Despite medical advances, migraines can be difficult to treat. About half of patients stop seeking medical care for their headaches because they are dissatisfied with therapy.
This type of chronic headache can be treated with two approaches: abortive and preventive.
Abortive: The goal of abortive therapy is to prevent an 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 medicines are especially useful for patients who vomit while experiencing the headache, and they work quickly.
Abortive treatment medicines 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)
These drugs also are 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)
These 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.
Preventive: This type of treatment is considered if a patient has more than one migraine per week. The goal is to lessen the frequency and severity of the attacks. Medication to prevent a migraine can be taken daily. Different drug classes have been used successfully as preventive therapies. Preventive treatment medications include:
- 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)
Botulinum toxin (BOTOX ®) injection has been found to help some migraine sufferers, and has been approved by the U.S. FDA to treat chronic migraine in adults. Injections are given at specific points in the head and neck muscles, and the effect lasts up to 3 months.
For more information, read our full medical article on migraines.
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American Headache Society. "New Guidelines: Treatments Can Help Prevent Migraine." Update: May 01, 2016.