Medications

Migraine Toolbox-horizontal

Finding a medication, or combination of medications, that works for you can be challenging and may require time and patience. Below is a list of medications which are frequently prescribed for migraine. We encourage you to talk to your doctor about which ones may be appropriate to add to your treatment toolbox.

You can also learn more about the newest migraine treatments, including how they work, possible side effects, access programs and more. In addition, there are some medications currently in the clinical trials, but not yet FDA-approved.

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Breaking News! Zavzpret, the first nasal spray CGRP inhibitor, was FDA approved on 3/10/23 and is now available by prescription.

Preventive/Prophylactic Medications

Preventive/prophylactic medications are used to reduce the severity and frequency of migraine attacks, and are commonly prescribed to those who get four or more migraine days per month.

FDA Approved For Migraine

  • Atogepant (Qulipta™) - oral tablet CGRP inhibitor
  • Divalproex sodium (Depakote®)
  • Eptinezumab-jjmr (Vyepti®) – monoclonal antibody CGRP inhibitor (IV infusion)
  • Erenumab-aooe (Aimovig®) – monoclonal antibody CGRP inhibitor (self-injection)
  • Fremanezumab-vfrm (Ajovy®) – monoclonal antibody CGRP inhibitor (self-injection)
  • Galcanezumab-gnlm (Emgality®) – monoclonal antibody CGRP inhibitor (self-injection)
  • Onabotulinum toxinA injection (Botox®)
  • Propanolol (Inderal®)
  • Rimegepant (Nurtec® ODT) – oral tablet CGRP inhibitor
  • Timolol maleate (Blocadren®)
  • Topiramate (Topamax®, Trokendi XR®, Quedexy® XR, Eprontia™)

Evidence-Based Off-Label

  • ACE Inhibitors (e.g.: benazepril, fosinopril sodium)
  • Alpha-2 Agonists (e.g.: clonidine)
  • Alzheimers medications (e.g.: memantine)
  • Angiotensin II Receptor Blockers (e.g.: candesartan)
  • Antihistamines (e.g.: cyproheptadine)
  • Beta Blockers (e.g.: metoprolol, nadolol)
  • Calcium Channel blockers (e.g.: diltiazem, felodipine)
  • Cox-2 Enzyme Inhibitors (e.g.: celecoxib)
  • Leukotriene blockers (e.g.: montelukast, zafirlukast)
  • Muscle relaxers (e.g.: carisoprodol, tizanidine)
  • Neuronal stabilizing agents, anticonvulsants (e.g.: gabapentin, zonisamide, lamotrigine)
  • SSRIs, SNRIs & MAOIs (e.g.: escitalopram, venlafaxine)
  • Tricyclic Antidepressants (e.g.: nortriptyline, amitriptyline)
  • Triptans sometimes used as preventives for menstrual migraine (e.g.: frovatriptan, naratriptan)

Abortive Medications

These treatments work to stop the migraine attack itself with its associated symptoms. Too frequent use of some of these can cause rebound headaches or medication overuse headache (MOH) for some people, so it’s important to follow your doctor’s directions for use.

Gepants

Gepants are a new class of migraine medication which are small molecule CGRP inhibitors/antagonists.

  • Rimegepant (Nurtec® ODT)—oral dissolving tablet, CGRP receptor-antagonist
  • Ubrogepant (Ubrelvy®)—oral tablet, CGRP receptor-antagonist
  • Zavegepant (Zavzpret™)—nasal spray, CGRP receptor-antagonist

Ditans

Ditans are a new class of migraine medication which are 5-HT1F receptor agonists that act on the trigeminal system without causing vasoconstriction.

  • Lasmiditan (Reyvow®)—oral tablet, 5-HT1F receptor agonist

Triptans

  • Almotriptan (Axert®)
  • Eletriptan (Relpax®)
  • Frovatriptan (Frova®)
  • Naratriptan (Amerge®)
  • Rizatriptan (Maxalt®)—available in USA as oral tablet, oral dissolving tablet
  • Sumatriptan –available in USA as tablet, nasal spray, injection (Imitrex®, Zembrace®, Onzetra®)
  • Sumatriptan with naproxen sodium (Treximet®)
  • Zolmitriptan (Zomig®)—available in USA as oral tablet, oral dissolving tablet, nasal spray

Ergotamines:

  • Dihydroergotamine nasal spray (Migranal®, Trudhesa™)
  • Dihydroergotamine subcutaneous injection (DHE-45®)

Anti-Emetics (anti-nausea)

  • Ondansetron (Zofran®)
  • Metoclopramide (Reglan®)
  • Prochlorperazine (Compazine®)
  • Promethazine (Phenergan®)

Muscle Relaxants

  • Carisoprodol (Soma®)
  • Cyclobenzaprine (Flexeril®)
  • Tizanidine (Zanaflex®)

Prescription Strength NSAIDs

  • Celecoxib (ELYXYB™)
  • Diclofenac potassium (Cambia®)
  • Indomethacin (Indocin®)
  • Ketorolac tromethamine – options include tablet, nasal spray, injection, IV (Toradol®, Sprix®)

Butalbital compounds

  • Butalbital, acetaminophen & caffeine (Fioricet®)
  • Butalbital, aspirin & caffeine (Fiorinal®)

Rescue Medications/Treatments

Rescue medications are migraine treatments taken if abortives fail OR if you can’t take abortives. Some of these rescue medications may only be available to you in your doctor's office, urgent care, or the emergency room. In addition, some of these may only temporarily “mask” migraine symptoms, only to wear off subsequently with the symptoms returning. Use of opioids and/or barbiturates can increase the risk of rebound headaches or medication overuse headaches (MOH) in some people.

Corticosteroids

  • Medrol®, Solu-Medrol®) Prednisone (Deltasone®, Prednisone Intensol®)
  • Methylprednisolone (Depo-Medrol®,

Ketamine

  • IV infusion
  • Nasal spray (compounded)

Nerve Blocks

May be used to abort an intractable migraine, or as a chronic migraine preventive. Nerves targeted include:

  • Auriculotemporal
  • Occipital
  • Supraorbital
  • Trigeminal
  • Sphenopalatine ganglion

IV "Cocktails

Various medications may be combined "in office" or in the ER to stop a migraine attack.

Download the Migraine Treatment Toolbox

Talk with your doctor to see if these options would be good to add to your treatment toolbox! Print out our Migraine Toolbox and bring it to your next appointment.