If you live with migraine, you know that it’s more than “just a bad headache.” Migraine is a complex neurological condition that can come with many different symptoms. The most common symptom is severe, throbbing pain on one side of the head, but migraine can also cause nausea and vomiting, light or smell or sound sensitivity, mood changes, and fatigue.
This is why finding the best medications for your migraine may take some time and trial. Today, there are more migraine treatments available than ever before, from over-the-counter pain relievers to advanced injectable medications that target specific brain pathways.
Understanding the major types of migraine drugs, how they work, and how to use them safely and effectively is important for managing your condition.
Treatment Goals for Migraine
The broad goal of migraine treatment is to:
- Stop attacks if and when you get them
- Prevent future attacks
- Help make each episode shorter and less severe
Part of migraine management involves lifestyle approaches such as identifying and avoiding triggers that set off your migraine, lowering your stress, and paying attention to your diet and physical activity. There are also procedures and devices your doctor can use for your migraine.
This guide will focus on medications that treat migraine. Medications are a proven, effective way to treat migraine and improve your quality of life. There is a wide range of options, each working on a different part of migraine management.
Most migraine medications fall into two broad categories.
- Abortive (acute or as-needed) medications are taken at the first sign of an attack to stop symptoms. The FDA-approved options for treating migraine in the moment typically reduce or completely get rid of your migraine within two hours.
- Preventive (prophylactic) medications are those that you take regularly (daily or monthly) to reduce how often your migraines happen. You might take these if you have very frequent or very severe migraine attacks.
You may need both types, and your doctor may adjust one or both over time as your migraine patterns change. Sometimes, taking a preventative medication can help an abortive medication work better.
Your migraine experience will be unique to you, and the best treatment plan for you will depend on factors like how frequently you get migraine attacks, other medical conditions you have, and how your body responds to certain medications.
Types of Migraine Medications
Migraine medications fall into two main categories, each containing several classes of drugs. Each has a different way of targeting the underlying cause of migraine symptoms. These include:
- Over-the-counter (OTC) pain relievers, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, or naproxen, which aren’t specific to migraine but ease general pain
- Triptans, which work on serotonin receptors to block pain signals
- Ditans, which work similarly to triptans but on a different receptor
- Gepants, which are available since 2020 and block calcitonin gene-related peptide (CGRP), a key molecule in migraine inflammation
- Ergot alkaloids, such as dihydroergotamine, which constrict blood vessels
Some other medications can be used to treat acute migraine attacks. These include lasmiditan, which works on the 1F serotonin receptor, and metoclopramide or prochlorperazine, both of which can help with the nausea and migraine pain. These can be used along with other agents or by themselves for acute migraine headaches. Other preventive medications include some beta-blockers, antidepressants, and seizure medicines.
Over-the-Counter (OTC) Medications
For many people, the first step in migraine management is trying OTC medications. They’re easier to have on hand and cheaper than most prescriptions. OTC medications can be very effective for mild to moderate migraine, especially if you take them at the very start of an attack.
These medications can work well for warding off migraine pain, but it’s best not to take them for more than 15 days a month. Taking them more often can lead to medication-overuse headache, a condition that actually causes more frequent pain. Overuse of OTC pain relievers can also lead to stomach irritation, liver issues, or kidney strain. If you’re using OTC medications several times a week or if your pain is no longer controlled, it’s a sign to check in with your doctor about prescription options.
Common OTC options include:
- Acetaminophen
- NSAIDs such as ibuprofen and naproxen
- Combination medications that blend acetaminophen, aspirin, and caffeine
Abortive Medications
Abortive or acute treatments are designed to stop a migraine in progress. The goal is to take them as soon as you feel an attack coming on, ideally during the earliest symptoms or aura phase.
Triptans
Triptans are some of the most common drugs doctors prescribe for migraine. They work on serotonin receptors in your brain, helping to narrow widened blood vessels and block pain pathways.
Triptans are fast-acting and come in tablets, nasal sprays, or injections. Some people notice side effects such as flushing, tingling, dizziness, or a tight feeling in the chest or throat. Because they can constrict blood vessels, triptans aren’t safe for everyone — especially those with heart disease or uncontrolled high blood pressure. For others, however, they can completely stop a migraine within a few hours.
Medications in this class include:
- Almotriptan
- Eletriptan
- Frovatriptan
- Naratriptan
- Rizatriptan
- Sumatriptan
- Zolmitriptan
Some triptans come in nasal spray or powder form:
- Sumatriptan nasal spray
- Zolmitriptan nasal spray
Gepants
Gepants are one of the newer categories of migraine medication. They work by blocking a protein (CGRP) that’s involved in inflammation and pain during a migraine attack.
Gepants tend to cause fewer side effects than triptans, and they don’t constrict blood vessels, which makes them a safer option for people with heart concerns. You take them as dissolvable tablets or nasal sprays, and the side effects are usually mild and include nausea or fatigue.
There are four FDA-approved gepants, three of which are abortive medications:
- Rimegepant
- Ubrogepant
- Zavegepant
Zavegapant is a nasal spray, while rimegepant and ubrogepant are tablets.
Doctors also prescribe rimegepant as a preventative. A fourth gepant, atogepant, is only for prevention.
Ergot derivatives
Ergot medications (dihydroergotamine and ergotamine) are older drugs that also narrow blood vessels and reduce pain signals in your body. Usually, doctors only prescribe these if you don’t respond to triptans. Side effects can include nausea, dizziness, and tingling sensations. You shouldn’t take ergots if you’re pregnant or have vascular disease.
The active ingredient is dihydroergotamine, and you can get it as:
- DHE-45 injection
- Ergotamine tartrate
- Migranal nasal spray
Preventative Migraine Medications
Doctors typically prescribe preventative medication for people who have four or more headache days per month or attacks that are especially severe or long-lasting. You might take your preventative daily, weekly, or monthly to make migraine attacks less frequent and less intense.
Blood pressure medications
Doctors sometimes prescribe blood pressure medications as migraine preventatives. These include:
- Beta-blockers
- Calcium channel blockers
- Angiotensin receptor blockers
- Angiotensin-converting enzyme (ACE) inhibitors
Two beta-blockers are FDA-approved for migraine prevention:
- Propranolol
- Timolol
These beta-blockers work by reducing the workload on blood vessels and lowering stress responses in the body. Some people experience fatigue, dizziness, or cold hands and feet. Beta-blockers aren’t ideal for people with asthma or depression, but for others, they can significantly reduce migraine days.
Other off-label blood pressure medications doctors prescribe for migraine include:
- Atenolol
- Candesartan
- Lisinopril
- Metoprolol
- Nadolol
Antidepressants
There are two different types of antidepressants doctors can choose from as migraine prevention medications: tricyclic antidepressants and selective serotonin/norepinephrine reuptake inhibitors (SNRIs). They prevent migraine attacks by affecting serotonin and norepinephrine levels, which influence pain regulation in the brain.
Tricyclic antidepressants have been around for a long time, and they can treat migraine, mood, and sleep. Many people gain weight, feel sleepy, and get dry mouth when they take it. SNRIs are newer and cause fewer side effects. You can take these in the morning because they don’t cause sleepiness.
Tricyclic antidepressants for migraine include:
- Amitriptyline
- Imipramine
- Nortriptyline
SNRIs include:
- Desvenlafaxine
- Duloxetine
- Levomilnacipran
- Milnacipran
- Venlafaxine
Anti-seizure drugs
These drugs are also called antiepileptic or anticonvulsant drugs. Originally used to treat seizures, they can also stabilize the brain’s electrical activity when you’re having a migraine attack.
They include:
- Topiramate
- Valproate/Divalproex
Topiramate can cause tingling in your hands and feet, mild weight loss, and problems finding the right words. Valproate can cause weight gain and tremors. You shouldn’t take either one during pregnancy.
Anti-calcitonin gene-related peptide (CGRP) therapies
One of the most important recent advances in migraine prevention is the development of CGRP monoclonal antibodies, a class of injectable medications that block CGRP or its receptor. CGRP is a protein that is part of the pain pathway in your head during migraine.
“We’ve made great strides in understanding some of the mechanisms going on in the brain during migraine,” says Helman. “It’s a complex process with genetic and environmental factors, but the more we understand, the better we’re able to develop targeted treatments like these.”
Typically, you get these drugs as injections once a month. They can cut migraine frequency in half for many people who take them, and they have few side effects. Some people have irritation at their injection site or mild constipation.
They include:
- Erenumab
- Eptinezumab
- Fremanezumab
- Galcanezumab
In addition to medications, neuromodulation devices — wearable gadgets that deliver gentle electrical stimulation to specific nerves — are offering a drug-free way to treat migraine attacks.
Safety Considerations
Migraine medications can interact with other prescriptions, so always tell your doctor all the medications you’re taking before starting a new treatment.
Combining triptans or ergots with certain antidepressants (like SSRIs or SNRIs) can increase the risk of serotonin syndrome, a rare but serious condition.
“We want to know about every medication and supplement you take, even herbal ones, to avoid harmful interactions,” says Dale Helman, neurologist at Central California Neurology in Salinas, California.
Taking too much of certain medications can sometimes make headaches worse. Using abortive drugs too often can lead to rebound or medication-overuse headaches, so it’s important to limit use to no more than 10-15 days per month.
If you get any new symptoms, write them down and inform your doctor.
“If your headache pattern suddenly changes or becomes more severe, or if you experience new neurological symptoms like weakness or vision loss, we want to know about that right away,” says Helman.
Migraine treatment during pregnancy
Treating migraine during pregnancy can be tricky. Most clinical trials don’t study effects on pregnant people, so there isn’t good data on how the medications could affect a pregnancy. But it doesn’t mean you’re without options altogether, says Helman.
“I try to counsel women, although we are a little more limited in treating migraine during pregnancy, there are safer options we can try, including nonmedication or procedural options like nerve blocks or Botox,” says Helman.
Doctors typically consider these options safe during pregnancy:
- NSAIDs (safe between weeks 12 and 20 of pregnancy only)
- Diphenhydramine (Benadryl)
- Peripheral nerve blocks with lidocaine
- Metoclopramide
- Prochlorperazine
- Promethazine
- Prednisone
- Butalbital (safe for pregnancy, but can cause medication overuse headache if you use it too often)
You should avoid medications such as ergotamines, topiramate, and valproate due to the risk of birth defects or pregnancy complications. Always talk to your doctor before starting or stopping any migraine treatment during pregnancy or breastfeeding.
