Migraine medication, such as sumatriptan, ibuprofen, prednisone, and propranolol, can be used to treat or prevent migraine attacks. These medicines work by blocking pain signals or reducing the dilation of blood vessels in the brain.
Treatment for migraines should be gradual and can include other techniques such as meditation or cognitive-behavioral therapy (CBT). These approaches help prevent excessive medication use and reduce the risk of new migraine episodes.
Migraine medication should be prescribed by a neurologist or primary care provider after evaluating your symptoms and determining which type of migraine you have. This allows the provider to choose the most appropriate medication for each individual case.
Treatment options
The main types of migraine medication that may be prescribed by a healthcare provider include:
1. Ibuprofen
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used to treat acute migraine attacks. It works by reducing the production of inflammatory substances in the body, which helps relieve severe headaches.
This medication is often the first choice for migraine treatment. The typical adult dosage is one 400 mg tablet every 6 to 8 hours, or one 600 mg tablet 2 to 3 times per day.
Other NSAIDs that may be prescribed include potassium diclofenac or aspirin.
2. Acetaminophen
Acetaminophen is an analgesic used to treat acute migraine attacks in people who cannot tolerate or are contraindicated for NSAIDs.
The usual adult dose is one 1000 mg (1 g) tablet 3 to 4 times a day. The maximum daily dose should not exceed 4000 mg, or four 1000 mg tablets.
3. Sumatriptan
Sumatriptan, also known as sumatriptan succinate, is a migraine medication in the triptan class. It is indicated for acute migraine attacks, with or without aura, and works best when taken at the first sign of symptoms.
This medicine is generally recommended when three consecutive migraine attacks do not improve with NSAIDs or pain relievers.
Sumatriptan acts by narrowing the blood vessels in the brain and blocking pain signals. It is available in 25 mg, 50 mg, and 100 mg tablets under brand names such as Imitrex, among others.
Other triptans that may be prescribed include naratriptan (Amerge), zolmitriptan (Zomig), and rizatriptan (Maxalt).
These medications should only be used by adults under medical supervision. They are not recommended during pregnancy or for people with high blood pressure, cerebrovascular disease, coronary artery disease, or peripheral vascular disease.
4. Ubrogepant
Ubrogepant, as well as rimegepant, are migraine medications approved in the United States for acute migraine treatment when triptans are not effective or contraindicated.
These drugs act by blocking the calcitonin gene–related peptide (CGRP) receptor, helping reduce pain and other migraine symptoms.
5. Dihydroergotamine mesylate
Dihydroergotamine mesylate is an ergotamine-class medication used to treat acute migraine attacks.
It can be administered as a nasal spray or injection and is typically prescribed when triptans are not effective or cannot be used. Dihydroergotamine works by constricting blood vessels in the brain and blocking pain signals.
It is sold under under the brand names Migranal, Trudhesa, and D.H.E. 45, among others, and should only be used under medical supervision.
6. Metoclopramide
Metoclopramide is an antiemetic used off-label to relieve nausea and vomiting during acute migraine attacks. It can be used alongside other migraine medications to help manage symptoms.
It works by increasing the contractions of the digestive tract muscles, speeding up stomach and intestinal emptying to ease nausea and vomiting. Its effects usually begin within 30 to 60 minutes after oral administration.
Another antiemetic that may be prescribed for migraines is chlorpromazine.
7. Prednisone
Prednisone, as well as methylprednisolone, are corticosteroids that may be prescribed to treat severe or acute migraine attacks. Although not officially labeled for migraines, these drugs can quickly relieve pain and are sometimes used when migraines are triggered by medication overuse.
Corticosteroid treatment is generally short-term to avoid side effects associated with long-term use.
In severe cases, methylprednisolone may be administered intravenously or intramuscularly by a healthcare professional in a hospital.
8. Propranolol
Propranolol is a beta-blocker that is often prescribed as a first-line migraine medication for prevention.
It works by dilating blood vessels and improving blood flow to the brain, which can help prevent migraine attacks.
Other beta-blockers that may be prescribed include metoprolol or atenolol.
9. Topiramate
Topiramate is an anticonvulsant medication used to prevent migraines in adults.
It is available in tablet form under brand names such as Topamax or Qudexy XR.
Another anticonvulsant that may be prescribed as a second-line option is valproic acid (Depakote or Depakene).
10. Amitriptyline
Amitriptyline is an antidepressant that can also be used off-label to prevent migraine attacks in adults.
It is available in tablet or capsule form under the brand name Elavil, among others.
11. Erenumab
Erenumab is a monoclonal antibody given as a subcutaneous injection to prevent migraine attacks in people who experience at least four migraine days per month.
This migraine medication is available under the brand name Aimovig. The recommended adult dosage is 70 mg to 140 mg, administered once a month.
Other monoclonal antibodies that may be prescribed include fremanezumab (Ajovy) and galcanezumab (Emgality).
12. Botulinum toxin type A
Botulinum toxin type A (Botox) injections may be recommended for preventing migraine attacks in adults with chronic migraine (defined as 15 or more headache days per month).
The toxin is injected around the scalp by a doctor in a single session and can reduce the frequency and severity of migraines while decreasing the need for preventive medications.
Side effects
The most common side effects of migraine medication include nausea, dizziness, muscle weakness, changes in sensation in the hands and feet, stomach ulcers, high blood pressure, palpitations, or paleness (pallor).
Side effects vary depending on the type of medication and individual response. If any of these effects occur, a healthcare provider may adjust the dosage or prescribe an alternative treatment.
Contraindications for use
Most migraine medications are not recommended for people who are pregnant or breastfeeding.
In addition, certain drugs should be used with caution by people with high blood pressure, heart problems, cerebral ischemia, diabetes, high cholesterol, or obesity.
It is always important to consult a neurologist, who can prescribe the most suitable migraine medication based on individual needs.