1. A Visual Guide to Migraine Headaches Slideshow Pictures
2. Headache and Migraine Triggers Slideshow Pictures
3. Take the Migraines Quiz

Medical Author:

John P. Cunha, DO, FACOEP

John P. Cunha, DO, FACOEP

John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Despite medical advances, migraines can be difficult to treat. About half of migraineurs stop seeking medical care for their headaches because they are dissatisfied with therapy.

Migraines can be treated with two approaches: abortive and preventive.

• Abortive: The goal of abortive therapy is to prevent a migraine attack or to stop it once it starts. The prescribed medications stop a headache during its prodrome stage or once it has begun and may be taken as needed. Some can be administered as a self-injection into the thigh; others, as a wafer that melts on the tongue, or as a nasal spray. These forms of medication are especially useful for people who vomit during a migraine, and they work quickly.

Abortive treatment medications include the triptans, which specifically target the chemical serotonin. The triptans are used only to treat headache pain and do not relieve pain from back problems, arthritis, menstruation, or other conditions. Triptan medications include:

• Sumatriptan (Imitrex)
• Sumatriptan/Naproxen (Treximet)
• Zolmitriptan (Zomig)
• Eletriptan (Relpax)
• Naratriptan (Amerge)
• Rizatriptan (Maxalt)
• Frovatriptan (Frova)
• Almotriptan (Axert)

The following drugs are also specific and affect serotonin, but they affect other brain chemicals as well. Occasionally, one of these drugs works when a triptan does not.

• Ergotamine tartrate (Cafergot)
• Dihydroergotamine (D.H.E. 45 Injection, Migranal Nasal Spray)
• Acetaminophen-isometheptene-dichloralphenazone (Midrin)

The following drugs are mainly used for nausea, but they sometimes have an abortive or preventive effect on headaches:

• Prochlorperazine (Compazine)
• Promethazine (Phenergan)

The next drugs are weak members of the narcotic class. They are not specific for migraine, but they can help relieve almost any kind of pain. Since they are habit forming, they are less desirable choices than the specific headache drugs listed above. These drugs should be used primarily as a "backup" for the occasions when a specific drug does not work.

• Butalbital compound (Fioricet, Fiorinal)
• Acetaminophen and codeine (Tylenol with Codeine)

• Preventive: This type of treatment is considered if a migraineur has more than one migraine per week. The goal is to lessen the frequency and severity of the migraine attacks. Medication to prevent a migraine can be taken daily. Different drug classes have been used successfully as preventive therapies. Preventive treatment medications include the following:
• Medications used to treat high blood pressure - Beta blockers (propranolol [Inderal]), calcium channel blockers (verapamil [Covera])
• Antidepressants - Amitriptyline (Elavil), nortriptyline (Pamelor)
• Antiseizure medications - Gabapentin (Neurontin), valproic acid (Depakote), topiramate (Topamax)
• Some antihistamines and anti-allergy drugs, including diphenhydramine (Benadryl) and cyproheptadine (Periactin)

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