| Acetaminophen or Paracetamol | Little Fevers, Panadol, Tylenol and many others | Analgesic (painkiller) | | Tablets, capsules, liquid, suppository | Acute | Acetaminophen is also known as paracetamol, and your location will determine whether you refer to this treatment as one or the other. A pain reliever and a fever reducer, the exact mechanism of action of acetaminophen/paracetamol is unclear. Many conditions including headache, muscle aches, arthritis, backache, toothaches, colds, and fevers, are treated with acetaminophen (paracetamol). It relieves pain in mild arthritis but does not affect the underlying inflammation and swelling of the joint. |
| Acetaminophen, Butalbital, Caffeine | Alagesic, Anolor 300, Dolgic LQ, Dolgic Plus, Esgic, Fioricet, Geone, Margesic, Medigesic, Orbivan, Repan, Zebutal | Combination - Barbiturate | X | Tablets | Acute | Acetaminophen is a pain reliever and fever reducer. Butalbital is part of a group of drugs called barbiturates. They are known to relax muscle contractions involved in a tension headache. Caffeine is a central nervous system stimulant that can relax muscle contractions in blood vessels to improve blood flow. The combination of acetaminophen, butalbital, and caffeine 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, Codeine | Tylenol 3 or 4, Panadeine | Combination - Narcotic | X | Tablets, Liquid | Acute | Acetaminophen/paracetamol with codeine is a narcotic and analgesic/antipyretic combination. It works in the brain and nervous system to decrease mild to moderately severe pain. |
| Acetaminophen, Dichloralphenazone & Isometheptene | Duradrin, Midrin | Analgesic (painkiller) | X | Capsules | 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, certain types of headaches (tension, neurovascular), and other conditions as determined by your doctor. |
| Acetazolamide | Diamox | Carbonic anhydrase inhibitor | X | Tablets, Capsules | Acute and preventive (depends on what it's treating, but for migraine, only preventive) | Acetazolamide is used to prevent and treat the symptoms of altitude sickness. It can also be used to reduce edema, treat glaucoma, control epileptic seizures, and, in some cases, prevent hemiplegic migraine. 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. |
| Acetazolamide, methazolamide | Diamox Sequels, Neptazane | Diuretic | X | Tablets | Acute/Preventive | Medications 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. |
| Acetylsalicylic Acid (ASA) | Aspirin, Baby Aspirin | Nonsteroidal anti-inflammatory drugs (NSAIDs) | | Tablets, dissolvable tablets | 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) & Combinations | AsproClear, Arthritis Pain, Ascriptin Enteric, Aspir 81, Aspir-Low, Bayer Aspirin, Bayer ChildrenÕs Aspirin, Bufferin, Easprin, Ecotrin, Ecpirin, Excedrin, Fasprin, Halfprin, Miniprin, St. Joseph Aspirin | Combinations Ð Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) | | Tablets, powder, and others | Acute | Aspirin is a nonsteroidal anti-inflammatory drug (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/paracetamol and caffeine. Check the label to be sure. Overuse of combination treatments containing caffeine may lead to rebound headaches. |
| Acyclovir | Zovirax | Antiviral | X | Tablets, capsules, 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 | Tablets | 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. |
| Air pressure modulation device | Nocira | Neuromodulation | X | Device | Acute | Nocira is an investigational new migraine treatment device intended to deliver a comfortable and non-invasive treatment experience. The device delivers a modulated pattern of gentle puffs of air into the ear, which stimulates pressure-activated sensory neurons to reset the brain's pain response. The pilot study saw 67% of its participants pain-free after 20 minutes of treatment with Nocira. The device operates by way of earpieces controlled through a mobile phone app. Additional clinical trials are planned. Not yet FDA approved as of March 2021. |
| Almotriptan | Axert, Almogran | Serotonin 5-HT1 agonists or triptans | X | Tablets | 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 a migraine attack is thought to be hypersensitive to widened blood vessels exerting pressure on the brain. |
| Alprazolam | Niravam, Xanax | Benzodiazepines | X | Tablets | Preventive | Alprazolam belongs to a group of drugs called benzodiazepines. It works by slowing down the movement of brain chemicals 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 | Tablets | Preventive | Amitriptyline is a tricyclic antidepressant. It affects chemicals in the brain that may become unbalanced. Amitriptyline is used to treat symptoms of depression. |
| Amphetamine | Adzenys XR-ODT, Dyanavel XR, Evekeo | Stimulant | X | Tablets | 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 (MOH). |
| Angiotensin-converting enzyme (ACE) inhibitors | Prinivil, Qbrelis, Zestril, Epanded, Vasotec, Altace | Hypertension | X | Tablets | 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. It has been thought that ACE inhibitors could be used as a preventive treatment for migraine because it can narrow the blood vessles in the brain. A 2019 study concluded that ACE inhibitors could be used a preventive treatment for migraine in persons with high blood pressure or high risk of side effects, but the evidence did not support use of it as a preventive otherwise. |
| Aprepitant | Emend | Neurokinin 1 receptor antagonist (antinausea) | X | Capsule | 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). |
| Asenapine | Saphris | Other - schizophrenic & bipolar | X | Tablets | Preventive | Asenapine treats schizophrenia. It is used alone or along with lithium or valproate to treat acute manic or mixed episodes associated with bipolar disorder or manic-depression. Asenapine is an atypical antipsychotic. Exactly how it works is not known. It may work by blocking certain substances in the brain. |
| Aspirin, Butalbital, Caffeine | Fiorinal, Fortabs, Laniroif, Farbital, Fiormor, Fiortal, Idenal, Isollyl, Lanorinal | Combination - Barbiturate | X | Tablets, Capsules | 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 (MOH). They are known to relax muscle contractions involved in a tension headache. Caffeine is a central nervous system 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 | NSAID Ð combination | X | Tablets | 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. |
| Aspirin, Codeine | Aspalgin, Disprin Forte | Analgesic (painkiller) | X | Tablets, capsules | 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. |
| Atenolol | Tenormin | Beta blockers | X | Tablets | 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 (high blood pressure). It may also be used to treat or prevent heart attack. |
| Atogepant | | Small molecule CGRP receptor antagonist (Gepant) | X | In testing for oral | Preventive | Atogepant is an oral CGRP receptor antagonist in development for the prevention of migraine. Atogepant is chemically distinct from ubrogepant, an orally-administered CGRP receptor antagonist for the acute treatment of migraine. Atogepant has a longer half-life, making it suitable for preventive treatment. Not FDA approved as of March 2021. |
| Baclofen | Lioresal, Gablofen | Muscle Relaxant | X | Tablets | 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 | Veronal, Medinal | Barbiturate | X | Capsule, cachets | Preventive | As barbital is a controlled substance, other substances have largely replaced barbital-based medications. When barbitone was first introduced, it was considered a great improvement over the existing hypnotics. It was used as a sleeping aid (hypnotic) from 1903 until the mid-1950s. Barbiturates have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment. |
| Bariatric surgery | N/A | - | X | Surgical Procedure | Preventive | Obesity is associated with an increased risk of progression from episodic to chronic migraine. For obese individuals, weight reduction by means of bariatric surgery may contribute to a reduction in the frequency, severity, and duration of migraine attacks. The beneficial impact of weight loss on migraine has been noted to a comparable degree for both bariatric surgery and weight lost through lifestyle modification. |
| Budesonide | Entocort, Pulmicort, Rhinocort Aqua | Steroid | X | Capsule, intranasal | Preventive | Budesonide is a steroid that reduces inflammation in the body. Budesonide is primarily used to treat mild to moderate Crohn's disease. |
| Buprenorphine | Buprenex, Temgesic | Narcotic | X | Injection, tablets | Acute | Buprenorphine is a narcotic analgesic. It works on the brain and nervous system to decrease pain. It can help relieve moderate to severe pain. |
| Butalbital (Discontinued) | N/A | Barbiturate | X | N/A | Acute | Butalbital 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. It has been discontinued as a single agent, and is not recommended due to high risk for addiction and medication overuse headache (MOH). |
| Candesartan | Blopress, Atacand, Amias, Ratacand | Hypertension | X | Tablets | 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. |
| Cannabidiol oil (CBD) | Hundreds of OTC brands; Epidiolex is the first FDA-approved prescription for highly purified CBD oil. | Phytocannabidiol | | Tinctures, oils, gummies and other edible forms, creams, gels, sublingual sprays, vapors, transdermal patches | Acute/Preventive | The nonpsychoactive part of the cannabis, or marijuana plant. CBD oil is made by extracting CBD from the cannabis plant, then 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. |
| Carbamazepine | Carbatrol, Epitol, Equetro, TEGretol, TEGretol XR | Anticonvulsant | X | Tablets | 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 | Tablets | Preventive | Carvedilol is a beta blocker. Beta blockers affect the heart and blood circulation. Carvedilol is used to treat heart failure and hypertension (high blood pressure). It is also used after a heart attack that has compromised your heartÕs ability to function effectively. |
| Celecoxib | Celebrex, Vioxx and Bextra | COX inhibitor | X | Tablets | Acute/Preventative | 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. Only COX-1 produces prostaglandins that protect the stomach and intestinal lining. 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 | | Tablets | 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 | Capsule, tablets, injection, suppository | Preventive | Chlorpromazine is a phenothiazine. 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. |
| Citalopram | Cipramil, Celexa | Antidepressant | X | Tablets | Preventive | Citalopram is a selective serotonin reuptake inhibitor (SSRI). This medication works by helping to restore the balance of a certain natural substance (serotonin) in the brain. Citalopram is used to treat depression. It may improve your energy level and feelings of well-being. Leading neurologist 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 be right for you. |
| Clonidine | Catapres, Dixarit, Kapvay | Hypertension | X | Tablets | 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 (high blood pressure). The Kapvay brand of clonidine is used to treat attention deficit hyperactivity disorder (ADHD). |
| Codeine | Migraleve | Opioid | X | Capsule, tablets, rectal suppository | Acute | Codeine is used to treat mild to moderately severe pain. Codeine or 3-methylmorphine (a naturally occurring methylated morphine) 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 has many other potential and indicated uses. It is often sold as a salt in the form of either codeine sulfate or codeine phosphate in the United States and Australia. Codeine hydrochloride is more common worldwide than codeine sulfate or phosphate, and citrate, hydroiodide, hydrobromide, tartrate, as well as other salts are also used. Opioids have a high risk of causing medication overuse headache and making migraine attacks less responsive to treatment. |
| CPAP Machine | RESmart, ResMed, Philips, Fisher & Paykel | Ventilator | X | Device | Preventive | Continuous Positive Airway Pressure (CPAP) therapy is a common treatment for obstructive sleep apnea. It includes a small machine that supplies a constant and steady air pressure, a hose, and a mask or nose cannula. |
| Cyclobenzaprine | Amrix, Fexmid, Flexeril | Muscle relaxant | X | Tablets | 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 | Tablets | 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. |
| Desvenlafaxine | Khedezla, Pristiq | Antidepressant | X | Tablets | Preventive | Desvenlafaxine is an oral drug that is used for treating depression. It is in a 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. |
| Diazepam | Valium | Other - psychoactive benzodiazepine | X | Tablets, injection, 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-XR, Zipsor, Zorvolex, Voltaren | Nonsteroidal anti-inflammatory drugs (NSAIDs) | | Tablets, injection, gel, suppository | Acute | Diclofenac is a nonsteroidal anti-inflammatory drug (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. Cambia will only treat a migraine attack that has already begun. |
| Dihydroergotamine mesylate (DHE) | Dihydergot, DHE 45, Migranal, INP104 (Trudhesa) | Ergot alkaloid - derivative | X | Injection, Nasal Spray | Acute | Dihydroergotamine is used to treat acute migraine with or without aura, and cluster headaches. Dihydroergotamine is an ergot derivative. It works by constricting blood vessels in the brain, which can help to relieve migraine. Unlike most acute treatments, it is thought that DHE does not contribute to medication overuse headache or worsening headache from increased use of the drug. |
| Diltiazem | Cardizem, Cartia XT, Dilacor XR, Dilt-CD, Dilt-XR, Diltia XT, Diltiazem Hydrochloride CD, Diltiazem, Diltzac, Flunarizine, Taztia XT, Tiazac, Cardizem Monovial, Matzim LA | Calcium channel blockers | X | Tablets | 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 (high blood pressure), angina (chest pain), and certain heart rhythm disorders. |
| Dimenhydrinate | Gravol, Dramamine and many others | Antihistamine, antiemetic | | Tablet, Capsule, Injection, Suppository, or Liquid | Acute | Used to prevent and treat nausea, vomiting, and dizziness due to
motion sickness. Gravol is used to control vomiting associated
with migraine, but it has largely been replaced by Zofran
(ondansetron). |
| Diphenhydramine | Benadryl, Nytol, Simply Sleep and others | Antihistamine | | Pill or Capsule | Acute | Used to control high levels of histamine. May speed relief of migraine when taken with migraine medications. |
| Divalproex sodium | Depakote, Depakote ER, Depakote Sprinkles | Anticonvulsant | X | Tablets | 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 (manic depression) and to prevent migraine headaches. |
| Domperidone | Molax, Motilium, Motinorm Costi, Nomit | Anti-emetic (anti-nausea) | X | Tablets, injection, suppository | Acute | Anti-emetics help relieve the nausea associated with migraine attacks. Domperidone helps increase the transit of food through the stomach which helps facilitate its anti-nausea properties. |
| Dosulepin/Dothiepin | Prothiaden, Dothep, Thaden, Dopress | Antidepressant | X | Tablets | 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 | Restavit, Dozile | Antihistamine | | Tablets | 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 | | Tablets | Acute | Helps produce drowsiness along with two active painkiller ingredients. See Codeine & Paracetamol. |
| Duloxetine | Cymbalta | Antidepressant | X | Tablets | 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. |
| Ear insufflation therapy | N/A | Neuromodulation | X | In-Office Procedure | Acute | Ear insufflation therapy is the administration of small bursts of air or ozone gas to the ear drum via a tool called a pneumatic otoscope. Researchers believe these controlled puffs of air stimulate pressure-activated nerve receptors found in the ears, resetting the pain centers in the brain. This procedure is not currently FDA approved. |
| Eletriptan | Relpax | Serotonin 5-HT1 agonists or triptans | X | Tablets | Acute | Eletriptan is a second-generation triptan drug intended for the treatment of migraine. It is used as an abortive treatment to help block a migraine attack that is already in progress. |
| Eptinezumab | Vyepti | CGRP monoclonal antibody | X | Intravenously | Preventive | Eptinezumab is a preventive CGRP monoclonal antibody approved by the FDA in February 2020. 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. |
| 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 | Tablets, 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. |
| Escitalopram | Lexapro | Antidepressant | X | Tablets | Preventive | Escitalopram is a selective serotonin reuptake inhibitor (SSRI). It works by restoring the balance of serotonin, a natural substance in the brain, which helps to improve certain mood problems. It is used to treat depression or generalized anxiety disorder. Leading neurologist 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 be right for you. |
| Estrogen patch | Alora, Estraderm, EstroGel, Vivelle and others | Estradiol hormone | X | Transdermal patch | Preventive | An estrogen patch used for 7 to 10 days during the tail end of the menstrual cycle before a menstrual period may blunt the cyclic fall in estrogen and prevent a menstrual migraine. |
| Eye Drops Ð Dry Eyes | Artificial Tears, Cyclosporine, Restasis | Immunosuppressant | * | 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/Restasis do not. Both decrease inflammation that can cause dry eyes and discomfort for people with migraine. |
| Eye Drops Ð Glaucoma | Timolol, Levobunolol | Beta blockers | 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. |
| Famciclovir | Famvir | Antiviral | X | Tablets | 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 | Other - corticosteroid | X | Tablets | Preventive | Fludrocortisone is a corticosteroid, which is a steroid hormone. 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 | Tablets, Capsules | 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 Òexcitable.Ó |
| Fluoxetine | Lovan, Prozac, Sarafem | Antidepressant | X | Capsules | Preventive | Fluoxetine is a selective serotonin reuptake inhibitors (SSRI) antidepressant. It is used to treat major depressive disorder, bulimia nervosa (an eating disorder), obsessive-compulsive disorder, panic disorder, and premenstrual dysphoric disorder (PMDD). Leading neurologist 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 be right for you. |
| Fluvoxamine | Luvox | Antidepressant | X | Tablets | 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). It may also be used for other conditions as determined by your doctor. |
Fosaprepitant
| Emend for Injection | Neurokinin 1 receptor antagonist (antinausea) | X | Intravenously | 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). |
| Fremanezumab | Ajovy | CGRP monoclonal antibody | X | Injection | Preventive | Fremanezumab is a preventive monoclonal antibody approved by the FDA in September 2018 for the prevention of migraine. This CGRP monoclonal antibody attaches to CGRP and inactivates it. Ajovy is self administered monthly or quarterly, as your physician advises. |
| Frovatriptan | Frova, Migard | Serotonin 5-HT1 agonists (Triptans) | X | Tablets | 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. |
| Gabapentin | Gralise, Horizant, Neurontin, Gabarone | Anticonvulsant | X | Tablets, capsules | 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. |
| Galcanezumab | Emgality | CGRP monoclonal antibody | X | Injection | Preventive | Galcanezumab is a CGRP monoclonal antibody approved by the 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, 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. |
| Greater Occipital Nerve (GON) Block | | 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 regular 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. |
| Hormone Replacement Therapy/Contraceptive pills | - | Other - hormones | X | Tablets | Preventive | Hormone replacement therapy (HRT) refers to any form of hormone therapy where the patient receives hormones, either to supplement a lack of naturally occurring hormones, or to substitute other hormones for naturally occurring hormones. HRT is typically prescribed for those experiencing either natural or surgically induced menopause. The main types of hormones involved are estrogens, progesterone or progestins, and sometimes testosterone. ItÕs often referred to as treatment rather than therapy. For pre-menopausal use, contraceptive pills containing hormones may be used to skip periods (and can avert menstrual migraine). |
| Hydrocodone | Hysingla ER, Zohydro ER | Opioid | X | Tablets, suppository, intranasal | 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 | Tablets | 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, Aterax, Durrax, Equipose, Masmoran Vistaril, Vistaril IM, Hyzine, Vistaject-50, Rezine, Tran-Q, Orgatrax, Quiess, Tranquizine, Vistacon, Vistacot, Vistazine | Antihistamine | X | Tablets, capsules, injection | 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 together with other medications for anesthesia. Hydroxyzine may also be used to control nausea and vomiting. Hydroxyzine is also used to treat allergic skin reactions such as hives or contact dermatitis. |
| Ibuprofen | Advil, Genpril, IBU, Midol, Motrin, Nuprin, Nurofen | Nonsteroidal anti-inflammatory drugs (NSAIDs) | | Tablets, suppository, injection, topical | Acute | Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). It 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, Rafen Plus, Panafen Plus, Nurofen Plus | Nonsteroidal anti-inflammatory drugs (NSAIDs) | | Tablets | Acute | In this combination formula Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), is combined with codeine to reduce pain and inflammation. See Ibuprofen and Codeine for their separate descriptions. |
| Indomethacin | Indocin, Indocid | Nonsteroidal anti-inflammatory drugs (NSAIDs) | X | Capsules suppository, injection, topical | Acute | Indomethacin is used to treat patent ductus arteriosus (PDA) in certain premature infants. Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID). It is thought to work by blocking the action of a certain chemical in the body called prostaglandin. |
| Irbesartan | Abisart, Avapro | Hypertension | X | Tablets | 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 | Midrin, Duradrin | Other | | Capsules | 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. |
| IUD | Liletta, Kyleena, Mirena, Skyla, ParaGard | Other - hormones | X | Device | Acute/Preventive | The 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. |
| 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 | Capsules, injection, 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. It is also used to treat menstrual cramps and pain. It may also be used for other conditions as determined by your doctor. |
| Ketorolac | Toradol | Nonsteroidal anti-inflammatory drugs (NSAIDs) | X | Tablets, injection, IV | Acute | Ketorolac is an NSAID indicated for short-term management of moderate to severe pain. Concerns about the high incidence of reported 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 (per package insert), 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 (up to five days) treatment of moderately severe pain (usually after surgery), alone or in combination with other medicines. |
| Lamotrigin | Lamictal | Anticonvulsant | X | Tablets | Preventive | Lamotrigine is an anticonvulsant. Exactly how it works is not known. It is used to treat certain types of seizures. It may be used alone or with other medicines. It may also be used to delay the occurrence of mood problems in certain patients with bipolar disorder. |
| Lasmiditan | Emgality | 5-HT1F receptor agonist (Ditan) | X | Tablets | 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. |
| Levetiracetam | Keppra | Anticonvulsant | X | Tablets | 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 most commonly used for numbing an area of the body to help 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 lidocaine creams are also availabe to help relieve joint and muscle pain. |
| Lithium | Eskalith, Lithobid | Antimanic agent | X | Tablets, Capsules, 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, lear-Atadine, Clear-Atadine Children's, Dimetapp ND, Loratadine Reditab, Tavist ND, Wal-itin | Antihistamine | | Tablets | 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. |
| Marijuana/Medical Cannabis | - | Other | X | Tea, edibles, capsules, oils | 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. |
| Mefenamic acid | Ponstan, Ponstel | Nonsteroidal anti-inflammatory drugs (NSAIDs) | | Capsules | 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 (not more than 7 days) treatment of mild to moderate pain. |
| Meloxicam | Mobic, Movalis | Nonsteroidal anti-inflammatory drugs (NSAIDs) | X | Tablets | Acute | Meloxicam (Mobic) is a nonsteroidal anti-inflammatory drug (NSAID). It 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. |
| Memantine | Abixa, Akatinol, Axura, Ebixa, Memox, Namenda | Other - central nervous system agent | X | Tablets | 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. |
| Meperidine | Demerol | Opioid | X | Tablets, injection | 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 | Tablets, capsules | Acute | Metaxalone (brand name Skelaxin) 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. |
| Methocarbamol, Acetaminophen | Robaxin, Robaxacet | Muscle relaxant | | Tablets, injection | 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. |
| Methyl Salicylate | Menthoderm, Thera-Gesic Plus, Salonpas Pain Patch | Other - topical rubefacient | | Topical | Acute | Methyl salicylate/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. |
| Methysergide | Deseril, Sansert | Anti-serotonergic (Anti 5-HT) | X | Tablets | 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 the potential side effects (retroperitoneal fibrosis and fibrosis of heart values and pleura). |
| Metoclopramide | Maxolon, Metozolv ODT, Pramin, Reglan | Anti-emetic (anti-nausea) | X | Tablets, injection | Acute | Metoclopramide increases muscle contractions in the upper digestive tract. This speeds up the rate at which the stomach empties into the intestines. Metoclopramide is used short-term to treat heartburn caused by gastroesophageal reflux in people who have used other medications without relief of 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 | Other - combination analgesic & anti-emetic (anti-nausea) | | Tablets | 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 anti-emetic). In addition to its direct anti-emetic 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 | Tablets | Preventive | Metoprolol is a beta blocker that affects the heart and circulation. Metoprolol is used to treat angina (chest pain) and hypertension (high blood pressure). It is also used to treat or prevent heart attack. |
| Mirtazapine | Remeron | Antidepressant | X | Tablets | 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 | | Topical, intranasal | Acute | Mometasone is a corticosteroid (a steroid hormone). It 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. |
| Morphine | AVINza, Kadian, MS Contin | Opioid | X | Tablets, injection, suppository, inhalation | 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. This form of morphine 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 | Hypertension | X | Tablets | Preventive | Monoxidine 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 | Tablets | 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. |
| Naproxen | Aleve, Anaprox, Anaprox-DS, EC-Naprosyn, Leader Naproxen Sodium, Midol Extended Relief, Naprelan 375, Naprosyn, Synflex | Nonsteroidal anti-inflammatory drugs (NSAIDs) | | Tablets | Acute | Naproxen is a nonsteroidal anti-inflammatory drug (NSAID). It 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 (for example, heart attacks or strokes) complications, due to its relatively low risk of causing such complications. |
| Naratriptan | Amerge, Naramig | Serotonin 5-HT1 agonists or triptans | X | Tablets | Acute | Naratriptan is a serotonin 5-HT1 receptor agonist. It works by narrowing blood vessels in the brain. It is used to relieve certain types of migraine. |
| Neurolief device | Relivion | Neuromodulation | | Device | Acute | Relivion is a smartphone-controlled, cloud-connected, multichannel neuromodulation device. It offers precise, personalized care by delivering stimulation to six branches of the occipital and trigeminal nerves via three adaptive output channels. This creates a cumulative effect by releasing neurotransmitters in the brain stem and modulating brain networks associated with control of pain and mood. Approved as an OTC in Europe in July 2019. Cleared by FDA in March 2021, expected to be available late summer 2021. |
| Nimodipine | Nimotop | Calcium channel blockers | X | Capsules, injection | 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, Arem, Insoma, Insomin, Mogadon, Nitrados, Nitrazadon, Nitrosun, Ormodon, Paxadorm, Remnos, Somnite | Hypnotic | X | Tablets | 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. |
| Nortriptyline | Allegron, Pamelor | Antidepressant | X | Capsule | 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. |
Omega Procedure
(see also Reed Procedure | | Neuromodulation | X | Surgically implanted neuromodulation | Preventive | The Omega Procedure is a trademarked surgical procedure for patients diagnosed with chronic migraine (15 or more attacks per month) that entails implanting an occipital-nerve stimulator beneath the skin while the patient is under general anesthesia. It requires an initial minor surgery for a trial period, a second surgery for permanent implantation, and a battery-pack change every 10 years. Removal or repair requires surgery, as well. The Omega Procedure and the Reed Procedure® are the exact same surgical procedure; the difference is solely in their registered names. From a practical standpoint, the difference comes in the relative experience of the physicians involved. |
| OnabotulinumtoxinA | Botox | Muscle relaxant | X | Injection | Preventive | OnabotulinumtoxinA (Botox), also called botulinum toxin type A, is made from the bacteria that causes botulism. Botulinum toxin blocks nerve activity in the muscles, causing a temporary reduction in muscle activity. Botox can be used to prevent chronic migraine in adults who have migraine for more than 15 days per month, each lasting 4 hours or longer. Botox should not be used to treat a common tension headache. In the doctorÕs office, multiple Botox injections are inserted into the muscles of the forehead, head and neck, and treatment is repeated every 12 weeks if successful. However, there are maximum dose limits to be aware of when using Botox. Botox is also used for other conditions and cosmetic purposes such as to smooth wrinkles or for an overactive bladder. |
| Ondansetron | Zofran, Zofran ODT, Zuplenz | Anti-emetic (anti-nausea) | X | Tablets, injection | 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). |
| Oxycodone | Endone, Oxecta, OxyContin, Oxyfast, Roxicodone | Opioid | X | Tablets, injection, suppository | Acute | This treatment contains the active ingredients paracetamol and codeine phosphate. It is used for the relief of moderate to severe pain when milder painkillers are not effective. Paracetamol belongs the analgesic group of medicines. It is 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. |
| Oxygen | -- | Inhalant/Device | X | Cannula/Mask | Acute/Preventive | It has been shown that oxygen causes a marked decrease in cerebral blood flow concurrent with a reduced degree of pain in cluster headache. There are two high-flow oxygen delivery methods for migraines: normobaric and hyperbaric, with normobaric more effective for migraine. |
| Oxymetazoline nasal | Allerest, Afrin, Mucinex, Nostrilla, Sinex | Decongestant | | Intranasal Spray | Acute | Oxymetazoline solution is a decongestant. It works by shrinking swollen and congested nasal tissues (mucous membranes) by constricting blood vessels. This results in relief of congestion, improved drainage of mucus, and improved 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 | Tablets, injection | Acute | Pantoprazole is a proton-pump inhibitor that decreases the amount of acid produced in the stomach. It is used to treat erosive esophagitis (damage to the esophagus from stomach acid), and other conditions involving excess stomach acid such as Zollinger-Ellison syndrome. Pantoprazole is not for immediate relief of heartburn symptoms. Leading neurologist Andrew Charles has flagged proton-pump inhibitors as having the potential to make migraine worse. If you use a proton-pump inhibitor and have migraine, consider discussing with your medical practitioner whether an alternative medication might be right for you. |
| Paracetamol, Codeine | Paracodol | Narcotic | X | Tablets | Acute | This treatment contains the active ingredients paracetamol and codeine phosphate. It is used for the relief of moderate to severe pain when milder painkillers are not effective. Paracetamol belongs the analgesic group of medicines. It is 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. |
| Paracetamol, Ibuprofen | Maxigesic | Combination - Analgesic & NSAID | | Tablets | Acute | For the temporary relief of mild to moderate pain associated with migraine, headache, backache, period 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. |
| PFO Valve Closure | N/A | Procedure | X | -- | Preventive | Multiple studies suggest that migraine with aura is more prevalent in subjects with patent foramen ovale (PFO), an open passage between the chambers of the heart. Several studies suggest that PFO closure, a surgical procedure, may be an effective treatment for migraine. However, the grade of evidence from these studies is low. |
| Phenylephrine hydrochloride, Ibuprofen | Sudafed PE | Combination - Decongestant & NSAID | | Tablets | 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 | | Tablets | 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 | Tablets | 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. |
| Potassium | Various | Vitamin/supplement | X | Tablets, liquid format, I.V. infusion | Acute/Preventive | A mineral and electrolyte that assists in several body functions, including blood pressure, water balance, muscle contractions, digestion, heart rhythm and pH balance. It is sometimes taken in supplement form to balance electrolytes which are often low due to migraine and nausea. |
| Prednisone | Rayos, Sterapred | Steroid | X | Tablets, injection, suppository, nasal | Acute | Prednisone is a corticosteroid. It prevents the release of substances in the body that cause inflammation. It also suppresses the immune system. Prednisone 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 | Capsules | 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 | Compazine, Stemzine, Buccastem, Stemetil, Phenotil | Anti-emetic (anti-nausea) & Antipsychotic | X | Tablets, injection, suppository | Acute | Prochlorperazine is a phenothiazine. It is not known exactly how it works. It is a highly potent typical antipsychotic, 10Ð20_ 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 | Phenergan, Promethegan, Romergan, Fargan, Farganesse, Fenazin, Prothiazine, Avomine, Atosil, Receptozine, Lergigan, Pipolphen, Sominex | Antihistamine & Anti-emetic (anti-nausea) | X | Tablets, injection, 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 | Tablets, injection, 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 (high blood pressure), heart rhythm disorders, and other heart or circulatory conditions. It is also used to treat or prevent heart attack and to reduce the severity and frequency of migraine. |
| Pseudoephedrine | Contac Cold, Drixoral Decongestant Non-Drowsy, Elixsure Decongestant, Entex, Genaphed, Kid Kare Drops, Nasofed, Seudotabs, Silfedrine, Sudafed, Sudodrin, SudoGest, Suphedrin, Triaminic Softchews Allergy Congestion, Unifed | Decongestant | | Tablets, capsules | 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 | Tablets | 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. |
| Radiofrequency ablation | N/A | N/A | X | In-Office Procedure | Preventive
| Radiofrequency ablation or neurotomy uses heat generated by radio waves to target specific nerves and temporarily turn off their ability to send pain signals. Due to the proximity to other nerves in the face, a high degree of technical precision is necessary to perform the procedure. Radiofrequency ablation is generally considered for the treatment of chronic headaches that have failed to respond to other treatments or procedures. |
| Reed Procedure (see also Omega Procedure) | | Neuromodulation | X | Surgically implanted neuromodulation | Preventive | The Reed Procedure® is a surgical procedure for patients diagnosed with chronic migraine (15 or more attacks per month) that entails implanting an occipital nerve stimulator beneath the skin while the patient is under general anesthesia. It requires an initial minor surgery for a trial period, a second surgery for permanent implantation, and a battery pack change every 10 years. Removal or repair requires surgery as well. The Omega Procedure and the Reed Procedure® are the exact same surgical procedure; the difference is solely in their registered names. From a practical standpoint, the difference comes in the relative experience of the physicians involved. |
| Remote wearable neuromodulation (REN) device | Nerivio | Neuromodulation | X | Device | Acute | Nerivio is a wireless non-invasive remote electrical stimulation wearable device applied to the upper arm at the onset of migraine headache or aura. Nerivio induces an inherent pain inhibition brain mechanism, resulting in clinically significant pain relief. Nerivio is controlled by a smartphone app, which includes a treatment diary. Nerivio was approved for use in adults in October 2020 and for adolescents in January 2021. |
| Rimegepant | Nurtec ODT | Small molecule CGRP receptor antagonist (Gepant) | X | Orally-dissolving Tablets | Acute | 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 as of March 2021 is being reviewed by the FDA for approval as a preventive treatment. |
| Rizatriptan | Maxalt | Serotonin 5-HT1 agonists or triptans | X | Tablets, sublingual | Acute | Rizatriptan is a serotonin 5-HT1 receptor agonist or "triptan.Ó It 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 migraines or to treat cluster headache. |
| Sertraline | Zoloft | Antidepressant | X | Tablets | Preventive | Sertraline is an antidepressant in a group of drugs called selective serotonin reuptake inhibitors (SSRIs). 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 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 | Tablets, capsules, injection | 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. |
| Sphenopalatine Ganglion (SPG) Device | Sphenocath, Allevio, & Tx360Ê | Neuromodulation | X | Device | Preventive | The Sphenopalatine Ganglion (SPG) is a group of nerve cells that is linked to the trigeminal nerve, the main nerve involved in headache. Application of local anesthetics (or numbing medications) to block or partially block the SPG, can be helpful in reducing head and facial pain. Three devices have been approved for performing SPG blocks. A doctor inserts a very thin plastic tube into the nose to insert numbing medication in and around the SPG. |
| Sumatriptan | Imigran, Imitrex, Treximet, Zembrace Symtouch, Onzetra XSail, Sumavel DosePro, | Serotonin 5-HT1 agonists or triptans | X | Tablets, injection, Needle-less injection, nasal spray | Acute | Sumatriptan is a serotonin 5-HT1 receptor agonist (triptan). It 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 itÕs scientific 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. |
| Telcagepant | | Gepant/ small molecule CGRP receptor antagonist | | N/A | 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. |
| THC (Tetrahydrocannabinol) | | Natural compound in
the cannabis plant (marijuana) | | Oils, Edibles, Tinctures, Capsules, or by consuming marijuana | Acute/Preventive | THC and marijuana are controlled substances in the U.S., prohibited by federal law. THC is a psychoactive compound of marijuana used by some for acute or preventive migraine relief. |
| Timolol | Blocadren, Betimol, Betrim, Istalol, Timoptic | Beta blocker | X | Tablets, eye drops | Preventive | Timolol is part of a group of drugs called beta blockers. It is used to treat hypertension (high blood pressure). 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. |
| Tizanidine | Zanaflex | Muscle relaxant | X | Tablets, injection, intranasal | 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 | Tablets | Preventive | Topiramate is an anticonvulsant that is also helpful to prevent 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 | Tablets, injection, 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/Acetaminophen | Tramacet, Ultracet | Narcotic-like & Analgesic (painkiller) | X | Tablets, injection | Acute | This formulation combines individual ingredients for a stronger effect. See individual active ingredients for mode of action. |
| Transcranial Magnetic Stimulation (TMS) device | sTMS mini | Neuromodulation | X | Device | Acute | TMS uses magnets to emit just a single pulse of electricity. This pulse has been shown to treat cortical spreading depression (CSD), which is the physical change in the brain during aura and migraine. Research shows that daily use of TMS for 3 months or longer can lead to a reduction in acute medication use. eNeuraÕs sTMS mini is a TMS device available via prescription. |
| Transcutaneous electrical nerve stimulation (TENS) device | Cefaly | Neuromodulation | X | Device | Preventive/Acute | TENS units are predominately used for nerve-related pain conditions, which may be acute or chronic. TENS machines work by sending stimulating pulses across the surface of the skin and along the nerve strands. The stimulating pulses help prevent pain signals from reaching the brain. TENS devices also help stimulate your body to produce higher levels of endorphins, its natural painkillers. The Cefaly I is a battery-powered headband. Cefaly II isa smaller rechargeable unit with adjustable intensity. |
| Ubrogepant | Ubrelvy | Small molecule CGRP receptor antagonist (Gepant) | X | Tablets | 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. |
| Vagus-Nerve Stimulation (VNS) device | Gammacore | Neuromodulation | X | Device | Acute | The vagus nerve runs from the brain stem through the chest and abdomen on each side of the body. Vagus nerve stimulation appears to inhibit cortical spreading depression as well as calm the brain’s excitability. A VNS device stimulates the production of inhibitory neurotransmitters in the brain, including GABA, serotonin, and norepinephrine, which affect migraine and cluster headache. gammaCore is a handheld VNS device that stimulates the nerves noninvasively when placed above the vagus nerve in the neck. |
| Valproic acid, zonisamide, lidocaine, amiloride | Valproic, Lidocaine, Ranolazine, Phenytoin, Disopyramide, Midamor | Sodium channel blockers | X | Tablets, injection | Acute/Preventive | Anti-arrhythmic compounds that bind to and block sodium influx through cell membranes. Some are also used as local anesthetics and anticonvulsants. Sometimes used to treat chronic migraine. Primarily prescribed for high blood pressure, heart failure, or edema. There have been some reports that it is used to treat patients with migraine with aura, but further studies are needed. |
| Zavegepant (formerly Vazegepant) | | Small molecule CGRP receptor antagonist (Gepant) | X | In testing as an intranasal and oral | | Zavegepant (formerly vazegepant) is a gepant currently in clinical trials. Trial participants treated with nasal zavegepant had rapid onset of pain relief at 15 minutes and returned to normal function as early as 30 minutes. The 10 mg and 20 mg zavegepant doses showed therapeutic benefits on both pain relief and return to normal function at 2 hours. Zavegepant is the first and only intranasal CGRP receptor antagonist in late-stage development. In September 2020, zavegepant received the go-ahead from FDA for clinical trials on oral formulations. Not yet FDA appoved as of March 2021. |
| Venlafaxine | Effexor | Antidepressant | X | Tablets, capsules | Preventive | Venlafaxine is an antidepressant in a group of drugs called selective serotonin and norepinephrine reuptake inhibitors (SSNRIs). Venlafaxine affects chemicals in the brain that may become unbalanced and cause depression. Venlafaxine is used to treat major depressive disorder, anxiety, and panic disorder. |
| Verapamil | Isoptin, Calan | Calcium channel blockers | X | Tablets, injection | 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 (high blood pressure), angina (chest pain), and certain heart rhythm disorders. |
| Zolmitriptan | Zomig | Serotonin 5-HT1 agonists or triptans | X | Tablets, nasal spray | Acute | Zolmitriptan is a serotonin 5-HT1 receptor agonist or "triptan." It 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 migraines. |
| Zolpidem | Ambien, Edluar, Intermezzo, Stilnox, Zonadin, Sanval, Zolpimist Hypnogen | Hypnotic | X | Tablets, 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 | Anticonvulsant | X | Capsules | Preventive | Zonisamide is often used in combination with other medications to treat certain types of seizures. Zonisamide is in a class of medications called anticonvulsants. It works by decreasing abnormal electrical activity in the brain. |
