Medications

Drug therapy is mainly aimed at lessening pain during the early and generally most painful phases of migraine headaches. Those who have repeated migraine episodes may need long-term preventive therapy. The following drugs are used to quickly stop migraine headaches in progress. They are often called abortive drugs because they abort, or stop, the headache. These drugs are used only to treat headaches and do not help relieve problems like back pain, arthritis, or menstrual cramps. The first group of drugs is within the triptan class. Drugs in this class are all very similar in their action and chemical structure and target the brain chemical serotonin. If 2-3 of these drugs have been tried without success, it is unlikely that others within the class will help.

• Sumatriptan (Imitrex, Imigran)
  
  
• Zolmitriptan (Zomig, Zomig-ZMT)
  
  
• Naratriptan (Amerge, Naramig)
  
  
• Rizatriptan (Maxalt, Maxalt-MLT)
  
  
• Almotriptan (Axert)
  
  
• Frovatriptan (Frova)
  
  
• Eletriptan (Relpax)

The following abortive drugs are also used only for headaches. Though they act on serotonin, they also act on other brain chemicals, including norepinephrine and dopamine. Sometimes, one of these drugs will be effective if the triptans fail.

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

The following drugs are not really for headache; they are for the nausea that often accompanies headaches. They occasionally have an abortive or preventive effect against migraine, however.

• Prochlorperazine (Compazine)
  
  
• Chlorpromazine (Thorazine)
  
  
• Promethazine (Phenergan)

The following are nonspecific painkillers of the narcotic class. Rarely, they have a strong abortive effect. Because of their habit-forming risk, they should generally be held in reserve as a backup to a specific abortive treatment.

• Butalbital-acetaminophen-caffeine (Fioricet)
  
  
• Butalbital-aspirin-caffeine (Fiorinal)
  
  
• Acetaminophen with codeine (Tylenol With Codeine)
  
  
• Hydrocodone (Vicodin)
  
  
• Oxycodone (OxyContin)
  
  
• Morphine (MS Contin)
  
  
• Meperidine (Demerol)

The following agents are nonsteroidal anti-inflammatory drugs (NSAIDs). They are meant for many types of pain, but they are sometimes very effective for migraine headaches and may occasionally provide preventive benefit.

• Ibuprofen (Ibuprin, Advil, Motrin)
  
  
• Naproxen (Anaprox, Naprelan, Naprosyn)
  
  
• Ketorolac (Toradol)
  
  
• Aspirin (Anacin, Ascriptin, Bayer Aspirin)

The following drugs have preventive effects when taken daily. They are mainly useful in people who have more than 1-2 headaches per week. Most of these drugs were developed for treatment of other conditions and were coincidentally found to be helpful in treating migraineurs.

• Valproic acid (Depakote)
  
  
• Topiramate (Topamax)
  
  
• Amitriptyline (Elavil)
  
  
• Nortriptyline (Pamelor)
  
  
• Propranolol (Inderal) and other beta-blockers
  
  
• Verapamil (Covera) and other calcium channel blockers
  
  
• Cyproheptadine (Periactin)