Pharmacological Treatments
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| Migraine Specific? X for yes | Generic Name (Active Ingredient List) | Brand Names | Treatment Class | RX | Format | Treatment Type | Description |
|---|---|---|---|---|---|---|---|
| Acetaminophen & Codeine | Tylenol 3 or 4, Panadeine | Combination - Opioid | X | Liquid, Pill | Acute | Acetaminophen/paracetamol with codeine is an opioid and analgesic/antipyretic combination. It works in the brain and nervous system to decrease mild to moderately severe pain. | |
| Acetaminophen & Oxycodone | Percocet | Combination - Opioid | X | Liquid, Tablets | Acute | Percocet is used to relieve moderate-to-severe pain. It contains a combination of oxycodone (an opioid pain medication that works in the brain to change how your body feels and responds to pain) and acetaminophen (a less powerful pain reliever that increases the effects of oxycodone). | |
| Acetaminophen (Paracetamol) | Little Fevers, Panadol, Tylenol & others | Analgesic (painkiller) | Liquid, Pill, Suppository | Acute | Acetaminophen is also known as paracetamol depending on where you live. A pain reliever and fever reducer, the exact mechanism of action of acetaminophen is unclear. Many common pain conditions including headache, muscle aches, arthritis, backache, colds, and fevers are treated with acetaminophen. It relieves pain in mild arthritis but does not affect the underlying inflammation and swelling of the joint. | ||
| Acetaminophen, Butalbital & Caffeine | Anolor 300, Esgic, Fioricet, Margesic, Orbivan, Repan, Zebutal & others | Combination - Barbiturate | X | Pill | Acute | Acetaminophen is a pain reliever and fever reducer. Butalbital is a barbiturate, known to relax muscle contractions involved in a tension headache. Caffeine is a stimulant that can relax muscle contractions in blood vessels to improve blood flow. The combination is used to treat tension headaches caused by muscle contractions. Butalbital has a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment. Butalbital is not available in some countries and restricted in others due to its dangerous side effects. | |
| Acetaminophen, Dichloralphenazone & Isometheptene | Duradrin, Midrin | Analgesic (painkiller) | X | Pill | Acute | Acetaminophen, dichloralphenazone, and isometheptene is a combination analgesic, sedative, and sympathomimetic. It works by decreasing pain, providing sedation, and narrowing the blood vessels in the head and brain. It is used to treat migraine and certain other types of headaches (tension, neurovascular), among other conditions. | |
| Acetazolamide | Diamox, Diamox Sequels | Diuretic | X | Pill | Acute & Preventive | Acetazolamide medications are used to treat glaucoma, epilepsy, altitude sickness, periodic paralysis, idiopathic intracranial hypertension, and heart failure. It is sometimes used to treat high-pressure headaches by lowering the production of cerebrospinal fluid. Acetazolamide is not well studied as a preventive treatment for migraine in general, and there is no solid evidence for its effectiveness outside the context of familial hemiplegic migraine. | |
| Acetylsalicylic acid (ASA) | Aspirin, Baby aspirin | Nonsteroidal anti-inflammatory drugs (NSAIDs) | Orally dissolving tablet, Pill | Acute & Preventive | Regular low-dose aspirin, or "baby" aspirin, may be one of the most effective ways to help prevent migraine with aura. When tested against topiramate, a common migraine preventive, Italian researchers found that low doses of aspirin daily may be up to six times more effective than topiramate. Up to 1,000 mg of aspirin may also be used in the acute treatment of migraine. | ||
| Acetylsalicylic acid (ASA) or Aspirin & Combinations | AsproClear, Bayer Aspirin, Bufferin, Easprin, Ecotrin, Ecpirin, Excedrin, Fasprin & others | Combination – NSAID | Pill, Powder, and others | Acute | Aspirin/ASA is an NSAID that works by reducing substances in the body that cause pain, fever, and inflammation. It is used to treat pain and reduce fever or inflammation. Sometimes aspirin is used to treat or prevent heart attacks, strokes, and chest pain (angina) but it should be used for cardiovascular conditions only under the supervision of a doctor. Some aspirin combination drugs, like Excedrin, also contain acetaminophen and caffeine. Check the label to be sure. Overuse of combination treatments containing caffeine may lead to medication overuse headache. | ||
| Acyclovir | Zovirax | Antiviral | X | Pill, Topical ointment | Preventive | Acyclovir is an antiviral drug that is used to treat infections caused by certain types of viruses. It treats shingles caused by herpes zoster and outbreaks of herpes simplex. In people with frequent outbreaks of genital herpes, acyclovir is used to help reduce the number of future episodes. Acyclovir can also be useful in the treatment of fibromyalgia and allodynia, often in conjunction with other medications. | |
| Agomelatine | Valdoxan | Antidepressant | X | Pill | Preventive | Agomelatine is primarily used to treat depression. It acts on brain receptors for melatonin, a hormone that is important for regulating sleep, as well as serotonin receptors. It is the only antidepressant that acts on melatonin receptors. | |
| Allergen Immunotherapy | N/A | Immunotherapy | x | Injection | Preventive | Allergen immunotherapy—or allergy shots—are treatments to stop or reduce allergy symptoms. Each allergy shot contains a tiny amount of the substances that trigger allergic reactions (i.e., allergens). Over time, the immune system gets used to the allergens and learns not to react to them. This may be beneficial for migraine if allergies are a trigger. | |
| X | Almotriptan | Almogran, Axert | Serotonin 5-HT1 agonists or Triptans | X | 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. |
| Alprazolam | Niravam, Xanax | Benzodiazepines | X | Pill | Preventive | Alprazolam belongs to a group of drugs called benzodiazepines. It works by slowing down the movement of chemicals in the brain that may become unbalanced. This results in a reduction in nervous tension or anxiety. Alprazolam is used to treat anxiety disorders, panic disorders, and anxiety caused by depression. | |
| Amitriptyline | Elavil, Endep | Antidepressant | X | Pill | Preventive | Amitriptyline is a tricyclic antidepressant. It affects brain chemicals that may become unbalanced. Amitriptyline is used to treat symptoms of depression. Amitriptyline has evidence of efficacy in the prevention of migraine. | |
| Amphetamine | Adzenys XR-ODT, Dyanavel XR, Evekeo | Stimulant | X | Pill | Preventive | Amphetamine is a stimulant used to treat attention-deficit hyperactivity disorder (ADHD), narcolepsy, and obesity. Stimulants increase the level of dopamine, a neurotransmitter associated with pleasure, movement, and attention. Use of this medication should be closely monitored, as it carries a high risk for addiction. In the context of migraine, amphetamine can contribute to medication overuse headache. | |
| Angiotensin-converting enzyme (ACE) inhibitors | Altace, Epanded, Prinivil, Qbrelis, Vasotec, Zestril | Antihypertensive | x | Pill | Preventive | Angiotensin-converting enzyme (ACE) inhibitors are commonly prescribed to treat high blood pressure, heart problems, and other conditions by helping to relax veins and arteries. A 2019 study concluded that ACE inhibitors could be used as a preventive treatment for migraine in persons with high blood pressure or high risk of side effects from other migraine treatments, but the evidence did not otherwise support use of it as a preventive. See entry: Lisinopril. | |
| Aprepitant | Emend | Neurokinin-1 receptor antagonist (antiemetic) | X | Pill | Acute | Used to prevent chemotherapy-induced or postoperative nausea and vomiting, and for CVS (Cyclic Vomiting Syndrome, a migraine variant). Also used to control nausea and vomiting related to intravenous DHE (dihydroergotamine). | |
| Aspirin & Codeine | Aspalgin, Disprin Forte | Analgesic (painkiller) | X | Pill | Acute | Aspirin with codeine is an analgesic combination. It works to relieve pain by dulling pain perception in the brain and blocking certain chemicals in the body that cause pain, swelling, and inflammation. It helps relieve mild to severe pain. Codeine is an opioid and opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment. | |
| Aspirin, Butalbital & Caffeine | Fiorinal, Fortabs, Farbital, Fiormor, Fiortal, Idenal, Isollyl, Lanorinal & others | Combination - Barbiturate | X | Pill | Acute | Aspirin is a pain reliever, anti-inflammatory, and fever reducer. Butalbital is part of a group of drugs called barbiturates, which have high risk for addiction and medication overuse headache; they are known to relax muscle contractions involved in tension headache. Caffeine is a stimulant that can relax muscle contractions in blood vessels to improve blood flow. The combination of aspirin, butalbital, and caffeine is used to treat tension headaches caused by muscle contractions. | |
| Aspirin, Caffeine & Orphenadrine | Norgesic | Combination - NSAID | X | Pill | Acute | Orphenadrine, aspirin, and caffeine is a muscle relaxant and stimulant combination. It works by decreasing pain and inflammation, which helps muscles to relax. This combination relieves mild to moderate pain from certain muscle problems. | |
| Atenolol | Tenormin | Beta-blocker | X | Pill | Preventive | Atenolol is part of a group of drugs called beta-blockers. Beta-blockers affect the heart and the circulation of blood flow through arteries and veins. Atenolol is used to treat angina (chest pain) and hypertension. It may also be used to treat or prevent heart attack. Atenolol has evidence of efficacy in the prevention of migraine. | |
| X | Atogepant | Qulipta, Aquipta | Small molecule CGRP receptor antagonist (Gepant) | X | 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. |
| Baclofen | Lioresal, Gablofen | Muscle Relaxant | X | Pill | Acute | Baclofen is a muscle relaxer and an antispastic agent. Baclofen is used to treat muscle symptoms caused by multiple sclerosis including spasm, pain, and stiffness. | |
| Barbital/Barbitone | Medinal, Veronal | Barbiturate | X | Pill | Preventive | As barbital is a controlled substance, other substances have largely replaced barbital-based medications. When barbital was first introduced, it was considered a great improvement over the existing hypnotics (sleeping aids). It was used as a hypnotic from 1903 until the mid-1950s. Barbiturates, in general, have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment. | |
| Budesonide | Entocort, Pulmicort, Rhinocort Allergy, Uceris | Steroid | X | Inhaler, Nasal Spray, Pill, Enema | Acute & Preventive | Budesonide is a steroid that reduces inflammation in the body. The inhaled form is used to treat asthma and chronic obstructive pulmonary disease; the nasal spray treats allergic rhinitis and nasal polyps; and the extended-release pills and enemas treat Crohn's disease, ulcerative colitis, and microscopic colitis. | |
| Buprenorphine | Buprenex, Temgesic | Opioid | X | Injection, Pill | Acute | Buprenorphine is an opioid analgesic. It works on the brain and nervous system to decrease pain. It can help relieve moderate to severe pain. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment. | |
| Butalbital | - | Barbiturate | X | - | Acute | Butalbital has been discontinued as a single agent and is not recommended as a single agent or in combination drugs, due to the high risk for addiction and medication overuse headache. It is known to relax muscle contractions involved in a tension headache. Butalbital is often combined with other medications, such as acetaminophen, aspirin, and codeine for the treatment of headache. | |
| Candesartan | Atacand, Amias, Blopress, Ratacand | Antihypertensive | X | Pill | Preventive | Candesartan is an angiotensin II receptor blocker (ARB). It works by relaxing blood vessels. This helps to lower blood pressure. Candesartan is used to treat high blood pressure alone or with other medicines. It is used in certain patients to treat heart failure. It may also be used for other conditions, as determined by your doctor. Candesartan has been established as effective in the prevention of migraine. | |
| Cannabidiol oil (CBD) | Epidiolex | Phytocannabidiol | X | Oral | Acute & Preventive | CBD is the nonpsychoactive part of the cannabis, or marijuana, plant. CBD oil is made by extracting CBD from the cannabis plant and diluting it with a carrier oil. It has quickly become popular in the health and wellness community, with several research-backed studies suggesting it may be helpful in alleviating such conditions as anxiety, depression, and chronic pain, including migraine. It comes in many formats, including edibles such as gummies and baked goods, topical creams and gels, among others. Epidiolex is the first FDA-approved prescription for highly purified CBD oil, which is used in some forms of epilepsy. See also: Cannabidiol oil (CBD) in Nonpharmocological Treatments. | |
| Carbamazepine | Carbatrol, Epitol, Equetro, TEGretol, TEGretol XR | Anticonvulsant | X | Pill | Preventive | Carbamazepine is an anticonvulsant. It works by decreasing nerve impulses that cause seizures and pain. Carbamazepine is used to treat seizures and nerve pain such as trigeminal neuralgia and diabetic neuropathy. It is also used to treat bipolar disorder. | |
| Carvedilol | Coreg | Beta-blocker | X | Pill | Preventive | Carvedilol is a beta-blocker. Beta-blockers affect the heart and blood circulation. Carvedilol is used to treat heart failure and hypertension. It is also used after a heart attack that has compromised the heart’s ability to function effectively. | |
| Celecoxib | Bextra, Celebrex, Elyxyb, Vioxx | Nonsteroidal anti-inflammatory drugs (NSAIDs) | X | Liquid, Pill | Acute & Preventive | Celecoxib is an NSAID. It works by reducing hormones that cause inflammation and pain in the body. Celecoxib is used to treat pain or inflammation caused by many conditions such as arthritis, ankylosing spondylitis, and menstrual pain. Celecoxib is also used in the treatment of hereditary polyps in the colon. Vioxx and Bextra are no longer available due to increased risk of heart attack and stroke. It is sometimes recommended before exercise to prevent a migraine attack. Celebrex is the only brand available in the U.S. Elyxcyb is an oral liquid format. | |
| Celecoxib | Celebrex, Vioxx, Bextra | COX inhibitor | X | Pill | Acute & Preventive | A subclass of NSAIDs that work by reducing the production of prostaglandins, the chemicals that promote inflammation, pain, and fever. The enzymes that produce prostaglandins are called cyclooxygenase (COX). There are two types: COX-1 and COX-2. Unlike older NSAIDs that block both inhibitors, the newer COX-2 inhibitors only block the COX-2 enzyme. Sometimes recommended before exercise to prevent a migraine attack. Celebrex is the only brand available in the U.S. Vioxx and Bextra are no longer available due to increased risk of heart attack and stroke. | |
| Cetirizine | Zyrtec | Antihistamine | Pill | Acute | Cetirizine is an antihistamine that reduces the natural chemical histamine in the body. Histamine can produce symptoms of sneezing, itching, watery eyes, and runny nose. Cetirizine is used to treat cold or allergy symptoms such as sneezing, itching, watery eyes, or runny nose. It is also used to treat itching and swelling caused by hives. | ||
| Chlorpromazine | Largactil, Thorazine | Other - schizophrenic & bipolar | X | Injection, Pill, Suppository | Preventive | The exact way chlorpromazine works is not known. It is used to treat certain mental or mood disorders (e.g., schizophrenia), the manic phase of manic-depressive disorder, anxiety and restlessness before surgery, the blood disease porphyria, severe behavioral and conduct disorders in children, nausea and vomiting, and severe hiccups. It is also used with other medicines to treat symptoms associated with tetanus. | |
| Cinnarizine | Arlevert, Sturgeron | Antihistamine | X | Pill | Acute, Preventive | Cinnarizine is an antihistamine used to treat inner ear and balance issues including dizziness, motion sickness, Ménière's disease, vertigo, and nausea. The brand Arlevert combines cinnarizine with dimenhydrinate. | |
| Citalopram | Cipramil, Celexa | Antidepressant | X | Pill | Preventive | Citalopram is a selective serotonin reuptake inhibitor (SSRI). This medication works by helping to restore the balance of serotonin in the brain. Citalopram is used to treat depression. It may improve your energy level and feelings of well-being. Leading neurologist Dr. Andrew Charles has flagged SSRI medications as having the potential to make migraine worse. If you take an SSRI and have migraine, consider discussing with your doctor whether an alternative medication might be right for you. | |
| Clonazepam | Klonopin | Benzodiazepines | X | Pill | Acute | Clonazepam belongs to a group of drugs called benzodiazepines and is known as an anticonvulsant drug. It is used as a treatment to prevent and control seizures and also for panic attacks, insomnia, and anxiety disorders. Clonazepam works by calming down the brain and nerves. | |
| Clonidine | Catapres, Dixarit, Kapvay | Antihypertensive | X | Pill | Preventive | Clonidine lowers blood pressure by decreasing the levels of certain chemicals in your blood. This allows your blood vessels to relax and your heart to beat more slowly and easily. Clonidine is used to treat hypertension. The Kapvay brand of clonidine is used to treat attention deficit hyperactivity disorder (ADHD). | |
| Codeine | Migraleve | Opioid | X | Pill, Suppository | Acute | Codeine is used to treat mild-to-moderately severe pain. Codeine is an opiate used for its analgesic, antitussive, antidiarrheal, antihypertensive, anxiolytic, antidepressant, sedative, and hypnotic properties. It is also used to suppress premature labor contractions, myocardial infarction, and for many other uses. It is often sold as a salt in the form of either codeine sulfate or codeine phosphate in the United States and Australia. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment. | |
| Cyclobenzaprine | Amrix, Fexmid, Flexeril | Muscle relaxant | X | Pill | Acute | Cyclobenzaprine is a muscle relaxant. It works by blocking nerve impulses or pain sensations that are sent to your brain. It is used together with rest and physical therapy to treat skeletal muscle conditions such as pain or injury. | |
| Cyproheptadine | Periactin | Antihistamine | X | Pill | Preventive | Cyproheptadine is an antihistamine. It works by blocking the action of histamine to reduce allergy symptoms. Cyproheptadine is used to treat symptoms of allergic reactions caused by seasonal allergies, food, blood, or plasma. It is also used to treat mild, uncomplicated hives. | |
| Desipramine | Norpramin | Antidepressant | X | Pill | Preventive | Desipramine is a tricyclic antidepressant used to treat symptoms of depression. It affects chemicals in the brain that may become unbalanced. | |
| Desvenlafaxine | Khedezla, Pristiq | Antidepressant | X | Pill | Preventive | Desvenlafaxine is in the class of antidepressant drugs called selective serotonin and norepinephrine reuptake inhibitors (SNRI). SNRIs block or delay the reuptake of the neurotransmitters, serotonin and norepinephrine by the presynaptic nerves. This increases the levels of these two neurotransmitters in the synapse and tends to elevate mood. Serotonin-norepinephrine reuptake inhibitors (SNRIs) are used to treat depression, anxiety disorder, panic disorder and other mood disorders. | |
| Dexamethasone | Decadron | Steroid | x | Pill, IV, injection | Acute | Dexamethasone is a potent corticosteroid used to reduce inflammation and suppress the immune system. It is commonly prescribed for conditions such as severe allergies, autoimmune diseases, and cerebral edema, and as an adjunct treatment for migraine attacks (often in emergency settings to prevent recurrence). Due to its long-lasting effects, it is typically used for short-term treatment to avoid side effects associated with prolonged steroid use. | |
| Diazepam | Valium | Other - psychoactive benzodiazepine | X | Injection, Pill, Suppository | Acute | Diazepam is a benzodiazepine. It affects chemicals in the brain that may become unbalanced and cause anxiety. Diazepam is used to treat anxiety disorders, alcohol withdrawal symptoms, or muscle spasms. Diazepam is sometimes used with other medications to treat seizures. | |
| Diclofenac | Cambia, Cataflam, Voltaren, Voltaren-XR, Zipsor, Zorvolex | Nonsteroidal anti-inflammatory drugs (NSAIDs) | Injection, Gel, Oral, Pill, Suppository | Acute | Diclofenac is an NSAID. It is used to treat mild to moderate pain, or signs and symptoms of osteoarthritis or rheumatoid arthritis. The Cataflam brand of this medicine is also used to treat menstrual cramps. Diclofenac oral powder (Cambia) is used to treat migraine attacks acutely. | ||
| X | Dihydroergotamine mesylate (DHE) | Dihydergot, DHE 45, Migranal, Trudhesa | Ergot alkaloid - derivative | X | 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. |
| Diltiazem | Cardizem, Cartia XT, Dilacor XR, Dilt-CD, Diltzac, Flunarizine, Matzim LA, Tiazac & others | Calcium channel blockers | X | Pill | Preventive | Diltiazem is part of a group of drugs called calcium channel blockers. These work by relaxing the muscles of your heart and blood vessels. Diltiazem is used to treat hypertension, angina (chest pain), and certain heart rhythm disorders. | |
| Dimenhydrinate | Gravol, Dramamine & others | Antihistamine, antiemetic | Injection, Liquid, Pill, Suppository | Acute | Dimenhydrinate is an antiemetic used to prevent and treat nausea, vomiting, and dizziness due to motion sickness. It is used to control vomiting associated with migraine, but it has largely been replaced by Zofran (ondansetron). | ||
| Diphenhydramine | Benadryl, Nytol, Simply Sleep & others | Antihistamine | Pill | Acute | Diphenhydramine is to control high levels of histamine. It may speed relief of migraine when taken with migraine medications. | ||
| Divalproex sodium | Depakote, Depakote ER, Depakote Sprinkles | Anticonvulsant | X | Pill | Preventive | Divalproex sodium affects chemicals in the body that may be involved in causing seizures. It is used to treat various types of seizure disorders. It is sometimes used together with other seizure medications. Divalproex sodium is also used to treat manic episodes related to bipolar disorder and has been established as effective in the prevention of migraine. | |
| Domperidone | Molax, Motilium, Motinorm Costi, Nomit | Antiemetic | X | Injection, Pill, Suppository | Acute | Antiemetics help relieve the nausea associated with migraine attacks. Domperidone helps increase the transit of food through the stomach which helps facilitate its antinausea properties. | |
| Dosulepin/Dothiepin | Dopress, Dothep, Prothiaden, Thaden | Antidepressant | X | Pill | Preventive | Dosulepin is a tricyclic antidepressant. This class of antidepressants is named after its chemical structure, which contains three rings of atoms. Today they have largely been replaced in clinical use by newer classes of antidepressants. | |
| Doxylamine | Dozile, Restavit | Antihistamine | Pill | Acute | Doxylamine is an antihistamine. It works by depressing the central nervous system to produce drowsiness. Doxylamine is used to treat occasional sleeplessness and reduce difficulty falling asleep. | ||
| Doxylamine, Paracetamol & Codeine | Mersyndol | Antihistamine | Pill | Acute | Mersyndol is an analgesic intended for short-term use to relieve moderate pain and fever. Paracetamol and codeine are both active ingredients designed to help reduce pain. See Codeine & Paracetamol. Doxylamine is a type of antihistamine that can cause drowisness and/or have a calming effect. | ||
| Duloxetine | Cymbalta | Antidepressant | X | Pill | Preventive | Duloxetine is a selective serotonin and norepinephrine reuptake inhibitor (SNRI). SNRIs block or delay the reuptake of the neurotransmitters, serotonin and norepinephrine, by the presynaptic nerves. This increases the levels of these two neurotransmitters in the synapse and tends to elevate mood. SNRIs are used to treat depression, anxiety disorder, panic disorder, and other mood disorders. Duloxetine can also be useful in the treatment of fibromyalgia and allodynia. | |
| X | Eletriptan | Relert, Relpax | Serotonin 5-HT1 agonists or Triptans | X | 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. |
| X | Eptinezumab | Vyepti | CGRP monoclonal antibody | X | 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. |
| X | Erenumab | Aimovig | CGRP monoclonal antibody | X | 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. |
| Ergotamine tartrate | Cafergot, Ergomar, Migril | Ergot alkaloid - derivative | X | Pill, Suppository | Acute | Ergotamine is an ergot derivative. It works by narrowing blood vessels in the brain, which can help to relieve migraine. Some brands, like Cafergot, also contain caffeine. Ergotamine derivatives have been established as effective for acute treatment of migraine. | |
| Escitalopram | Lexapro | Antidepressant | X | Pill | Preventive | Escitalopram is a selective serotonin reuptake inhibitor (SSRI). It works by restoring the balance of serotonin which helps to improve certain mood problems. It is used to treat depression or generalized anxiety disorder. Leading neurologist Dr. Andrew Charles has flagged SSRI medications as having the potential to make migraine worse. If you take an SSRI and have migraine, consider discussing with your Doctor whether an alternative medication might be right for you. | |
| Estradiol | Alora, Estraderm, EstroGel, Vivelle & others | Other - hormones | X | Transdermal patch | Preventive | Estradiol is the most commonly used estrogen in hormone replacement therapy (HRT or MHT). For more details, see the entry on HRT. | |
| Eszopiclone | Lunesta | Hypnotic | X | Pill | Acute | Eszopiclone is a sedative, also called a hynoptic. It affects chemicals in one's brain that may be unbalanced in people with insomnia. Eszopiclone causes relaxation to help one fall asleep and stay asleep. | |
| Exenatide | Byetta | GLP-1 Agonist | x | Injection | Preventive | Exenatide is generally used as a diabetes medicine to help control blood sugar; it helps the pancreas to produce insulin more efficiently. Because exenatide has been recently shown to reduce cerebrospinal fluid (CSF) secretion and intracranial pressure, it could potentially be used as a treatment for idiopathic intracranial hypertension (IIH). | |
| Eye Drops – Dry Eyes | Artificial Tears, Cyclosporine, Restasis | Immunosuppressant | X | Eye drops | Preventive | Because dry-eye symptoms are prevalent in people with migraine, doctors may prescribe artificial tears. Nonprescription eye drops contain preservatives, while prescription formulas like Cyclosporine or Restasis do not. Both decrease inflammation that can cause dry eyes and discomfort for people with migraine. | |
| Eye drops – Glaucoma | Levobunolol, Timolol | Beta-blocker | X | Eye drops | Acute & Preventive | Beta-blocker eye drops, used to treat glaucoma, have been shown in a series of patients to provide almost complete pain relief from acute migraine over years of use. The mechanism of action of the drops is believed to be the passage of the beta-blockers into the nasal cavity, which is then rapidly absorbed into the blood vessels.See also: Timolol. | |
| Famciclovir | Famvir | Antiviral | X | Pill | Preventive | Famciclovir is an antiviral drug that is used to treat infections caused by certain types of viruses. It treats shingles caused by herpes zoster and outbreaks of herpes simplex. In people with frequent outbreaks of genital herpes, famciclovir is used to help reduce the number of future episodes. It can also be useful in the treatment of fibromyalgia and allodynia, often in conjunction with other medications. | |
| Fludrocortisone | Florinef Acetate | Steroid | X | Pill | Preventive | Fludrocortisone is a corticosteroid. It works by causing the kidneys to retain sodium and acting as a replacement for cortisone when the body does not produce enough. It is used to treat adrenocortical insufficiency in Addison’s disease and for treating salt-losing adrenogenital syndrome. | |
| Flunarizine | Sibelium | Calcium channel blockers | X | Pill | Preventive | Flunarizine is part of a group of drugs called calcium channel blockers. These work by relaxing the muscles of your heart and blood vessels. Flunarizine reduces calcium entry into neurons making them less “excitable.” | |
| Fluoxetine | Lovan, Prozac, Sarafem | Antidepressant | X | Pill | Preventive | Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) antidepressant used to treat major depressive disorder, bulimia nervosa, obsessive-compulsive disorder, panic disorder, and premenstrual dysphoric disorder (PMDD). Leading neurologist Dr. Andrew Charles has flagged SSRI medications as having the potential to make migraine worse. If you take an SSRI and have migraine, consider discussing with your Doctor whether an alternative medication might be right for you. | |
| Fluticasone | Flonase | Steroid | Nasal Spray | Acute | Fluticasone treats allergy symptoms such as sneezing, itching, and runny or stuffy nose. It works by decreasing inflammation in the nose, making it easier to breathe. It may be beneficial for migraine if allergies are a trigger; however, there is some limited evidence suggesting that intranasal corticosteroids, including fluticasone, may trigger or worsen migraine-like headaches in a small subset of patients. | ||
| Fluvoxamine | Luvox | Antidepressant | X | Pill | Preventive | Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI). It works by restoring the balance of serotonin, a natural substance in the brain, which helps to decrease obsessive or compulsive behavior. It is used to treat obsessive-compulsive disorder (OCD) and other conditions. Leading neurologist Dr. Andrew Charles has flagged SSRI medications as having the potential to make migraine worse. If you take an SSRI and have migraine, consider discussing with your doctor whether an alternative medication might be right for you. | |
| Fosaprepitant | Emend for Injection | Neurokinin 1 receptor antagonist (antiemetic) | X | Injection | Acute | Used to prevent chemotherapy-induced or postoperative nausea and vomiting and for CVS (Cyclic Vomiting Syndrome, a migraine variant). Also used to control nausea and vomiting related to intravenous DHE (dihydroergotamine). | |
| X | Fremanezumab | Ajovy | CGRP monoclonal antibody | X | 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. |
| X | Frovatriptan | Frova, Migard | Serotonin 5-HT1 agonists or Triptans | X | 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. |
| Gabapentin | Gabarone, Gralise, Horizant, Neurontin | Anticonvulsant | X | Pill | Preventive | Gabapentin is an anticonvulsant medication. It affects chemicals and nerves in the body that are involved in the cause of seizures and some types of pain. Gabapentin is used in adults to treat nerve pain caused by herpes virus or shingles. The Horizant brand is also used to treat restless legs syndrome (RLS). The Neurontin brand is also used to treat seizures in adults and children who are at least 3 years old. | |
| X | Galcanezumab | Emgality | CGRP monoclonal antibody | X | 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. |
| Glucagon-Like Peptide-1 Receptor (GLP-1) Agonists | Mounjaro, Ozempic, Rybelsus, Trulicity, Victoza, Wegovy, Zepbound and others | GLP-1 Agonist | x | Injection | Preventive | GLP-1 agonists are currently approved for type 2 diabetes and weight loss. They mimic the GLP-1 hormone that is naturally released in the gastrointestinal tract in response to eating. For type 2 diabetes, this helps to control blood sugar levels. For obesity, this helps to reduce hunger and delay the stomach in emptying, which makes one feel full longer. There is some indication in the scientific literature that GLP-1 agonists could be beneficial in pain and central sensitization pathways, but more research is needed to understand that connection. | |
| Greater occipital nerve (GON) block | Decadron, Dexamethasone Intensol, Dexasone, Solurex, Baycadron / Xylocaine, XTLido & others | Other - steroid & anesthetic | X | Injection | Preventive | This treatment injects a steroid and lidocaine into the greater occipital nerve (GON) to block pain messages to the brain from the GON. The occipital nerves are two pairs of nerves originating in the upper cervical vertebrae. The GON is located beneath the scalp in the back of the head. This region of the brain deals with vision including color recognition, spatial awareness, and word recognition. Most people who have migraine and headache also have tenderness in the suboccipital region of the skull. In cases where migraine is resistant to medication, or treatment is hindered by adverse effects, a GON block may be explored. | |
| Hormonal Contraceptives | Various | Other - Hormones | X | Intradermal, Intrauterine Device, Patch, Pill, Vaginal Ring | Preventive | Hormonal contraceptives are birth control that use hormones to prevent pregnancy. They contain estrogen and progesterone, or progesterone only. They prevent pregnancy by blocking the release of eggs from the ovaries, thinning the lining of the uterus, or thickening the mucus in the cervix to help keep sperm from reaching the egg. Hormonal contraceptives may be taken by mouth, injected or inserted under the skin, placed on the skin as a patch, or placed in the vagina or uterus. Dips in estrogen are most commonly associated with migraine onset, which may lead menstruating persons to seek out hormonal balancing methods as a form of treatment. | |
| Hormone replacement therapy (HRT) | Various | Other - hormones | X | Cream, Patch, Pill, Spray | Preventive | Hormone replacement therapy (HRT), also called hormone therapy or menopausal hormone therapy (MHT) depending on the country, is typically prescribed for individuals experiencing natural or surgically-induced menopause. Common hormones used in HRT include estrogens, progesterone or progestins, and sometimes testosterone. Significant hormonal changes during menopause can trigger migraine for many people. HRT aims to supplement these hormones during the menopausal stages, potentially reducing migraine frequency or severity. However, HRT is not recommended for migraine management in individuals who are not currently experiencing any stage of menopause. | |
| Hydrocodone | Hysingla ER, Zohydro ER | Opioid | X | Nasal Spray, Pill, Suppository | Acute | Hydrocodone is an opioid pain medication. Zohydro ER and Hysingla ER are extended-release forms of hydrocodone that are used for around-the-clock treatment of severe pain. Extended-release hydrocodone is not for use on an as-needed basis for pain. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment. | |
| Hydromorphone | Dilaudid-HP, Jurnista | Opioid | X | Pill | Acute | Hydromorphone is an opioid analgesic. It works in the brain and nervous system to reduce pain. It is used to treat moderate to severe pain in opioid-tolerant patients who require larger than usual doses to provide adequate pain relief. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment. | |
| Hydroxyzine | Atarax, Alamon, Equipose, Hyzine, Rezine, Vistaril IM, Vistazine & others | Antihistamine | X | Injection, Pill | Acute | Hydroxyzine reduces activity in the central nervous system. It also acts as an antihistamine that reduces natural chemical histamine in the body. Histamine can produce symptoms of sneezing and runny nose, or hives on the skin. Hydroxyzine is used as a sedative to treat anxiety and tension. It is also used with other medications for anesthesia. Hydroxyzine may also be used to control nausea and vomiting, and to treat allergic skin reactions such as hives or contact dermatitis. | |
| Ibuprofen | Advil, Genpril, IBU, Midol, Motrin, Nuprin, Nurofen & others | Nonsteroidal anti-inflammatory drugs (NSAIDs) | Injection, Pill, Suppository, Topical | Acute | Ibuprofen is an NSAID that works by reducing hormones that cause inflammation and pain in the body. Ibuprofen is used to reduce fever and treat pain or inflammation caused by many conditions such as headache, toothache, back pain, arthritis, menstrual cramps, or minor injury. | ||
| Ibuprofen & Codeine | ProVen Plus, Panafen Plus, Nurofen Plus, Rafen Plus | Nonsteroidal anti-inflammatory drugs (NSAIDs) | Pill | Acute | Ibuprofen, an NSAID, combined with codeine, an opioid, is used to reduce pain and inflammation. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment. See ibuprofen and codeine for their separate descriptions. | ||
| Indomethacin | Indocid, Indocin | Nonsteroidal anti-inflammatory drugs (NSAIDs) | X | Pill | Acute | Indomethacin is an NSAID used to relieve pain for various conditions including for swelling, and joint stiffness from arthritis, gout, bursitis and tendonitis. It is the treatment of choice for hemnicrania continua and is also used for acute treatment of migraine. | |
| Intrauterine Device (IUD) | Kyleena, Liletta, Mirena, ParaGard, Skyla | Other - hormones | X | Device | Preventive | An IUD is a T-shaped device that is inserted into the uterus as a birth control method. There are five types, four of which are hormonal (Liletta, Kyleena, Mirena, and Skyla) and one that is made of copper and is hormone free (ParaGard). For some women with menstrual migraine, continuous hormone treatment may be helpful in preventing attacks linked to falling estrogen levels. | |
| Irbesartan | Abisart, Avapro | Antihypertensive | X | Pill | Preventive | Irbesartan is an angiotensin II receptor blocker (ARB), which relaxes blood vessels. This helps to lower blood pressure. It is also used in certain patients to treat kidney problems caused by diabetes. | |
| Isometheptene mucate | Duradrin, Midrin | Other | Pill | Acute | Isometheptene works by causing the blood vessels in the brain to narrow. By decreasing the width of blood vessels, isometheptene helps relieve the pain from migraine attacks. It is often used in combination with other active ingredients. The British National Formulary states that, as more effective preparations are now available, this is no longer widely used. | ||
| Ketamine | Ketalar | Anesthetic | X | Injection, IV | Acute | Ketamine is an anesthetic. It works in the brain to inhibit painful sensations. Because it has powerful psychogenic side effects and can produce adverse reactions in some patients, it is frequently administered under careful supervision by an anesthesiologist. | |
| Ketoprofen | Actron, Orudis, Oruvail | Nonsteroidal anti-inflammatory drugs (NSAIDs) | X | Injection, Pill, Topical | Acute | Ketoprofen is an NSAID. Exactly how it works is not known. It may block certain substances in the body that are linked to inflammation. NSAIDs treat the symptoms of pain and inflammation. They do not treat the disease that causes those symptoms. Ketoprofen is used to treat rheumatoid arthritis or osteoarthritis, menstrual cramps and pain, and other conditions as determined by your doctor. | |
| Ketorolac | Toradol | Nonsteroidal anti-inflammatory drugs (NSAIDs) | X | Injection, IV, Pill | Acute | Ketorolac is an NSAID indicated for short-term management of moderate to severe pain. Concerns about the high incidence of side effects has led to restriction in its dosage and maximum duration of use. In the U.K., treatment should be initiated only in a hospital. Maximum duration of treatment should not exceed five days for tablets, or two days for continuous daily dosing with intravenous or intramuscular formulations. May be used intravenously in hospital or emergency settings. Ketorolac is used in the short-term treatment of moderately severe pain (usually after surgery), alone or in combination with other medicines. | |
| Lamotrigine | Lamictal, Subvenite | Anticonvulsant | x | Pill | Preventive | Lamotrigine is an antiepileptic medication used to control and prevent seizures and is also prescribed for bipolar disorder. It works by stabilizing overactive nerve activity in the brain. While lamotrigine is not generally recommended for migraine prevention, some reports suggest it may be beneficial for migraine with aura. | |
| X | Lasmiditan | Reyvow | 5-HT1F receptor agonist (Ditan) | X | 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. |
| Levetiracetam | Keppra | Anticonvulsant | X | Pill | Preventive | Levetiracetam is an anticonvulsant. Exactly how it works is not known, but it may work by slowing abnormal nerve impulses in the brain. Levetiracetam is used to treat partial-onset, myoclonic, or other types of seizures in patients with epilepsy. It may be used in combination with other medicines. | |
| Lidocaine | Burn-O-Jel, LMX4, LMX5 | Analgesic (painkiller) | X | Topical | Acute | Lidocaine is commonly used for numbing an area of the body to reduce pain or discomfort. Some topical lidocaine prescriptions can also be used to relieve nerve pain — these come in forms of gel or skin patches that can be worn on the neck, shoulders and forehead for migraine. Over-the-counter creams are also available to help relieve joint and muscle pain. | |
| Lisinopril | Prinivil, Qbrelis, Zestril | Antihypertensive | X | Pill | Preventative | See entry on Angiotensin-converting enzyme (ACE) inhibitors. | |
| Lithium | Eskalith, Lithobid | Antimanic agent | X | Pill, Solution | Preventive | Lithium can be used to prevent hypnic headache, a type of headache that occurs exclusively during sleep and awakens the patient. Taken at bedtime, lithium has been shown to be effective in preventing a hypnic headache attack from occurring. Lithium is also indicated for use as a mood stabilizer to treat manic episodes associated with bipolar disorder. Lithium should be used with caution in cases of kidney or thyroid disease, dehydration, or in conjunction with diuretics. | |
| Loratadine | Alavert, Alavert Allergy, Claritin, Clear-Atadine Children's, Dimetapp ND, Tavist ND, Wal-itin & others | Antihistamine | Pill | Acute | Loratadine is an antihistamine that reduces the effects of natural chemical histamine in the body. Histamine can produce symptoms of sneezing, itching, watery eyes, and runny nose. Loratadine is used to treat the symptoms of allergies, such as sneezing, watery eyes, and runny nose. It is also used to treat skin hives and itching in people with chronic skin reactions. | ||
| Lorazepam | Ativan | Benzodiazepines | X | Injection, Pill | Acute | Lorazepam belongs to a group of drugs called benzodiazepines and is used to treat the symptoms of anxiety disorders. It is thought lorazepam works by enhancing the activity of certain neurotransmitters in the brain. | |
| Marijuana (medical) | - | - | X | Edibles, Oils, Pill, Tea | Acute | The use of medical marijuana for the management of chemotherapy-induced nausea, glaucoma, spasticity in multiple sclerosis, and neuropathic pain has been clinically demonstrated to some extent. The likelihood of undesirable adverse reactions limits its applications, and therapeutic use may be limited to either concomitant therapy or when conventional therapy has failed. See entry: Marijuana in Nonpharmacological. | |
| Meclizine | Antivert, Bonine, Dramamine Less Drowsy | Antiemetics | Pill | Acute & Preventive | Meclizine is an antiemetic with less associated drowsiness than some other antiemetics. It is used to help prevent motion sickness and treat dizziness (vertigo), both of which can be symptoms of migraine. | ||
| Mefenamic acid | Ponstan, Ponstel | Nonsteroidal anti-inflammatory drugs (NSAIDs) | Pill | Acute | Mefenamic acid is an NSAID. Exactly how it works is not known. It may block certain substances in the body that are linked to inflammation. NSAIDs treat the symptoms of pain and inflammation. Mefenamic acid is used for menstrual pain. It may be used for short term (no more than 7 days) treatment of mild to moderate pain. | ||
| Meloxicam | Mobic, Movalis | Nonsteroidal anti-inflammatory drugs (NSAIDs) | X | Pill | Acute | Meloxicam is an NSAID that works by reducing hormones that cause inflammation and pain in the body. Meloxicam is used to treat pain or inflammation caused by osteoarthritis or rheumatoid arthritis in adults and children who are at least 2 years old. | |
| X | Meloxicam & Rizatriptan | Symbravo | NSAID & Triptan | x | Pill | Acute | Symbravo is an oral medication developed for the acute treatment of migraine. It combines meloxicam (a long-acting NSAID) and rizatriptan (a triptan commonly used for migraine relief) using MoSEIC™ (Molecular Solubility Enhanced Inclusion Complex) technology, which enhances the absorption of meloxicam for faster action. It is thought to work by inhibiting the release of CGRP, reversing vasodilation, and reducing neuroinflammation, pain signal transmission, and central sensitization—key mechanisms involved in migraine attacks. The goal of this combination therapy is to provide faster, more effective, and longer-lasting pain relief compared to standard treatments. As of January 30, 2025, Symbravo has been FDA-approved and is expected to be commercially available in the United States within approximately four months. |
| Memantine | Abixa, Akatinol, Axura, Ebixa, Memox, Namenda | Other - central nervous system agent | X | Pill | Preventive | Memantine is an N-methyl-D-aspartate (NMDA) receptor antagonist. It works by blocking excess activity of a substance in the brain called glutamate, which may reduce the symptoms associated with Alzheimer disease. Memantine is not a cure for Alzheimer disease. It is used to help treat moderate to severe Alzheimer-type dementia. Memantine has evidence of efficacy in the prevention of migraine. | |
| Menopausal Replacement Therapy (MHT) | Various | Other - Hormones | X | Cream, Patch, Pill | Preventive | Menopausal hormone therapy (MHT), also known as hormone therapy, or hormone replacement therapy (HRT) depending on the country, is typically prescribed for individuals experiencing natural or surgically-induced menopause. Common hormones used in HRT include estrogens, progesterone or progestins, and sometimes testosterone. Significant hormonal changes during menopause can trigger migraine for many people. HRT aims to supplement these hormones during the menopausal stages, potentially reducing migraine frequency or severity. However, HRT is not recommended for migraine management in individuals who are not currently experiencing any stage of menopause. | |
| Meperidine | Demerol | Opioid | X | Injection, Pill | Acute | Meperidine is an opioid analgesic. It works in the brain and nervous system to decrease pain. Meperidine is used in the short-term treatment of moderate to severe pain. It may also be used before or during surgery (e.g. to support anesthesia), for pain relief during labor and delivery, or for other conditions as determined by your doctor. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment. | |
| Metaxalone | Skelaxin | Muscle relaxant | X | Pill | Acute | Metaxalone is a muscle relaxant used to relax muscles and relieve pain caused by strains, sprains, and other musculoskeletal conditions. Its exact mechanism of action is not known, but it may be due to general central nervous system depression. | |
| Methazolamide | GlaucTabs, Neptazane | Diuretic | X | Pill | Acute & Preventive | These medications are used to treat glaucoma, epilepsy, altitude sickness, periodic paralysis, idiopathic intracranial hypertension, and heart failure. Sometimes used to treat high-pressure headaches by lowering the production of spinal fluid. | |
| Methocarbamol & Acetaminophen | Robaxin, Robaxacet | Muscle relaxant | Injection, Pill | Acute | Methocarbamol is a central muscle relaxant used to treat skeletal muscle spasms. It is used in conjunction with acetaminophen. See acetaminophen for a separate description of this medication. | ||
| Methylergonovine or Methylergometrine | Methergine | Ergot alkaloid | X | Pill | Acute | Methergine is an ergot alkaloid used to control uterine hemorrhage during and after childbirth. In the past, it was sometimes used off-label to treat migraine due to its vasoconstrictive properties but has since been replaced by more effective and safer treatments. | |
| Methyl salicylate | Menthoderm, Thera-Gesic Plus, Salonpas Pain Patch | Other - topical rubefacient | Topical | Acute | Methyl salicylate, or menthol cream, is a topical analgesic. It works by temporarily relieving minor pain. Topical rubefacients cause irritation and reddening of the skin, due to increased blood flow. They are used in the treatment of pain in various musculoskeletal conditions and in the temporary relief of minor aches and pains caused by arthritis, simple backache, strains, sprains, and bruises. | ||
| Methylprednisolone | Medrol, Medrol Dosepak | Steroid | x | Pill | Acute | Methylprednisolone is a corticosteroid that prevents the release of substances in the body that cause inflammation. A short-term, tapering course of methylprednisolone may be prescribed to interrupt a cycle of migraine attacks, such as status migrainosus or medication overuse headache. This regimen typically starts with a higher dose and gradually decreases over 3–7 days to reduce inflammation and prevent recurrence. | |
| Methysergide | Deseril, Sansert | Anti-serotonergic (Anti 5-HT) | X | Pill | Preventive | The exact way that methysergide works is unknown. It is believed to be involved in narrowing the veins and arteries that supply blood to your head. Serotonin 5-HT is a chemical occurring in the body, and is thought to play a key role in migraine. These drugs block 5-HT2 receptors to stop the effects of 5-HT. Methysergide is a semi-synthetic ergot alkaloid. It should only be administered under hospital supervision because of potential side effects including retroperitoneal fibrosis and fibrosis of heart values and pleura. | |
| Metoclopramide | Maxolon, Metonia, Metozolv ODT, Pramin, Reglan | Antiemetic | X | Injection, Pill | Acute | Metoclopramide increases muscle contractions in the upper digestive tract which speeds up the rate at which the stomach empties into the intestines. It is used short-term to treat heartburn caused by gastroesophageal reflux when other medications have not relieved symptoms. Metoclopramide is also used to treat slow gastric emptying in people with diabetes (also called diabetic gastroparesis) which can cause nausea, vomiting, heartburn, loss of appetite, and a feeling of fullness after meals. | |
| Metoclopramide & Paracetamol | Anagrain, Metomax, Paramax | Combination - Analgesic & antiemetic | Pill | Acute | The combination of metoclopramide and paracetamol is used to treat the symptoms of migraine, both to relieve headache (the paracetamol) and to treat associated nausea and vomiting (the antiemetic). In addition to its direct antiemetic effect, metoclopramide also stimulates gastric emptying (prokinetic), which is often delayed during migraine attacks, and accelerates the absorption of paracetamol. | ||
| Metoprolol | Dutoprol, Betaloc, Lopressor | Beta blocker | X | Pill | Preventive | Metoprolol is a beta-blocker that affects the heart and circulation. Metoprolol is used to treat angina (chest pain) and hypertension. It is also used to treat or prevent heart attack. Metoprolol has been established as effective in the prevention of migraine. | |
| Mexiletine | Mexitil | Antiarrhythmics | x | Pill | Preventive | Although mexiletine is generally used to treat irregular heartbeat (i.e., arrhythmia), some studies indicate that is useful in treating pain syndromes—including migraine, fibromyalgia, and neuropathy—as it has a similar function to lidocaine. | |
| Mirtazapine | Remeron | Antidepressant | X | Pill | Preventive | Mirtazapine is an antidepressant. It affects chemicals in the brain that may become unbalanced and cause depression. Mirtazapine is used to treat major depressive disorder. | |
| Mometasone | Elocon, Nasonex | Steroid | Nasal Spray, Topical | Acute | Mometasone is a corticosteroid that works by reducing inflammatory reactions and modifying immune reactions in the body. The topical format is used for treating and preventing allergic nasal symptoms including congestion, sneezing, itching, and runny nose. It is also used for treatment of growths in the nose (nasal polyps). As a spray, it reduces inflammatory reactions in the nasal airway in response to allergens and irritants in the air. It is used to treat itching, redness, and swelling in many skin conditions. | ||
| Montelukast | Singulair | Leukotriene modifier | x | Pill | Preventive | Montelukast helps prevent and treat symptoms of asthma and allergies by decreasing inflammation in airways, making it easier to breathe. It may be beneficial for migraine if allergies are a trigger. | |
| Morphine | AVINza, Kadian, MS Contin | Opioid | X | Inhalation, Injection, Pill, Suppository | Acute | Morphine is an opioid pain medication. Morphine is used to treat moderate to severe pain. Short-acting formulations are taken as needed for pain. The extended-release form of this medicine is for around-the-clock treatment of pain and is not for use on an as-needed basis for pain. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment. | |
| Moxonidine | Physiotens | Antihypertensive | X | Pill | Preventive | Moxonidine is a blood pressure treatment that works by relaxing the muscles in the walls of your blood vessels. This means that your blood vessels widen, which reduces your blood pressure and allows blood and oxygen to circulate more freely around your body. | |
| Nadolol | Corgard | Beta blocker | X | Pill | Preventive | Nadolol is a beta-blocker. It works by slowing down the heart and decreasing the amount of blood it pumps out. This helps to decrease blood pressure, helps the heart pump more efficiently, and reduces the workload on the heart. Nadolol is used in the long-term management of angina (chest pain). It is also used alone or with other medicines to treat high blood pressure. Nadolol has evidence of efficacy in migraine prevention. | |
| Naproxen | Aleve, Anaprox, Midol Extended Relief, Naprelan 375, Naprosyn, Synflex & others | Nonsteroidal anti-inflammatory drugs (NSAIDs) | Pill | Acute | Naproxen is an NSAID that works by reducing hormones that cause inflammation and pain in the body. Naproxen is used to treat pain or inflammation caused by conditions such as arthritis, ankylosing spondylitis, tendinitis, bursitis, gout, or menstrual cramps. Naproxen is the preferred NSAID for long-term use in people with a high risk of cardiovascular complications, due to its relatively low risk of causing such complications. | ||
| X | Naratriptan | Amerge, Naramig | Serotonin 5-HT1 agonists or Triptans | X | 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. |
| Nimodipine | Nimotop | Calcium channel blockers | X | Injection, Pill | Preventive | Nimodipine is a calcium channel-blocking agent. Exactly how nimodipine works is unknown. It is used to help reduce problems from a lack of oxygen caused by bleeding from a blood vessel in the brain. | |
| Nitrazepam | Alodorm, Insoma, Mogadon, Nitrosun, Ormodon, Paxadorm, Somnite & others | Hypnotic | X | Pill | Acute | Nitrazepam is a hypnotic drug of the benzodiazepine class, indicated for the short-term relief of severe, disabling anxiety and insomnia. It also has sedative and motor-impairing properties, as well as amnestic, anticonvulsant, and skeletal muscle relaxant effects. | |
| Nonsteroidal anti-inflammatory drugs (NSAIDs) | Advil, Aleve, Bayer Aspirin, Celebrex, Miniprin, Motrin, Ponstel, Voltaren & others | Nonsteroidal anti-inflammatory drugs (NSAIDs) | Pill | Acute & Preventive | Nonsteroidal anti-inflammatory drugs (NSAIDs) are a group of medicines that reduce inflammation and relieve pain and fever. There are many different kinds of NSAIDs which can be grouped according to their preference for COX-1 and COX-2 enxymes. NSAIDs are used to treat mild-to-moderate pain from a wide range of conditions including headaches, migraine attacks, arthritis, toothache and fevers. | ||
| Nortriptyline | Allegron, Pamelor | Antidepressant | X | Pill | Preventive | Nortriptyline belongs to a group of medicines called tricyclic antidepressants (TCAs). It is used to treat depression and some other conditions. It affects chemicals in the brain that may become unbalanced. | |
| OnabotulinumtoxinA | Botox | Muscle relaxant | X | Injection | Preventive | OnabotulinumtoxinA (Botox) blocks nerve activity in the muscles, causing a temporary reduction in muscle activity. Botox can be used to prevent chronic migraine in adults but should not be used to treat tension headache. It is an in-office procedure where multiple injections are inserted into the muscles of the forehead, head and neck. Treatment is repeated every 12 weeks if successful; however, there are maximum dose limits to be aware of. Botox is also used for other conditions and for cosmetic purposes. Botox can be combined with many other types of treatments. Botox has evidence of efficacy in the prevention of chronic migraine. | |
| Ondansetron | Zofran, Zofran ODT, Zuplenz | Antiemetic | X | Injection, Pill | Acute | Ondansetron blocks the actions of chemicals in the body that can trigger nausea and vomiting. It is used to prevent nausea and vomiting that may be caused by surgery or by medicine to treat cancer (chemotherapy or radiation). It can be taken prior to acute migraine medications to increase medication absorption and to decrease nausea and vomiting from migraine. | |
| Oxycodone | Endone, Oxecta, OxyContin, Oxyfast, Roxicodone | Opioid | X | Injection, Pill, Suppository | Acute | Oxycodone is an opioid pain medication used to treat moderate to severe pain. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment. | |
| Oxymetazoline nasal | Allerest, Afrin, Mucinex, Nostrilla, Sinex | Decongestant | Nasal Spray | Acute | Oxymetazoline solution is a decongestant. It works by shrinking swollen and congested nasal tissues (mucous membranes) by constricting blood vessels. This helps relieve congestion, improve drainage of mucus, and improve breathing through the nose. Local application using nose drops or sprays causes more intense and rapid vasoconstriction than oral medicines such as tablets or syrups. | ||
| Pantoprazole | Protonix, Protonix IV, Somac | Proton-pump inhibitors | X | Injection, Pill | Acute | Pantoprazole is a proton-pump inhibitor that decreases the amount of acid produced in the stomach. It is used to treat erosive esophagitis and other conditions involving excess stomach acid, such as Zollinger-Ellison syndrome. Pantoprazole is not for immediate relief of heartburn symptoms. Leading neurologist Dr. Andrew Charles has flagged proton-pump inhibitors as having the potential to make migraine worse. If you use one and have migraine, consider discussing with your doctor whether an alternative medication might be right for you. | |
| Paracetamol & Codeine | Paracodol | Opioid | X | Pill | Acute | Paracetamol combined with codeine phosphate is used for the relief of moderate to severe pain when milder painkillers are not effective. Paracetamol is an analgesic and also an antipyretic, which helps reduce your body temperature if you have a fever. Codeine phosphate is also an analgesic and acts by blocking pain and emotional response to pain. See codeine for more detail. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment. | |
| Paracetamol & Ibuprofen | Maxigesic | Combination - Analgesic & NSAID | Pill | Acute | For the temporary relief of mild to moderate pain associated with migraine, headache, backache, menstrual pain, dental pain, rheumatic and muscular pain, pain of non-serious arthritis, cold and flu symptoms, sore throat and fever. This combination is especially suitable for pain which requires stronger analgesia than ibuprofen or paracetamol alone. | ||
| Paracetamol (Acetaminophen) | Little Fevers, Panadol, Tylenol & others | Analgesic (painkiller) | Liquid, Pill, Suppository | Acute | Paracetamol is also known as Acetaminophen depending on where you live. A pain reliever and fever reducer, the exact mechanism of action of paracetamol is unclear. Many common pain conditions including headache, muscle aches, arthritis, backache, toothaches, colds, and fevers are treated with paracetamol. It relieves pain in mild arthritis but does not affect the underlying inflammation and swelling of the joint. | ||
| Phenylephrine Hydrochloride & Ibuprofen | Sudafed PE | Combination - Decongestant & NSAID | Pill | Acute | Contains ibuprofen and phenylephrine hydrochloride, which are effective in relieving the symptoms of influenza and cold, including fever, headache, painful sinuses, sore throat, and muscle and joint pain. Moreover, it helps relieve a runny or stuffy nose and nasal sinuses. | ||
| Phenylephrine Hydrochloride & Paracetamol | Dimetapp PE Sinus Pain, Lemsip Cold & Flu, Panadol Cold & Flu, Sudafed | Combination - Decongestant & Analgesic | Pill | Acute | This combination medication contains a decongestant & analgesic (paracetamol) and can help ease symptoms such as blocked or runny nose, sore throat, and body aches and headaches. | ||
| Pizotifen | Sandomigran | Anti-serotonergic (Anti 5-HT) | X | Pill | Preventive | Pizotifen acts on serotonin 5-HT, a chemical that is thought to play a key role in migraine. It is part of a class of drugs that block 5-HT2 receptors to inhibit the effects of 5-HT. Pizotifen also has antihistamine properties and is related to the tricyclic group of antidepressants. | |
| Prednisone | Rayos, Sterapred | Steroid | X | Injection, Nasal Spray, Pill, Suppository, | Acute | Prednisone is a corticosteroid that prevents the release of substances in the body that cause inflammation. It is used as an anti-inflammatory or an immunosuppressant medication. Prednisone treats many different conditions such as allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, and breathing disorders. | |
| Pregabalin | Lyrica | Anticonvulsant | X | Pill | Preventive | Pregabalin is an anticonvulsant and neuropathic pain agent. Exactly how pregabalin works is not known. It is thought to bind to certain areas in the brain that help reduce seizures, nerve pain, and anxiety. Pregabalin is used to treat fibromyalgia or nerve pain caused by certain conditions (e.g., shingles, diabetic nerve problems, spinal cord injury). It is also used in combination with other medicines to treat certain types of seizures. Pregabalin can also be useful in the treatment of allodynia. | |
| Prochlorperazine | Buccastem, Compazine, Phenotil, Stemzine, Stemetil | Antiemetic & Antipsychotic | X | Injection, Pill, Suppository | Acute | Prochlorperazine is a phenothiazine. It is not known exactly how it works. It is a highly potent typical antipsychotic, 10–20× more potent than chlorpromazine. It is used to help control severe nausea and vomiting, and to treat schizophrenia. It is also used to treat migraine. Intravenous administration can be used to treat status migrainosus. | |
| Promethazine | Phernergan, Phenadoz, Promethegan | Antihistamine & antiemetic | X | Injection, Pill, Suppository | Acute | Promethazine works by changing the actions of chemicals in your brain. Promethazine also acts as an antihistamine. It blocks the effects of the naturally occurring chemical histamine in your body. Promethazine is used to treat allergy symptoms such as itching, runny nose, sneezing, itchy or watery eyes, hives, and itchy skin rashes. It also prevents motion sickness, and treats nausea and vomiting or pain after surgery. It is also used as a sedative or sleep aid. | |
| Propranolol | Hemangeol, Inderal LA, Inderal XL, InnoPran XL, Inderal | Beta-blocker | X | Injection, Pill, Suppository | Preventive | Propranolol is a beta-blocker. Beta-blockers affect the heart and blood circulation. Propranolol is used to treat tremors, angina (chest pain), hypertension, heart rhythm disorders, and other heart or circulatory conditions. It is also used to treat or prevent heart attacks and to reduce the severity and frequency of migraine. | |
| Pseudoephedrine | Contac Cold, Elixsure Decongestant, Entex, Genaphed, Sudafed, Suphedrin, Unifed & others | Decongestant | Pill | Acute | Pseudoephedrine is a decongestant that shrinks blood vessels in the nasal passages. Dilated blood vessels can cause nasal congestion or stuffy nose. Pseudoephedrine is used to treat nasal and sinus congestion, or congestion of the tubes that drain fluid from your inner ears, called the Eustachian tubes. | ||
| Quetiapine | Seroquel | Antipsychotic | X | Pill | Preventive | Quetiapine is an atypical antipsychotic. Exactly how it works is not known. It is thought to affect certain substances in the brain. It is used to treat schizophrenia or bipolar disorder. | |
| X | Rimegepant | Nurtec ODT, Vydura | Small molecule CGRP receptor antagonist (Gepant) | X | 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. Nurtec ODT (rimegepant) is FDA-approved in the U.S. for both acute and preventive migraine treatment. It is available on the NHS in England for acute and preventive use and was approved in Canada in 2024 for acute treatment. |
| X | Rizatriptan | Maxalt, Rizalt, RizaFilm | Serotonin 5-HT1 agonists or Triptans | X | 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. |
| Sertraline | Zoloft | Antidepressant | X | Pill | Preventive | Sertraline is an selective serotonin reuptake inhibitors (SSRIs) antidepressant. It is used to treat depression, obsessive-compulsive disorder, panic disorder, anxiety disorders, post-traumatic stress disorder (PTSD), and premenstrual dysphoric disorder (PMDD). Leading neurologist Dr. Andrew Charles has flagged SSRI medications as having the potential to make migraine worse. If you take an SSRI and have migraine, consider discussing with your medical practitioner whether an alternative medication might work for you. | |
| Sodium valproate | Epilim | Anticonvulsant | X | Injection, Pill | Preventive | Valproate is an anticonvulsant that works by increasing a certain chemical in the brain. The injectable form of sodium valproate is used to control epileptic seizures in patients who are unable to take the oral form. It is also used for the treatment of migraine and bipolar disorder. | |
| X | Sumatriptan | Imigran, Imitrex, Onzetra XSail, Sumavel DosePro, Tosymra, Treximet, Zembrace Symtouch | Serotonin 5-HT1 agonists or Triptans | X | 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. |
| X | Telcagepant | - | Gepant/small molecule CGRP receptor antagonist | - | Acute & Preventive | Early CGRP treatment withdrawn from market by its manufacturer, Merck in 2009. A previous safety study showed patients taking it experienced elevated liver enzymes. | |
| Timolol | Betimol, Betrim, Blocadren, Istalol, Timoptic | Beta-blocker | X | Eye drops, Pill | Preventive | Timolol is part of a group of drugs called beta-blockers. It is used to treat hypertension. Timolol eye drops are used to treat increased pressure in the eye (ocular hypertension) and open-angle glaucoma. It may also be used for other conditions as determined by your doctor. Timolol has been established as effective in the prevention of migraine. See also: Eye drops (glaucoma). | |
| Tizanidine | Zanaflex | Muscle relaxant | X | Injection, Nasal Spray, Pill | Acute | Tizanidine is a short-acting muscle relaxant. It works by blocking nerve impulses or pain sensations that are sent to your brain. Tizanidine is used to treat spasticity by temporarily relaxing muscle tone. | |
| Topiramate | Topamax | Anticonvulsant | X | Pill | Preventive | Topiramate is an anticonvulsant that is also established as effective in the prevention of migraine. It works by affecting several chemicals in the brain that help to reduce seizure activity and prevent migraine from occurring. It may be used alone or with other medications. | |
| Tramadol | ConZip, Rybix ODT, Ryzolt, Ultram | Opioid | X | Injection, Pill, Suppository | Acute | Tramadol is a centrally-acting, oral opioid-like analgesic and is approved for the treatment of moderate to moderately severe pain in adults. The extended-release form of tramadol is for around-the-clock treatment of pain and not for use on an as-needed basis for pain. | |
| Tramadol & Paracetamol (Acetominophen) | Tramacet, Ultracet | Opioid-like & Analgesic (painkiller) | X | Injection, Pill | Acute | This formulation combines individual ingredients for a stronger effect. See individual active ingredients for mode of action. | |
| X | Ubrogepant | Ubrelvy | Small molecule CGRP receptor antagonist (Gepant)Small molecule CGRP receptor antagonist (Gepant) | X | 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. |
| Valproic Acid | Depacon, Depakene, Stavzor, Valproate Sodium | Anticonvulsant | X | IV, Liquid, Pill | Preventive | Valproic acid is used to treat various types of seizure disorders, sometimes together with other seizure medications. Valproic acid is also used to treat manic episodes from bipolar disorder and is established as effective in the prevention of migraine. | |
| Venlafaxine | Effexor | Antidepressant | X | Pill | Preventive | Venlafaxine is an antidepressant in a group of drugs called selective serotonin and norepinephrine reuptake inhibitors (SNRIs). Venlafaxine is used to treat major depressive disorder, anxiety, and panic disorder. Venlafaxine has evidence of efficacy in the prevention of migraine. | |
| Verapamil | Calan, Isoptin | Calcium channel blockers | X | Injection, Pill | Preventive | Verapamil is a calcium channel blocker. It works by relaxing the muscles of your heart and blood vessels. Verapamil is used to treat hypertension, angina (chest pain), and certain heart rhythm disorders. | |
| Zaleplon | Sonata | Hypnotic | X | Pills | Acute | Zaleplon is a sedative, also called a hynoptic. It affects chemicals in one's brain that may be unbalanced in people with insomnia. Zaleplon causes relaxation to help one fall asleep and stay asleep. | |
| X | Zavegepant | Zavzpret | Small molecule CGRP receptor antagonist (Gepant) | X | 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. |
| X | AscoTop, Zomig, Zomigon, Zomigoro | Zomig | Serotonin 5-HT1 agonists or Triptans | X | 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. |
| Zolpidem | Ambien, Edluar, Intermezzo, Sanval, Stilnox, Zonadin, Zolpimist Hypnogen | Hypnotic | X | Pill, Suppository | Acute | Zolpidem is a sedative, also called a hypnotic. It affects chemicals in your brain that may become unbalanced and cause sleep problems or insomnia. The immediate-release forms of zolpidem are Ambien, Intermezzo, Edluar, and Zolpimist. The extended-release form of zolpidem is Ambien CR. Ambien, Edluar, and Zolpimist are used to help you fall asleep when you first go to bed. Intermezzo is used to help you fall back asleep if you wake up in the middle of the night. | |
| Zonisamide | Zonegran, Zonisade | Anticonvulsant | X | Pill | Preventive | Zonisamide is an antiepileptic medication used alongside other treatments to manage partial seizures in individuals 16 years and older by reducing abnormal electrical activity in the brain. It may also be prescribed for migraine prevention, particularly for individuals who have not responded to other preventive treatments. |
