The long list of migraine medications gives you many treatment choices. Learn about the medications approved and recommended for migraine relief, sorted by med type.
There are basically three categories that I have broken down so you can easily see what’s FDA approved and recommended.
Over the Counter (OTC), Abortive and Preventative.
This list is not just what's available for headaches, but the approved medications specifically designed to target migraines.
Headache tablets are not recommended for migraines as they perform the wrong action. I have clients that say they take Mersyndol for the pain and then take too many when they don't work. There is a risk of overdose. Lets get clear on what works for migraines then you can discuss these with your doctor to find what will work best for you.
1. Three Over The Counter Products Are Approved
That’s right – three. Only three OTC products are currently on my list of migraine medications because they are approved by The Food and Drug Administration (FDA) to specifically treat migraines. These are:
Excedrin® Migraine is a combination of aspirin, acetaminophen and caffeine. It is recommended for reducing migraine pain and the associated symptoms.
Advil® Migraine and Motrin® Migraine Pain, both ibuprofen medications, are approved to treat migraine headaches and the associated pain.
This is what drugs.com says about Motrin Migraine Pain: "This medicine may cause life-threatening heart or circulation problems such as heart attack or stroke, especially if you use it long term."
Always discuss the side effects with your doctor before you take anything, or the pharmacist. Remember Non-steroidal anti-inflammatory agents or NSAIDs carry risks too, even though you can get them over the counter.
I never found any of these OTC combinations by themselves to help reduce my severe migraine pain. Not even a little bit! It was not until I combined ibuprofen with the triptan Naramig that I found effective relief from the attacks and symptoms. Please work with your doctor on finding a combination that works for you.
2. Abortive Medications
Here is the approved A-Z list of migraine medications called Triptans, with my accompanying results.
My research reveals these are all potent serotonin 5HT1 agonists:
• Almotriptan (Axert®)
• Eletriptan (Relpax®)
• Frovatriptan (Frova®)
• Naratriptan (Amerge®, Naramig®) seems to be working the best for me long term.
• Rizatriptan (Maxalt®) is available as a rapidly dissolving tablet. This one is nice it just dissolves and tastes like peppermint. Fantastic for those of us who experience nausea as a symptom. However, it was not long enough acting for my long episodes, so I felt I had to take too many for just one migraine. And waiting to take more in the recommended time ironically resulted in more nausea and vomiting.
• Sumatriptan (Imitrex®, Imigran®) is available in self-injection form, nasal spray and rapidly dissolving tablets. I found this tablet really strong. I felt like I was having a heart attack. But it aborted the migraine and boy did I feel euphoric after that.
• Sumatriptan and Naproxen Sodium (Treximet™) contains both Sumatriptan and Naproxen sodium which is a non steroidal anti-inflammatory drug (NSAID). There are strong warnings that this may increase the chance of a heart attack or stroke, and this chance increases with longer use of NSAID medicines.
• Zolmitriptan (Zomig®) available in tablets and nasal spray. Too strong for me! I experienced hot flushes and heart attack like side effects.
Some common side effects of these Triptans - and these are only a few - are: high cholesterol, heart disease, increased susceptibility to strokes, uncontrolled hypertension and diabetes.
I recommend getting the complete print out from your Pharmacist as there are contra indications with other medications like ergotamine and selective serotonin re-uptake inhibitors (SSRI's).
And just FYI - I am very skeptical of the Triptan drugs being sold over the internet. Please use a reputable local pharmacy and be safe.
3. Ergotamine Medications
Ergot Alkaloids relieve migraine or cluster headache symptoms by stimulating the chemical serotonin which is needed to transmit various nerve signals to the brain.
It decreases inflammation and reverses blood vessel dilation surrounding the brain.
Here are just a few to add to the list of migraine medications:
• Dihydroergotamine (DHE-45) is available by self injection and as a nasal spray called Migranal.
• Methysergide (Sansert)
• Ergotamine Tartrate (Bellamine, Cafergot, Ergostat)
Ergotamine preparations are normally made up by a compounding chemist making them more expensive and potentially hard to get. Ergotamine is the oldest "first line" of treatment. It is also known to have more severe side effects than some of the more recent medications.
Watch out for stomach or chest pain, tingling in your fingers and toes, blurred vision or any weakness experienced in your limbs. Please note - these drugs must not be taken for prolonged periods over weeks or months due to these high risks.
My body severely rejected
Cafergot on a number of occasions. The suppository made me vomit almost
instantly for hours. So much for that! This was not a good medication
for me. I wish you better luck with this one. My doctor takes this for her migraines because of its track record of successes.
4. Other Medications Recommended for Acute Migraine Attack Treatment
• Acetaminophen – isometheptene - dichloralphenazone (Midrin®). This combination constricts blood vessels, is a pain reliever and a mild sedative.
According to the National Headache Foundation, research shows that this is not "usually" an effective treatment for migraine headaches. It's also subject to additional rebound headaches if taken too often. I have not added it to my personal use list of migraine medications. If you do use it, use it for mild migraine headaches only.
• Corticosteroids may be used due to their anti-inflammatory effects.
• Alternative medical treatments that use medications in the Phenothiazine group have proved effective. These non-analgesic options treat severe migraine headaches and attacks lasting longer than 24 hours (these long attacks are called status migraines).
• And the approved over-the-counter medications listed above.
**Please note that the medications can have very different names in different countries. And note that ALL medications on this list of migraine medications have side effects. Please treat them, yes even natural herbs and supplements, with care and caution.
Always check with your Doctor first before taking anything. Develop a treatment plan ahead of time to manage your attacks.
The goal of preventative treatment medications is to lessen the frequency and severity of the migraine attacks.
The FDA has approved four drugs for migraine prevention – these are considered the “first line” of treatment medications (what doctors' should try first):
o Divalproex sodium (Depakote®) an anti-seizure medication
o Propranolol (Inderal®, Timolol®) a beta-blocker
o Timolol (Blocadren®) a beta-blocker
o Topiramate (Topamax®) an anti-seizure medication
It is essential that you take the adequate dose of the medicine for a sufficient length of time in order to determine its effectiveness for your migraine. You may need to reduce the dose if you are experiencing side effects. This is called “Titration” and needs to be discussed with your doctor.
If none of the four preventatives work for you, don't give up hope. Here is a list of prevention alternatives:
Amitriptyline (Elavil®, Endep®)
Nortriptyline (Pamelor®, Aventyl®)
Sodium Valproate (Epilim®)
Calcium channel blockers:
Diltiazem ( Dilacor®)
Minerals to Calm Nerve and Muscle Cells:
Magnesium - It is common for migraine sufferers to have low magnesium blood levels. It took me over two years to get my level up with intravenous magnesium pushes. If you experience confusion, jerking muscle movements, muscle weakness, or an uneven heart rate tell your doctor asap. You could be low in this vital mineral that calms the muscles and nerves.
Lithium Carbonate - Lithium affects the flow of sodium through nerve and muscle cells in the body to reduce the intensity of excitation and mania.
Some drugs are used in the treatment for headaches but are not specific for migraines.
These include analgesics, narcotics, and barbiturates. Since they can be addictive, they are less desirable than specific headache drugs listed above.
A narcotic analgesic like Codeine (or Fioricet, or Tylenol#3) can also be used as a "backup" for the occasions when a specific drug does not work, assuming it works for you in the first place.
Let this long list of migraine medications be motivation for you to find what works. It can be trial and error so use this medication tracker to help you work it out.
My research uncovered over 100 different migraine headache medications available on prescription. In some cases, one drug will have different names in different countries.
No matter what you read or what you decide to take as your migraine treatment, always consult your doctor first. Migraine is a serious medical condition and the medications used must not be taken lightly. Ask for drugs that have been through randomized controlled clinical trials, and not just clinical testing.
Walgreens is a reputable and reliable US (only) pharmacy that will refill prescriptions automatically and mail them to you. They also have compounding services. And you can ask questions of the Walgreens pharmacists in an online 'chat' for free.
Just click on the links to order your migraine medications from Walgreens. They offer free standard shipping on all orders of $25 or more.
Subscribe to our free periodic e-zine called Surviving Chronic Migraine to learn more about pain management strategies and becoming resilient. You can live well despite the migraines.
Until next time, be well and be pain free,
List of Migraine Medications References:
1. The National Headache Foundation (2011) Headache Topic Sheet: Migraine. www.headaches.org.
2. The U.S. Food and Drug Administration (2011) Patient Information Medication Guide: Treximet™ at: www.fda.gov/downloads/Drugs/DrugSafety/ucm089804.pdf.
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No one told me that the light at the end of the tunnel is a freight train.
- my adaptation on Charles Barkley's quote