Medications for migraines fall into two categories: those that relieve pain, and those that prevent migraines. Drugs commonly used in the treatment of this condition include:

Angiotensin-Converting Enzyme (ACE) inhibitors (Lisinopril, Enalapril, Candesartan)

  • Drugs normally used to treat high blood pressure that also help prevent migraines and reduce symptoms
  • May cause dizziness or fainting from too-low blood pressure if taken with alcoholic beverages

Acetaminophen (Tylenol, others)

  • Over-the-counter medication believed to work on brain areas that receive pain signals and control body temperature
  • Overuse of any OTC pain reliever may cause gastrointestinal bleeding, ulcers or medication-overuse headaches.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs including aspirin, ibuprofen, naproxen)

  • Over-the-counter medication that reduces levels of prostaglandins (hormone-like substances) that irritate nerve endings, causing pain
  • Overuse of any OTC pain reliever may cause gastrointestinal bleeding, ulcers, and/or medication- overuse headaches.

Anti-nausea medications (Chlorpromazine, Metoclopramide, Prochlorperazine, Indomethacin)

  • Combined with pain relievers
  • Used to help prevent and relieve nausea and vomiting commonly associated with migraines

Anti-seizure drugs (Valproate, Topiramat, Valproate)

  • Normally used to treat seizures; reduces the frequency of migraines
  • Believed to calm over- excitable nerve cells that send pain signals to the brain
  • Not for use in pregnant women, due to a high risk of potentially devastating effects on the fetus

Beta blockers (Propranolol, Metoprolol, Timolol)

  • Normally used to treat high blood pressure and coronary artery disease; may reduce frequency and severity of migraines.
  • May take several weeks of taking them to see improvement
  • Not be recommended for people who smoke, are aged 60 or older, or have certain heart or blood vessel problems

OnabotulinumtoxinA (Botox)

  • Given by injection in the forehead and neck
  • May need to be repeated every 12 weeks to remain effective

Calcium channel blockers (Diltiazem, Nifedipine, Nimodipine, Verapamil)

  • Normally used to treat high blood pressure; may also help relieve migraine pain
  • Used with other pain relievers to help improve symptoms

Corticosteroids (Dexamethasone Prednisone)

  • Mimics the effects of hormones your body produces naturally; suppresses inflammation
  • Risk of steroid toxicity limits frequency of use

Ergots (Dihydroergotamine, Ergotamine)

  • Most effective when pain lasts longer than 48 hours
  • May cause medication overuse headaches

Opioids (Codeine, Hydrocodone, Meperidine, Oxycodone)

  • Short-acting forms used for moderate to severe migraine pain
  • May be prescribed alone or with acetaminophen
  • Act on nerve cell pain receptors to relieve pain
  • Habit-forming; risk of dependence limits frequency of use
  • Used for people who can’t take ergot or triptans and when other pain relievers fail

Selective Serotonin-Norepinephrine Reuptake Inhibitors (Venlafaxine, Desvenlafaxine)

  • Antidepressants that act on brain chemicals used to send messages from one nerve cell to another; helps to prevent migraines
  • Risk of suicidal thoughts, especially in children younger than age 18

Tricyclic antidepressant (Amitriptyline)

  • Acts on brain chemicals, including serotonin
  • Amitriptyline is the only tricyclic proven to prevent migraines

Triptans (Sumatriptan, Rizatriptan, Almotriptan, Naratriptan, Zolmitriptan, Frovatriptan, Eletriptan)

  • Target and stimulate serotonin receptors in the brain to block pain pathways
  • Side effects include dizziness, nausea, drowsiness and muscle weakness
  • Not recommended for people at risk for heart attacks and stroke