Which medication should I use for migraine headaches?

Migraine headaches are throbbing headaches where the pain is usually felt on one side of your head. Other migraine symptoms include sensitivity to light or sound, nausea, vomiting, ringing in your ears, and a burning or tingling sensation in your head or limbs. You may also experience something called an “aura” before a migraine attack, which may appear as lights, lines, or blind spots in your vision.

Over-the-counter (OTC) pain relief

Headaches, including migraine headaches, can be treated with OTC pain relievers such as Aleve, Advil, Excedrin, and Tylenol. These medications come with risks such as gastrointestinal bleeding, kidney injury, and rebound headaches, especially with excessive use. Talk to your pharmacist to determine if one of these OTC pain relievers may be right for you.

Prescription pain relief

If OTC pain relievers do not help your migraine headache pain, speak with your doctor about prescription options.

Triptans are the preferred prescription treatment for migraine pain relief. The generic names of the medications in this class end in “triptan,” like sumatriptan (Imitrex) and rizatriptan (Maxalt). Triptans work by imitating a brain chemical called serotonin. This chemical narrows the blood vessels in the brain, which reduces pain during a migraine. Triptans are very effective and are available as both oral tablets and nasal sprays, but they cannot be used in some patients, such as those with uncontrolled high blood pressure. They also may cause “triptan sensations” in some patients, which can include tingling, numbness, and pressure in the chest and neck.

Another class of medications used for migraine pain relief is CGRP antagonists like rimegepant (Nurtec ODT). These medications reduce inflammation caused by a protein released around the brain called CGRP. CGRP antagonists are used when patients have failed multiple other treatments. They are well-tolerated and can be used in patients who cannot use triptans, but they can be more expensive. Most medications in this class come as an injection given once monthly. Some CGRP antagonists may be used to prevent migraines as well.

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Prescription migraine prevention

For patients who have frequent migraines (more than four per month), there are other medications that can be of benefit. These medications are typically taken once a day, every day, to prevent migraines including:

• Beta blockers like propranolol (Inderal LA, Inderal XL, and others) reduce blood vessel widening in the brain
• Anticonvulsants like topiramate (Eprontia, Qudexy XR, Topamax, and others) calm overactive nerve cells in the brain
• Antidepressants like amitriptyline (many generic options) prevent migraines by altering levels of multiple chemicals in the brain.

If your doctor prescribes you one of these medications, your pharmacist can teach you how to take it and explain the possible side effects. Your pharmacist can also help you find ways to help make your medication less expensive.

Summary

If you have migraine headaches consistently or they are increasing in frequency, severity, or interfering with your daily activities, you should speak with your doctor. If you are experiencing extreme headache pain, lose consciousness, have uncontrollable vomiting, or your headache lasts longer than 72 hours, seek medical attention immediately.