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The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. Remember that all medications, including over-the-counter, can cause or worsen certain chronic headaches. It is important that you become aware of the alternative treatments, including stress management, which are an important part of treatment. If you have further questions about usage or side effects, contact your doctor.

Medications for Treating Migraines
Prescription Medications to Treat Migraines
Triptans (Serotonin Agonists)

Common names include:

  • Sumatriptan (Imitrex)
  • Almotriptan (Axert)
  • Naratriptan (Amerge)
  • Rizatriptan (Maxalt)
  • Zolmitriptan (Zomig)
  • Frovatriptan (Frova)

Triptans are drugs that act similar to the brain chemical serotonin, which constricts blood vessels in the brain. For best results, these drugs should be taken at the first signs of migraine or cluster headache. Some are injectable and others are taken by mouth or by nasal spray. Do not use within 24 hours of taking ergotamine tartrate or similar medications. Do not take with monoamine oxidase (MAO) inhibitors. Triptans should not be used if you have uncontrolled hypertension, coronary artery disease, angina, severe liver disease, or neurovascular disease.

Possible side effects include:

  • Dry mouth
  • Headache
  • Nausea
  • Tiredness
  • Sensation of burning or tingling
Ergot-based Preparations (Ergotamine Tartrate)

Common brand names include:

  • Ergomar
  • Cafergot
  • Migergot

Ergotamine tartrate constricts blood vessels. It helps offset blood vessel widening during a migraine. Do not use within 24 hours of taking triptan drugs or serotonin agonists. Ergot preparations should not be used if you have coronary artery disease, uncontrolled hypertension, kidney or liver disease, peripheral artery disease, or severe systemic infections.

Possible side effects include:

  • Nausea and vomiting
  • Feelings of coldness in hands and feet
  • Weakness and pain in the leg muscles
Dihydroergotamine

Common brand names include:

  • DHE 45
  • Migranal

Dihydroergotamine constricts dilated blood vessels. It is injected to prevent or stop a migraine headache. Do not take this drug long-term. Notify your doctor right away if side effects occur.

Possible side effects include:

  • Nausea and vomiting
  • Feelings of coldness in hands and feet
  • Weakness and pain in the leg muscles
  • Chest pain
  • Risk of heart attack and stroke
Phenothiazines

Common names include:

  • Prochlorperazine (Compazine, Compro)
  • Metoclopramide (Reglan)

Certain phenothiazines have been FDA-approved for the treatment of nausea and vomiting associated with migraines.

Possible side effects may include:

Over-the-Counter Medications to Treat Migraines
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Common names include:

  • Naproxen sodium (Aleve)
  • Ibuprofen (Motrin)
  • Aspirin (Bayer)

These drugs should not be used if you have peptic ulcer disease, recent bleeding from the gut, kidney disease, or heart disease. These drugs work to control pain and inflammation. Possible side effects include:

  • Rebound headache if pain reliever is taken on a regular basis
  • Gastrointestinal bleeding
  • Stomach upset
Analgesic Combinations
  • Excedrin Migraine—contains aspirin, acetaminophen, and caffeine
  • Advil Migraine—contains ibuprofen
  • Motrin Migraine—contains ibuprofen

These drugs also work to control pain and inflammation. Possible side effects include:

  • Rebound headache if pain reliever is taken on a regular basis
  • Gastrointestinal bleeding
  • Stomach upset
  • Acetaminophen can cause liver problems if taken with alcohol. Do not take more than the recommended dose.
Medications for Preventing Migraines
Beta-Blockers

Common names include:

  • Propranolol (Inderal)
  • Metoprolol (Lopressor)
  • Timolol (Blocadren)

Beta-blockers are commonly used to treat high blood pressure, but are also used to prevent migraine headaches. Beta-blockers work by affecting the response to some nerve impulses in certain parts of the body. They also decrease the heart's need for blood and oxygen by reducing its workload.

Possible side effects include:

  • Lightheadedness
  • Drowsiness
  • Nausea
  • Vomiting
  • Upset stomach
Anticonvulsants

Common name: Valproic acid (Depakene)

Valproic acid may be used to prevent migraine headaches. Your doctor will order periodic blood tests to check drug levels and liver function. This drug should not be used if you have severe liver disease. This medication should not be used by women who are pregnant.

Possible side effects include:

  • Sedation
  • Nausea and vomiting
  • Liver problems
  • Blood problems
  • Pancreatitis
  • Hyperammonemia
  • Increased risk of suicidal thinking and behavior
Topiramate

Common name: Topiramate (Topamax)

Topiramate may be used to treat migraine headaches. Do not abruptly discontinue this drug.

Possible side effects include:

  • Lightheadedness
  • Problems with coordination and concentration
  • Fatigue
  • Tingling in the fingertips and toes
  • Kidney stones
  • Glaucoma
Other Medications for Treating Migraines
Tricyclic Antidepressants

Common names: Amitriptyline (Elavil, Endep), Nortiptyline

Antidepressants are given for their pain-relieving abilities. Do not stop taking antidepressants without first checking with your doctor. These drugs should not be used if you have glaucoma, are recovering from a recent heart attack, or have used MAO inhibitors within two weeks.

Possible side effects include:

  • Blurred vision
  • Dry mouth
  • Lightheadedness when standing up
  • Constipation
  • Weakness
Botulinum Toxin Injections

Botulinum toxin is made from a type of bacteria. The toxin blocks the chemical signals from the nerves to muscles. This will decrease the muscle contraction. Botulinum toxin injections can be used to prevent migraines. This treatment may also help to decrease the duration and intensity of migraines if they do occur.

Medications for Treating Cluster Headaches

Many medications may be prescribed to treat cluster headaches. Examples include:

  • Oxygen therapy
  • Sumatriptan or other triptans
  • Octreotide given as an injection
Medications for Preventing Cluster Headache

Other medications may be given to prevent or reduce the frequency of headaches. Examples of these drugs include:

  • Intranasal civamide and capsaicin cream
  • Steroid injections
  • Verapamil such as Calan, Isoptin
  • Lithium such as Eskalith
  • Melatonin
  • Valproate such as Depakote or gabapentin such as Neurontin
  • Topiramate such as Topamax
  • Baclofen such as Lioresal
  • Prednisone
  • Clonidine such as Catapres-TTS
Medications for Treating Sinus Headache
Antibiotics

Common name: Amoxicillin (Amoxil)

Antibiotics may be ordered to treat a sinus infection caused by bacteria. Take with food to decrease stomach upset. It is important that you finish the complete course of therapy. Do not stop taking the antibiotics even if you feel better.

Possible side effects include:

  • Upset stomach
  • Diarrhea
  • Vaginal yeast infections
Decongestants

Common names include:

  • Pseudoephedrine hydrochloride (Sudafed)
  • Phenylephrine (Neo-Synephrine)

Decongestants may be given to treat sinusitis. Decongestants open clogged nasal passages, allowing the sinuses to drain. Do not use these drugs longer or more often than directed. Overuse of decongestant nose sprays may increase swelling and make your symptoms worse.

Possible side effects include:

  • Increased blood pressure and pulse
  • Anxiety
  • Palpitations
Special Considerations

Whenever you are taking a prescription medication, take the following precautions:

  • Take your medicines as directed. Do not change the amount or the schedule.
  • Do not stop taking them without talking to your doctor.
  • Do not share them.
  • Ask what results and side effects to expect. Report them to your doctor.
  • Some drugs can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one drug. This includes over-the-counter medicines and herb or dietary supplements.
  • Plan ahead for refills so you don’t run out.

References

Dihydroergotamine. EBSCO DynaMed website. Available at: https://www.ebscohost.com/dynamed. Updated January 18, 2013. Accessed November 18, 2013.

FDA's MedWatch safety alerts: March 2009. US Food and Drug Administration website. Available at: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm142815.htm. Published March 23, 2009. Accessed November 18, 2013.

Headache—frequently asked questions. National Headache Foundation website. Available at: http://www.headaches.org/education/Tools_for_Sufferers/Headache_-_Frequently_Asked_Questions. Accessed November 18, 2013.

Migraine in adults. EBSCO DynaMed website. Available at: https://www.ebscohost.com/dynamed. Updated July 17, 2013. Accessed November 18, 2013.

NINDS headache information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/headache/headache.htm. Updated November 8, 2013. Accessed November 18, 2013.

Pascual J, El Berdei Y, et al. How many migraine patients need prolonged (>1 year) preventive treatment? Experience with topiramate. J Headache Pain. 2007;8:90-93. Epub 2007 Jan 15.

Sumatriptan. EBSCO DynaMed website. Available at: https://www.ebscohost.com/dynamed. Updated January 18, 2013. Accessed November 18, 2013.

4/23/2007 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Brandes UK, Kurdrow D, et al. Sumatriptan-naproxen for acute treatment of migraine: a randomized trial. JAMA. 2007;297:1443-1454.

7/5/2007 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Mannix LK, Loder E, et al. Rizatriptan for the acute treatment of ICHD-II proposed menstrual migraine: two prospective, randomized, placebo-controlled, double-blind studies. Cephalalgia. 2007;27:414-421.

5/14/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Patorno E, Bohn RL, et al. Anticonvulsant medications and the risk of suicide, attempted suicide, or violent death. JAMA. 2010;303(14):1401-1409.

10/25/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Francis GJ, Becker WJ, et al. Acute and preventive pharmacologic treatment of cluster headache. Neurology. 2010;75(5):463-473.

10/25/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: US Food and Drug Administration. FDA approves Botox to treat chronic migraine. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm229782.htm. Published October 15, 2010. Accessed November 18, 2013.

2/18/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Serretti A, Mandelli L. Antidepressants and body weight: a comprehensive review and meta-analysis. J Clin Psychiatry. 2010;71(10):1259-1272.

3/3/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Chankrachang S, Arayawichanont A, et al. Prophylactic botulinum type A toxin complex (Dysport) for migraine without aura. Headache. 2011 Jan;51(1):52-63.

5/13/2013 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: US Food and Drug Administration. Valproate anti-seizure products contraindicated for migraine prevention in pregnant women due to decreased IQ scores in exposed children. US Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/ucm350684.htm. Published May 6, 2013. Accessed November 18, 2013.



Last reviewed November 2013 by Rimas Lukas, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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