Medications for Migraine- A Comprehensive Guide
October 29, 2024

Migraines are a debilitating neurological condition that affects millions of people worldwide. They can cause intense, throbbing pain, often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Managing migraines effectively often requires a combination of lifestyle changes, preventative measures, and medications. This comprehensive guide explores the various medications available for treating migraines, helping you understand your options and find the best approach to managing your symptoms.

Understanding Migraines

Before diving into the specifics of migraine medications, it’s important to understand what migraines are and how they differ from regular headaches. According to the Mayo Clinic, migraines are a type of headache characterized by intense, pulsating pain, usually on one side of the head. They can last for hours or even days and are often accompanied by symptoms such as nausea, vomiting, and sensitivity to light and sound.

Types of Migraine Medications

Migraine medications can be broadly categorized into two types: acute (abortive or rescue) treatments and preventative (prophylactic) treatments.

  1. Acute (Abortive) Treatments
    • These medications are taken at the onset of migraine symptoms to stop the attack or reduce its severity.
  2. Preventative (Prophylactic) Treatments
    • These medications are taken regularly to reduce the frequency and severity of migraine attacks.

Acute Migraine Medications

    1. Over-the-Counter Pain Relievers
      • Aspirin, Ibuprofen (Advil, Motrin), Aleve (Naproxen), and Acetaminophen (Tylenol): These can be effective for mild to moderate migraines. Combination medications like Tylenol Ultra, which includes aspirin, acetaminophen, and caffeine, can also be helpful. 
    2. Prescription NSAIDS (Nonsteroidal Anti-Inflammatories)
      • Cambia, Diclofenac, Celebrex: These medications have pain-relieving and anti-inflammatory properties. 
    3. Triptans
      • Sumatriptan (Imitrex), Rizatriptan (Maxalt), Zolmitriptan (Zomig), and Eletriptan (Relpax): Triptans are specifically designed to treat migraines. They work by narrowing blood vessels and blocking pain pathways in the brain. Suvexx, also available, is a combination of sumatriptan and naproxen. 
    4. Ergot Alkaloids
      • Ergotamine (Ergomar) and Dihydroergotamine (Migranal): These are less commonly used today but can be effective for migraines that don’t respond to other treatments. They work by constricting blood vessels in the brain. 
    5. Anti-nausea Medications
      • Metoclopramide (Metonia) and Prochlorperazine (Compazine): These can be used in combination with other migraine medications to help control nausea and vomiting. 
    6. CGRP Inhibitors
      • Rimegepant (Nurtec ODT) and Ubrogepant (Ubrelvy): These newer medications target the calcitonin gene-related peptide (CGRP) pathway, which is involved in migraine pain.

Preventative Migraine Medications

If you experience more than 4 migraines a month, it may be beneficial for you to start a preventative medication.

There are 2 types of preventative medications:

A: Oral medications:

Beta-Blockers

  • Propranolol (Inderal) and Metoprolol (Lopressor): These medications are commonly used to treat high blood pressure but can also help prevent migraines by relaxing blood vessels.

Antidepressants

  • Amitriptyline (Elavil) and Venlafaxine (Effexor): These can help prevent migraines by affecting the levels of certain neurotransmitters in the brain.

Anticonvulsants

  • Topiramate (Topamax) and Valproate (Depakote): Originally developed to treat epilepsy, these medications can help prevent migraines by stabilizing electrical activity in the brain.

Calcium Channel Blockers

Verapamil (Isoptin): Primarily used to treat high blood pressure, these medications can also help prevent migraines by affecting blood flow in the brain.

B: Newer Oral or Injection Medications:

Generally, you will need to have been tried on several oral preventative medications before getting approval for coverage by your medical benefits or provincial drug plans for the newer class of medications and Botox 

CGRP Monoclonal Antibodies

  • Erenumab (Aimovig), Fremanezumab (Ajovy), Galcanezumab (Emgality), Eptinezumab (Vyepti), and Atogepant (Qulipta): These are newer preventative treatments that block the CGRP pathway, reducing the frequency of migraine attacks.

Botox Injections

  • OnabotulinumtoxinA (Botox): Approved for chronic migraines (greater than 15 migraines a month), Botox injections can help reduce the frequency of migraine attacks by blocking nerve signals involved in pain.

Choosing the Right Medication

Choosing the right medication for migraine management depends on several factors, including the frequency and severity of your migraines, any underlying health conditions, and your response to previous treatments. Here are some steps to help you and your healthcare provider find the best treatment plan:

  1. Track Your Migraines:
    • Keep a detailed migraine diary, noting the frequency, duration, and intensity of your migraines, potential triggers, and treatments’ effectiveness.
  2. Consult a Family Doctor or Specialist:
    • If your migraines are severe or do not respond to over-the-counter treatments, consider seeing a migraine or headache specialist. They can help diagnose your migraine type and recommend appropriate treatments.
  3. Evaluate Treatment Options:
    • Discuss different medications’ potential benefits and side effects with your healthcare provider. Consider trying different medications or combinations to find what works best for you.
  4. Monitor and Adjust:
    • Regularly review your migraine management plan with your healthcare provider and adjust as needed. This may involve changing medications, dosages, or incorporating new treatments.

Lifestyle and Non-Pharmacological Approaches

In addition to medications, several lifestyle changes and non-pharmacological approaches can help manage migraines:

  1. Regular Exercise:
    • Engage in regular physical activity to help reduce the frequency and severity of migraines.
  2. Healthy Diet:
    • Maintain a balanced diet and avoid known migraine triggers such as alcohol and certain foods.
  3. Adequate Sleep:
    • Ensure you get enough sleep and maintain a regular sleep schedule.
  4. Stress Management:
    • To reduce stress, practice relaxation techniques such as yoga, meditation, and deep breathing exercises.
  5. Hydration:
    • Stay well-hydrated by drinking plenty of water throughout the day.
  6. Alternative Therapies:
    • Consider alternative treatments such as acupuncture, biofeedback, and cognitive behavioural therapy (CBT) to help manage migraines.

Conclusion

Managing migraines often requires a multi-faceted approach, combining medications with lifestyle changes and non-pharmacological treatments. By understanding the different types of migraine medications available and working closely with your healthcare provider, you can develop a personalized treatment plan that effectively manages your symptoms and improves your quality of life.

At The Health League, our team of experts is dedicated to providing comprehensive care for migraine sufferers. Contact us today to learn how we can help you manage your migraines effectively.

For more information on migraine medications and treatments, visit reputable sources such as WebMD and the American Migraine Foundation. Empower yourself with knowledge and take proactive steps towards better migraine management.