What Medications Can Treat Migraines?

By Terez Malka, MD
Medically reviewed checkmarkMedically reviewed
June 17, 2022

Approximately 1 in 7 American adults suffer from migraines, a headache disorder that can cause nausea, vomiting, sensitivity to light and sound, and a neurological disturbance known as an aura.

Migraines may be common, but they can also be debilitating.

A migraine headache may last for hours or even days, interfering with people’s ability to function in everyday life. 

There is no cure for migraine, but there are several migraine medications and effective treatment options.

Some medications prevent migraines from occurring, while others treat pain from a migraine after it happens.

If you suffer from migraines, talk to your doctor or primary care provider.

They can diagnose you and recommend a treatment plan to reduce your symptoms.

In this article, I’ll explain what migraines are, and outline their symptoms.

Then, I’ll describe some acute treatment options for migraines, along with preventive migraine medications. 

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What is a Migraine?

A migraine is a type of headache that can cause severe pain that people often describe as throbbing or pulsing.

Migraine headaches usually occur on one side of the head, and they start gradually before becoming more severe.

The pain may get worse when you move, sneeze, or cough.

Along with headache, people can experience nausea, vomiting and sensitivity to light, sound, and smell during a migraine. 

Some people experience migraines with an aura either before or during the headache.

An aura is a neurological disturbance that can include visual disturbances, such as seeing flashes of light or other changes in vision.

A migraine aura can also cause tingling on one side of a person’s face or on one side of their body. 

If left untreated, a migraine can last several hours or even days.

If you suffer from migraines, talk with your doctor or healthcare provider, who can help diagnose and treat you. 

What causes migraines? 

Both genetics and environmental factors can contribute to migraines.

Certain factors are known to be migraine triggers in some people.

These include: 

  • Hormonal changes 
  • Caffeine (changes to normal intake)
  • Alcohol
  • Stress
  • Sleep deprivation
  • Weather changes
  • Certain foods, such as aged cheese, cured meats, or processed foods
  • Monosodium glutamate (MSG), a common food additive
  • Artificial sweeteners, such as aspartame
  • Skipping meals
  • Bright or flashing lights
  • Strong smells
  • Certain medications, such as hormonal birth control and some blood pressure medications

If you get migraines, keep track of them in a journal and make note of your triggers.

Doing your best to avoid things that contribute to your migraines may reduce the severity or frequency of migraine episodes.

For some people, lifestyle changes aren’t enough, and a doctor or headache specialist may recommend medication for migraines. 

Acute Treatment

Acute medication, also known as abortive treatment, is a type of medication you take when you have migraine symptoms.

Some are available over the counter, while others require a prescription.

Generally, the sooner you take an acute treatment for a migraine, the more effective it will be.

Depending on factors such as the frequency and severity of your headaches, your healthcare provider may recommend any of the below migraine medications.

OTC painkillers

Common over-the-counter (OTC) painkillers include analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), and caffeine.

The following OTC painkillers may help relieve migraines: 

  • Ibuprofen (Advil, Motrin)
  • Naproxen (Aleve)
  • Aspirin 
  • Acetaminophen (Tylenol)
  • Excedrin and other combination medications, which typically contain aspirin, acetaminophen, and caffeine

While any of the above drugs can help migraines—and they often have minimal side effects—it’s best not to rely on OTC painkillers for everyday use.

Taking analgesics or NSAIDs every day can result in worse headaches due to medication overuse.

Long-term use of NSAIDs can also cause ulcers and bleeding in the digestive tract. 

Ergotamines

Ergotamines are in a group of drugs called ergot alkaloids.

They’re used to treat severe, throbbing headaches, such as migraines that are severe enough to require hospital admission.

Two examples of ergot alkaloids are: 

  • Dihydroergotamine (D.H.E. 45, Migranal)
  • Ergotamine (Cafergot, Ergomar)

Ergotamines may be useful in treating severe headaches that do not respond to other more common treatments.

They are usually given in the hospital, not at home. 

Antinausea drugs

Migraine headaches cause nausea as well as head pain.

The following antiemetics can help treat both the pain and nausea associated with migraines.

They are most effective when given by an IV, but are sometimes also prescribed as an oral pill.

  • Prochlorperazine (Compazine)
  • Metoclopramide (Reglan)
  • Promethazine (Phenadoz, Promethegan, Phenergan)

Doctors and healthcare providers sometimes prescribe anti-nausea drugs alone for migraines with nausea and vomiting.

Other times, a clinician may recommend taking one of these drugs with another migraine medication, such as an OTC painkiller or triptan. 

Triptans

Medications called triptans are often prescribed when over-the-counter painkillers don’t work, or if a person’s headaches are moderate or severe.

They work by blocking pain pathways in a person’s brain.

Triptans can be taken as pills, dissolvable tablets, injections, or nasal sprays.

Currently, seven triptan medications are approved by the FDA as acute migraine treatments: 

  • Sumatriptan (Imitrex, Imitrex Statdose, Sumavel DosePro, Alsuma, Zembrace SymTouch)
  • Eletriptan (Relpax)
  • Naratriptan (Amerge)
  • Zolmitriptan (Zomig, Zomig ZMT)
  • Rizatriptan (Maxalt, Maxalt-Mlt)
  • Frovatriptan (Frova)
  • Almotriptan (Axert)

While triptans may reduce migraine symptoms, they are associated with high blood pressure.

Your doctor may not prescribe a triptan to you if you have uncontrolled hypertension, or high blood pressure.

Triptans are also not considered safe for people at risk for stroke or heart attack. 

CGRP antagonists 

Calcitonin gene-related peptide (CGRP) antagonists are a newer drug class used to treat acute migraine.

CGRP is a protein that’s released around the brain.

In excess, it can worsen the pain of migraine headaches.

Examples of CGRP antagonists for migraines include: 

  • Ubrogepant (Ubrelvy)
  • Rimegepant (Nurtect ODT)

Preventive Treatment

If you get severe migraines more than four times a month and acute treatment isn’t helping, your healthcare provider may recommend preventive migraine medications and/or treatment to manage the frequency and severity of your headaches.

There are several types of preventive drugs for migraine.

Your doctor can help you determine the best one for you.

Beta-blockers

This type of drug is also used for treating high blood pressure.

Common beta-blockers for migraines include: 

  • Propranolol (Inderal, Innopran XL)
  • Timolol (Timoptic-xe, Istalol, Timoptic)
  • Bisoprolol (Monocor, Zebeta)
  • Metoprolol tartrate (Lopressor)
  • Atenolol (Tenormin)
  • Nadolol (Corgard)

Calcium channel blockers

Calcium channel blockers, also used for treating high blood pressure, are another option for preventive migraine treatment. One calcium channel blocker used for migraine is verapamil (Verelan). 

CGRP antagonists

CGRP monoclonal antibodies are a newer drug for preventing migraines.

They’re given either once a month or four times a year via injection.

CGRP monoclonal antibodies for migraine include: 

  • Erenumab-aooe (Aimovig)
  • Fremanezumab-vfrm (Ajovy)
  • Galcanezumab-gnlm (Emgality)
  • Eptinezumab-jjmr (Vyepti)

Antidepressants

Medications that treat depression and anxiety, including selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants, can also help prevent migraines for some.

For others, though, they may make headaches worse.

  • Fluoxetine (Prozac)
  • Amitriptyline (Elavi)

The serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine (Effexor) may also help reduce migraines for some.

Anticonvulsants 

Anticonvulsants, also called antiepileptics, are drugs used to treat seizures.

A few of these drugs have been shown effective in preventing migraines, including: 

  • Piramate (Depakote, Depakote ER)
  • Sodium valproate (Dyzantil, Epilim, Episenta, Epival)
  • Topiramate (Topamax, Topiragen, Qudexy DR, Trokendi-XR2)
  • Gabapentin 

Botox (Botulinum toxin type A)

For people who get migraines 15 or more days a month, botox injections may be an option.

Botox is a type of toxin that, when used in tiny doses, can reduce muscle contractions for up to three months.

For migraine prevention, it can help block chemical activity that causes migraine pain.

Botox injections are often more effective when people get more migraines each month, and it can become more effective the more treatments people receive. 

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When to See a Medical Provider

If you regularly get headaches, keep track of your symptoms, and share them with your doctor or healthcare provider.

Your provider can diagnose the problem and recommend a treatment plan that reduces your headaches, whether or not they’re migraines.

Talk to your healthcare provider if you’re already diagnosed with migraines and they’re getting worse or not responding to treatment, or if you’re experiencing unwanted side effects from your migraine medication.

See a doctor if your migraines feel different or take on a new pattern.

While migraines don’t usually require emergency care, some headaches do.

Go to the emergency room right away or call 9-1-1 if you experience any of the below signs: 

  • A sudden, severe headache that comes on rapidly
  • Severe headache after a head injury 
  • A headache accompanied by stiff neck, fever, seizures, confusion, numbness, or weakness anywhere in your body 
  • Chronic headache that gets worse when you cough, strain, or suddenly move

How K Health Can Help

Did you know you can get affordable primary care with the K Health app?
Download K to check your symptoms, explore conditions and treatments, and if needed text with a doctor in minutes. K Health’s AI-powered app is HIPAA compliant and based on 20 years of clinical data.

Frequently Asked Questions

What is the best medication for migraines?
There are many different migraine medications available, from over-the-counter treatments to medications prescribed by doctors. Acute treatments work by relieving symptoms once they occur, and preventive drugs can prevent the frequency and severity of migraines. Your healthcare provider can help you determine the best migraine medication for you.
What medications does the ER give for migraines?
Many hospitals give patients what’s known as a “migraine cocktail,” which often includes NSAIDs and an antiemetic (anti-nausea) medication. These medications can be given orally or intravenously, through an IV. If a person is dehydrated from vomiting, the treatment may also include IV fluids. In rare cases, you may be admitted to the hospital for further IV treatments, such as ergotamines.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Terez Malka, MD

Dr. Terez Malka is a board-certified pediatrician and emergency medicine physician.