Migraine Medication: If You Have Migraine, Here Are All the Medications You Need to Know About

By Petra Guglielmetti

If only there were a magical pill you could pop to make migraine symptoms go away permanently—a one-and-done migraine medication that would eradicate headaches forever. But if you’re someone who's living with migraine, you already know: There's still no cure for this chronic neurological condition, which causes not just throbbing headaches that can last for days, but an array of debilitating symptoms, including nausea and vomiting, and extreme sensitivity to light and sound. It's not like migraine is some rare condition; it will affect up to 43 percent of all women at some point in their lifetime.

That said, while there's no end-all fix, migraine medications have come a long way in recent years. Maybe they’re not quite in the realm of magical, but for some people living with migraine, they can come pretty close. An ever-expanding roster of migraine medications is being formulated using scientists’ increased understanding of what exactly causes migraine, allowing them to ease migraine headaches and other symptoms much more effectively and with fewer serious side effects.

In the past, many migraine treatments utilized drugs originally designed to treat other conditions; although those drugs were later approved by the FDA to treat migraine, they weren't developed with the condition (or people living with it) in mind. And while plenty of those drugs are still prescribed for migraine patients today, there are also many new drugs that have been developed specifically for migraines, often as a preventive treatment. They come in just about every form—oral capsules and tablets, nasal sprays, self-injection pens—making it easier for people with migraine to find a method that works. (Popping a pill is easier said than done when your symptoms include nausea and vomiting.)

When thinking about your migraine medication arsenal, keep in mind that medications generally fall into two main categories (though some drugs cover both). The first are known as acute or abortive medications, which you take to ease pain and other symptoms when they occur. Then there are preventive treatments—also known as preventative medications—which, as the name implies, are taken to prevent a migraine (e.g., before your period, if you’re prone to period migraines) and can reduce the frequency and intensity of migraine attacks before they happen. Not every medication works for every person with migraine, and it can take some trial and error to find the combination that's most effective for you, with the most manageable side effects. Speak with your healthcare provider about the best place to start, and refer to this alphabetical glossary of migraine medications to help you understand the many options that are out there and exactly how they work.

WHAT IT IS This common over-the-counter pain medication can be effective at treating migraine headaches when taken as soon as symptoms start. (There's conflicting research about whether acetaminophen or ibuprofen (an NSAID, see below) is the more effective over-the-counter option when it comes to treating migraine headaches.) Acetaminophen is often combined with aspirin and caffeine in medications that are designed specifically for migraine treatment—an example of a migraine cocktail (a combination of multiple migraine treatments that are even more effective when administered together).

HOW IT WORKS Acetaminophen works by reducing pain signals within the central nervous system and lowering the number of prostaglandins, which are a root cause of inflammation.

HOW IT’S ADMINISTERED oral capsules, tablets, powders

TYPES Tylenol, Genexa, Excedrin Migraine Pain (also contains aspirin)

WHAT THEY ARE Certain prescription drugs primarily used for the treatment of epilepsy and nerve pain can also help reduce the frequency of migraine attacks by 50 percent or more. Specifically, the drugs topiramate and Depakote were later FDA-approved for migraine prevention. Another drug called carbamazepine is backed by some research showing its effectiveness as well. Researchers have found that migraine and epilepsy might share underlying causes, and there is also overlap among people living with these two conditions: People with epilepsy are twice as likely to have migraine, and migraine occurs more commonly among people with epilepsy than within the general population.

HOW THEY WORK Anticonvulsants (also known as antiepileptics) target channels in the body that deliver electrical impulses to nerve, muscle, and brain cells to calm nerves, which could be why they may help prevent migraine attacks. Anticonvulsants generally need to be taken for a couple of months before their effects on migraine are noticeable.

HOW THEY’RE ADMINISTERED oral tablet, capsule

TYPES carbamazepine (Tegretol, Curatil), topiramate (Topamax, Topiragen, Trokendi XR, Qudexy XR), sodium valproate (Epilim), divalproex sodium (Depakote)

WHAT THEY ARE Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant that increase levels of serotonin in the brain. SNRIs are similar drugs that elevate levels of both serotonin and norepinephrine. By altering the brain's chemistry in this way, these drugs interfere with the bodily processes that create pain, and thus can reduce the frequency and severity of migraine attacks. Within this category, venlafaxine is the most commonly prescribed drug for migraine.

HOW THEY WORK Like triptans (see below), which are commonly prescribed for acute treatment of migraine pain, SSRIs and SNRIs combat migraine by raising levels of serotonin—in this case, by blocking the reabsorption of serotonin (and in the case of SNRIs, norepinephrine) into neurons. They are useful as a preventative migraine treatment, not to treat symptoms when they hit.

HOW THEY’RE ADMINISTERED oral capsules, tablets

TYPES milnacipran (Savella), fluoxetine (Prozac, Rapiflux, Selfemra, Sarafem), venlafaxine (Effexor), duloxetine (Cymbalta, Irenka)

WHAT THEY ARE These drugs, first released in the late 1950s, were developed to treat mental health conditions like depression but may also reduce the frequency and severity of migraines.

HOW THEY WORK Tricylic antidepressants affect the balance of chemicals like serotonin and norepinephrine in the brain. These chemicals are involved in the bodily processes that create the sensation of pain, and migraine pain specifically. Amitriptyline is the most commonly prescribed and longest-used antidepressant for migraine and is backed by clinical trials demonstrating that it's effective at preventing migraine. For those who experience problematic side effects when taking this drug, nortriptyline is typically the second choice.

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HOW THEY’RE ADMINISTERED tablet, capsule

TYPES amitriptyline (Amitid, Amitril, Elavil, Endep, Vanatrip), nortriptyline (Aventyl, Pamelor)

WHAT THEY ARE Anti-hypertensive medications used to treat cardiovascular conditions like high blood pressure are also commonly prescribed for migraine prevention. This includes beta blockers like propranolol (the most commonly recommended), timolol, and metoprolol tartrate. Calcium channel blockers such as verapamil (Verelan) may be even more effective than beta blockers in preventing migraine with aura. There is also evidence from clinical trials that lisinopril, a different kind of blood-pressure medication known as an ACE inhibitor, helps in preventing migraines.

HOW THEY WORK These drugs reduce blood-vessel dilation, which is a factor that contributes to migraine, and also calm the nervous system by reducing electrical activity.

HOW THEY’RE ADMINISTERED oral tablets, capsules

TYPES atenolol (Tenormin), candesartan (Atacand), metoprolol tartrate (Lopressor), nadolol (Corgard), lisinopril (Qbrelis, Prinivil, Zestril), propranolol (Inderal, InnoPran XL), timolol (Timoptic, Timoptic-xe, Istalol), verapamil (Verelan)

WHAT IT IS A purified version of a neurotoxin produced by the bacteria that causes botulism. Injected in targeted microdoses, these neuromodulating drugs temporarily relax muscle contractions for up to three months. Generally used cosmetically to treat and prevent wrinkles, this drug can also help prevent migraine attacks and was FDA-approved for this purpose in 2010.

HOW IT WORKS When administered via tiny needle by a neurologist or headache specialist, botulinum toxin enters nerve endings near the injection point and interrupts the pathway of chemicals in the brain and spinal-cord nerves that cause migraine pain. It generally takes two or three treatments to see a difference in the frequency and severity of migraine attacks, with benefits increasing over time.

HOW IT’S ADMINISTERED multiple injections into the head and neck every few months

TYPES onabotulinumtoxinA (Botox), abobotulinumtoxinA (Dysport), incobotulinumtoxinA (Xeomin), prabotulinumtoxinA-xvfs (Jeuveau), daxibotulinumtoxinA-lanm (Daxxify)

WHAT THEY ARE Relatively new drugs—the first was FDA approved in 2018—designed specifically to prevent migraine attacks, with few serious side effects. There are two types of CGRP inhibitors: monoclonal antibodies, which are administered via injection or IV, and the newer gepants, which are taken orally or nasally.

HOW THEY WORK CGRP inhibitors (also known as CGRP antagonists) interfere with the production of calcitonin gene-related peptide (CGRP), a molecule within the brain/spinal cord that's involved in pain transmission and blood-vessel dilation and has been pinpointed as a trigger for migraine symptoms.

HOW THEY’RE ADMINISTERED oral medication or nasal spray, in the case of gepants, or via monthly or quarterly self-injections (using a pre-filled pen or syringe) or IV infusions, in the case of monoclonal antibodies.

TYPES atogepant (Qulipta), eptinezumab (Vyepti), erenumab (Aimovig), fremanezumab (Ajovy), galcanezumab (Emgality), rimegepant (Nurtec), ubrogepant (Ubrelvy), zavegepant (Zavzpret)

WHAT THEY ARE The oldest migraine-specific medications, released in 1926, are still in use because they can quickly relieve severe headache pain and other migraine symptoms, including sensitivity to light and sound. However, ergots (also known as ergot alkaloids) can have serious side effects, including reducing blood flow to various parts of the body, so doctors usually reserve them for patients whose severe migraine symptoms don't respond to other pain relievers like triptans.

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HOW THEY WORK They narrow blood vessels in the brain to reduce throbbing pain, increase levels of serotonin, and stop the release of proteins in the brain that cause inflammation. Some products contain caffeine and anti-nausea drugs as well.

HOW THEY’RE ADMINISTERED oral capsule or under-tongue tablet, injection, nasal spray, rectal suppository

TYPES dihydroergotamine (D.H.E. 45, Migranal, Trudhesa), ergotamine tartrate (Cafergot, Ergomar, Migergot)

WHAT THEY ARE Non-steroidal anti-inflammatory drugs (NSAIDs) are common drugs used to lower inflammation and reduce pain, with both over-the-counter and more potent prescription versions available. Often, NSAIDs like aspirin or ibuprofen are combined with acetaminophen and caffeine in medications that are designed specifically for migraine treatment—an example of what is often called a migraine cocktail (a combination of multiple migraine treatments that are even more effective when administered together). While NSAIDs can be excellent for in-the-moment pain relief, possible side effects of frequent, heavy use include stomach ulcers that can lead to internal bleeding and anemia. If you have chronic migraine, it's important to ask your healthcare provider about the best long-term treatment option in terms of common side effects.

HOW THEY WORK NSAIDs interfere with the enzymes the body uses to produce prostaglandins, which are involved with inflammation and creating the sensation of pain.

HOW THEY’RE ADMINISTERED oral capsules, tablets, and solutions

TYPES acetylsalicylic acid (aspirin, Bayer, Excedrin), diclofenac (Cataflam, Cambia), ibuprofen (Advil, Motrin), naproxen sodium (Aleve, Anaprox-DS, Naprosyn, Midol Extended Relief)

WHAT THEY ARE Triptans are considered the gold standard for the acute relief of migraine symptoms, working similarly to ergots but faster-acting and with fewer serious side effects. However, they may not be safe for people with vascular conditions. In that case, or when migraine patients don't respond to triptans, doctors may recommend similar drugs called ditans, the first of which was FDA approved in 2019.

HOW THEY WORK Triptans and ditans relieve migraine by binding to serotonin receptors. Because they bind to different receptors, triptans have the effect of narrowing blood vessels, while ditans do not. Ditans can have a sedative effect, so they’re often reserved for people whose migraine symptoms occur during the night.

HOW THEY’RE ADMINISTERED oral tablets, nasal spray, sometimes injections

TYPES Triptans: almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Alsuma, Imitrex, Onzetra, Sumavel, Zembrace), zolmitriptan (Zomig). Ditan: lasmiditan (Reyvow)

Petra Guglielmetti is a health, wellness, and beauty journalist who taps into a broad network of doctors, scientists, and medical experts to write in-depth service articles for leading publications like Glamour, Health, Real Simple, and Parents.