhibitor), propranolol (a beta-blocker), and candesartan (an angiotensin receptor blocker). Most doctors believe that these medications prevent migraine symptoms by lowering the blood pressure of the individual using them.

Unfortunately, these medications can come with side effects. Furthermore, since they lower blood pressure, they can cause issues for individuals who already experience low blood pressure.

Anticonvulsants, which are also called anti-seizure medications, can also help people experience less frequent and less severe symptoms. Topiramate (Topamax®) and valproate (Depakote®) are commonly used anticonvulsants for migraine. These medications are also used for epilepsy, and researchers believe these medications work as a preventative for migraine because the two conditions share several characteristics.

However, anticonvulsants aren’t a great preventative option for everyone, especially women who also use birth control. They can also cause many side effects, including nausea, dizziness, tremors, or tingling in the arms.

Believe it or not, some antidepressants also work for migraine prevention. More specifically, some tricyclic antidepressants (amitriptyline) and SNRI antidepressants (Effexor) help prevent migraine attacks by affecting chemical levels within the brain. As an added bonus, these medications can also help if people live with a comorbidity of depression with migraine.

More recently, doctors have started using calcitonin gene-related peptide (CGRP) inhibitors for migraine prevention. Unlike the other migraine preventative options out there, these come in the form of injections that can be self-administered or administered by a healthcare provider either monthly or quarterly. Although Aimovig is the most commonly recognized CGRP inhibitor available, there are several different options.

Finally, some people receive Botox injections as a migraine preventative. Typically this is only an option for people with chronic migraine, and are administered quarterly.

With any of these preventatives, your doctor will need to weigh the pros and cons with you to determine which options may be best based on your health and any other underlying conditions. Furthermore, your insurance may impact your ability to receive some of these preventatives, especially in the case of the CGRP inhibitors and Botox injections.

Abortive Migraine Medications

Unfortunately, even the most effective preventative medications don’t stop migraine attacks completely. For this reason, many people who live with migraine rely on acute medications, also called abortives, on an as-needed basis to help stop migraine once a person notices the first signs of an attack. Abortive medications include: triptans, nonsteroidal anti-inflammatory drugs (NSAIDs), ergotamines, CGRP antagonists, and dihydroergotamine (DHE).

Although they are often the topic of migraine memes, triptans are some of the most commonly prescribed acute medications for migraine. These medications are specifically designed for migraine management and come in a variety of forms. In fact, there are triptans available as tablets, injections, and even nasal sprays. There are a total of seven types of triptans available.

Triptans work almost like serotonin and essentially reverse the effects of migraine. When taken early enough, people find these abortives highly effective. Unfortunately, triptans are not recommended for hemiplegic migraine, nor can anyone with a history of heart disease or hypertension take these abortive medications. They also come with a fair amount of side effects.

While typically available as over-the-counter medications, prescription NSAIDs are also available for the treatment of migraine. These medications are usually most effective when taken in the early stages of a migraine attack, and can even be taken alongside triptans in some cases.

Unfortunately, NSAIDs can impact a person’s digestive tract, especially the lining of the stomach and intestines. Furthermore, NSAIDs commonly cause rebound headaches in people who take these medications more than 10 times per month.

CGRP antagonists are a relatively new type of acute migraine treatment. These medications essentially decrease artery inflammation, which essentially stops a migraine from escalating. Currently, there are three oral CGRP antagonists available with FDA approval, and studies show these may be the most effective form of migraine abortive yet.

Dihydroergotamine (DHE) is another prescription abortive available. Although it is primarily used in emergency rooms, it has become more available to the general public in recent years. It works rapidly to narrow blood vessels and relieve other symptoms of migraine. It can be used both during prodrome and during the headache or attack phase for relief.

DHE is a great alternative to many of the other acute migraine medications out there because it comes in many forms, including nasal sprays, intravenous infusions, and injections.

Over-the-Counter Migraine Medications

People who live with migraine often rely on many over-the-counter medications to help with their symptoms as well. These are typically pain relievers that can help with acute migraine treatment or as a preventative.
Common over-the-counter medications for migraine include:

  • Acetaminophen
  • Ibuprofen
  • Naproxen (Aleve)
  • Aspirin
  • Aspirin + Acetaminophen + Caffeine (Excedrin, Goody’s)

While these medications can help with migraine pain, they can also cause rebound headaches and other unwanted side effects. Anyone who experiences 10 or more days of migraine attacks in a month should consider replacing over-the-counter medication use with other options if at all possible.

As you can tell, there are countless options out there for migraine medications. However, most of them fall under one of three main umbrellas (preventative, abortive, and over-the-counter) as a part of one of about a dozen categories of migraine treatment. Hopefully, this list makes the confusing world of migraine medication a little easier to understand.

Just remember — it’s always best to consult a doctor who specializes in migraine and ask the right questions before starting on any type of medication or other treatment for your migraine symptoms.

Getty image by Marko Geber.

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