| Pharmacological | Almotriptan | Almogran, Axert | Serotonin 5-HT1 agonists or Triptans | Widely Available | Pill | Acute | Almotriptan is a second-generation serotonin 5-HT1 receptor agonist, also known as a triptan. An agonist mimics the effects of the neurotransmitter found naturally in the brain. It works by narrowing the blood vessels around the brain, blocking pain signals and the release of substances that cause other migraine symptoms. A person with migraine is thought to be hypersensitive to widened blood vessels exerting pressure on the brain. |
| Pharmacological | Atogepant | Qulipta, Aquipta | Small molecule CGRP receptor antagonist (Gepant) | AUS, CAN, EU, USA | Pill | Preventive | Atogepant is an oral CGRP receptor antagonist used for the preventive treatment of episodic and chronic migraine. Atogepant has a longer half-life than another similar gepant (ubrogepant), making it suitable for preventive treatment. It was approved by the US FDA in September 2021 for episodic migraine prevention and in April 2023 for chronic migraine prevention. |
| Pharmacological | Dihydroergotamine mesylate (DHE) | Dihydergot, DHE 45, Migranal, Trudhesa | Ergot alkaloid - derivative | Widely Available | Injection, IV, Nasal Spray | Acute | Dihydroergotamine (DHE) is used to treat acute migraine with or without aura and cluster headaches. DHE is an ergot derivative. It works by constricting blood vessels in the brain, which can help to relieve migraine. Trudhesa, a DHE nasal spray targeting the upper nasal space, was approved by the FDA in September 2021; it is thought that the nasal spray allows the medication to work faster and more effectively. |
| Pharmacological | Eletriptan | Relert, Relpax | Serotonin 5-HT1 agonists or Triptans | Widely Available | Pill | Acute | Eletriptan is a second-generation triptan drug intended for the treatment of migraine. It is used as an abortive treatment to treat a migraine attack that is already in progress. |
| Pharmacological | Eptinezumab | Vyepti | CGRP monoclonal antibody | AUS, CAN, ENG, EU, IRE, USA, & more | IV Infusion | Preventive | Eptinezumab is a preventive CGRP monoclonal antibody approved by the FDA in February 2020, and also approved for prevention in other countries including Australia, Canada, England, and Ireland. CGRP monoclonal antibodies attach to the calcitonin gene-related peptide (CGRP) and inactivate it. Eptinezumab is given as an IV infusion four times a year with few side effects for most people. |
| Pharmacological | Erenumab | Aimovig | CGRP monoclonal antibody | AUS, CAN, ENG, EU, IRE, USA, & more | Injection | Preventive | Erenumab is a preventive CGRP monoclonal antibody approved by the FDA in May 2018. This CGRP monoclonal antibody attaches to CGRP receptors to inhibit its function. Erenumab is self administered monthly. An FDA warning was added for erenumab about high blood pressure after the first dose. If you are on erenumab or start it, you should monitor your blood pressure. |
| Pharmacological | Fremanezumab | Ajovy | CGRP monoclonal antibody | AUS, CAN, ENG, EU, IRE, USA, & more | Injection | Preventive | Fremanezumab is a preventive monoclonal antibody approved by the US FDA in September 2018 for the prevention of migraine and is now available in many other countries. This CGRP monoclonal antibody attaches to CGRP and inactivates it. Ajovy is self-administered monthly or quarterly, as your physician advises. |
| Pharmacological | Frovatriptan | Frova, Migard | Serotonin 5-HT1 agonists or Triptans | Widely Available | Pill | Acute | Frovatriptan is a triptan. It works by narrowing the blood vessels in the brain, which helps to relieve migraine. It is used to treat acute migraine with or without aura in adults. It should not be used as a migraine preventive except for short-term prevention ("mini-prevention") in menstrual migraine. |
| Pharmacological | Galcanezumab | Emgality | CGRP monoclonal antibody | AUS, CAN, ENG, EU, IRE, USA, & more | Injection | Preventive | Galcanezumab is a CGRP monoclonal antibody approved by the US FDA in September 2018 for prevention of migraine, and for treatment of episodic cluster headache in June 2019. This CGRP monoclonal antibody attaches to CGRP and inactivates it. Emgality is self-administered monthly for migraine. For cluster headache, it is self-administered initially at a loading dose at the start of a cluster period and then monthly until the end of the cluster period. |
| Pharmacological | Lasmiditan | Reyvow | 5-HT1F receptor agonist (Ditan) | EU, IND, USA | Pill | Acute | Like triptans, ditans work on serotonin receptors, but they work on the receptors that are not found on the blood vessels. Ditans are a potential acute therapy option for people with migraine who have heart conditions, as they avoid the blood vessels while working on similar mechanisms as triptans. Lasmiditan has been shown to work when migraine pain has progressed to moderate or severe. Lasmiditan was FDA-approved in 2019, is not available in Canada, and approved for medical use in the European Union in 2022. |
| Pharmacological | Naratriptan | Amerge, Naramig | Serotonin 5-HT1 agonists or Triptans | Widely Available | Pill | Acute | Naratriptan is a serotonin 5-HT1 receptor agonist (also known as a triptan). It works by narrowing blood vessels in the brain. It is used to relieve certain types of migraine attacks. |
| Pharmacological | Rimegepant | Nurtec ODT, Vydura | Small molecule CGRP receptor antagonist (Gepant) | AUS, ENG, EU, USA | Orally dissolving tablet | Acute & Preventive | Rimegepant is a gepant that treats acute migraine with or without aura by blocking CGRP receptors. CGRP is a brain chemical that causes vasodilation, inflammation, and pain at sites along the trigeminovascular pathway. Early studies show promise in the lack of association of gepants with medication overuse headache. It was FDA-approved for acute treatment in February 2020 and for the preventive treatment of episodic migraine in June 2021. As of September 2023, rimegepant is for acute and preventive treatment of migraine on the NHS in England. Approval is pending in Canada; it is expected to be in 2024. |
| Pharmacological | Rizatriptan | Maxalt, Rizalt, RizaFilm | Serotonin 5-HT1 agonists or Triptans | AUS, CAN, ENG, IND, IRE, USA & more | Oral Film, Pill, Sublingual | Acute | Rizatriptan is a triptan that works by narrowing dilated blood vessels in the brain, relieving migraine. It is used to treat migraine with or without aura. It should not be used to prevent migraine or to treat cluster headache. RizaFilm is rizatriptan in an oral film form and was FDA-approved in 2023. |
| Pharmacological | Sumatriptan | Imigran, Imitrex, Onzetra XSail, Sumavel DosePro, Tosymra, Treximet, Zembrace Symtouch | Serotonin 5-HT1 agonists or Triptans | Widely Available | Needle-less injection, Nasal Spray, Pill | Acute | Sumatriptan is a triptan that works by narrowing blood vessels in the brain, which helps to relieve migraine and cluster headache. Sumatriptan is used to treat migraine with or without aura. It is one of the most common treatments with numerous high-quality studies demonstrating its efficacy for the treatment of acute migraine. It is also used to treat cluster headache. The Treximet brand is a combination of sumatriptan and naproxen sodium, both of which are available as generics. |
| Pharmacological | Ubrogepant | Ubrelvy | Small molecule CGRP receptor antagonist (Gepant) | CAN, USA | Pill | Acute | Ubrogepant is a gepant designed to treat migraine with or without aura as well as the symptoms of light sensitivity, sound sensitivity, or nausea. Ubrogepant targets CGRP receptors, blocking the CGRP from attaching. CGRP is a brain chemical that causes vasodilation, inflammation and pain at sites along the trigeminovascular pathway. Early studies show promise in the lack of association of gepants with medication overuse headache. It was FDA approved for acute treatment in December 2019. |
| Pharmacological | Zavegepant | Zavzpret | Small molecule CGRP receptor antagonist (Gepant) | USA | Nasal Spray, Oral | Acute | Zavegepant (formerly vazegepant) is a gepant for the acute treatment of migraine, approved by the FDA in a nasal spray in March 2023. It is the first and only CGRP receptor antagonist as a nasal spray formulation. It is meant to have quick absorption, and provide possible pain relief in as little as 15 minutes, for up to 48 hours, and provide an alternative to oral medications. Zavegepant is also in clinical trials as an oral formulation. |
| Pharmacological | Zolmitriptan | AscoTop, Zomig, Zomigon, Zomigoro | Serotonin 5-HT1 agonists or Triptans | Widely Available | Nasal Spray, Pill | Acute | Zolmitriptan is a triptan that works by narrowing blood vessels in the brain, which helps to relieve migraine. It is used to treat migraine with or without aura in adults. It is not intended to prevent migraine attacks. |
