Medications for Migraine Headaches

Medications are excellent options for many patients who respond to these modalities. Neurologists, pain management physicians, and other medical specialists have had great success with migraine headache patients, and even in cases where surgery is a great option Dr. Lowenstein strongly urges his patients to followup with their medical headache specialist.  The following information is provided for educational purposes, but Dr. Lowenstein does not provide prescriptions for migraine medications.  Migraine medications should be prescribed by a neurologist.  For patients who are finding that migraine medications are not providing adequate headache relief, or if side effects to these medications are not tolerable, Dr. Lowenstein can evaluate you for migraine surgery, which can provide long term, medication-free migraine headache relief.

Migraine Medication Classifications

Medications can be classified into those that try to prevent the onset of a headache and those that try to abort a headache once symptoms begin. Medications such as ergots (DHE) and triptans ( Amerge, Axert, Frova, Imitrex, Maxalt, Relpax, Zomig,) are used to try to stop migraine headache symptoms once they have started. Other drugs such as anti-depressants, anti-seizure drugs, and blood pressure medications can be used to try to prevent headaches from starting.  The newest category of migraine medications targets specific pain chemicals in the brain.  These medications, such as Emgality, Aimovig, Ajovy, and others have variable success in providing improvement in migraine pain.  The published success rates of these CRGP inhibitors reflect lower success rates than migraine surgery, and the majority of patients who stop these medications do so because of their lack of reli or side effects.

Narcotic & Opioid Medication for Migraines

Unfortunately, another class of medication that is sometimes needed to control pain is narcotics, also called opioids. These medications are addictive and can ruin lives unto themselves, inducing addictive behaviors, hospitalizations, and even deaths. The department of Health and Human Services estimates that in 2014 the economic impact of the opioid epidemic was 55 billion dollars. One of the main advantages of the use of migraine headache surgery is the ability of migraine headache patients to cut down on if not completely stop the use of medications and opioids in particular.

Medications for pain relief

These medications work to relieve migraine pain. They work best when taken at the first sign of an oncoming migraine, and are also known as abortive medications.

Pain relievers

These are over the counter or prescription pain relievers including ibuprofen and aspirin. If taken too long, these can cause issues with your gastrointestinal tract.


Triptans

ie. Amerge, Axert, Frova, Imitrex, Maxalt, Relpax, and Zomig. These prescription drugs block certain pain pathways in the brain. They are taken as pills, shots, or nasal sprays.


Dihydroergotamines

ie. DHE or ergots. These are most effective when taken shortly after the start of symptoms for migraines that last longer than 24 hours. They are taken as nasal sprays or injections.


Lasmiditan

Also called Reyvow, this is a new option. Reyvow is an oral tablet that significantly improved pain as well as nausea and sensitivity to light and sound in clinical trials.


CRGP antagonists

These are new medications, including Aimovig, Ajovy, Emgality, Byepti, Ubrelvy, and Nurtec ODT. These medications block the CRGP molecule or its receptor, which are instrumental in pain transmission.


Opioids

These are only used if all other treatments have been unsuccessful, as they are highly addictive. They are to be avoided if at all possible.


Anti-nausea drugs

If a migraine with aura is accompanied by nausea and vomiting, anti-nausea drugs such as chlorpromazine, metoclopramide, or prochlorperazine can be helpful.


 

Medications to prevent migraines

Neurologists may use these drugs for patients who have frequent, long-lasting, or severe headaches that don’t respond to pain treatment. These prescription medications seek to reduce how often the person gets a migraine, how severe the migraine, and the duration of the migraine. If you are not considering migraine surgery with Dr. Lowenstein at this time, your neurologist may recommend the following medications:

Blood pressure-lowering medications

Beta-blockers and calcium channel blockers can be helpful in preventing migraines with aura.


Antidepressants

Tricyclic antidepressants can prevent migraines in some patients.


Anti-seizure drugs

Valproate and topiramate can decrease the frequency of migraines.


Botox

Injections of the botulinum toxin type A every 12 weeks can prevent migraines in some patients.


Calcitonin gene-related peptide monoclonal antibodies

This is a new class of drugs approved by the FDA to treat migraines. They’re given monthly by injection.

FAQ's

  • Who is a good candidate for migraine medication?

    People suffering from migraines often don’t seek treatment. They’ve either heard that medication and other possible treatments don’t have any effect, or they simply think it’s up to them to push through their headaches. That’s not the way to go. The understanding of migraine headaches has come a long way, and while Dr. Lowenstein is not a neurologist and cannot prescribe medications for migraines, there are medications available that can provide relief, both in curbing the frequency and lowering the intensity of the migraines. If you are not ready to pursue migraine surgery at this time, we recommend speaking to a neurologist to see if there are particular medications that may work well for you.
  • How do I know which migraine medication would be right for me?

    A neurologist is the only medical professional who can prescribe any of the various prescription migraine medications. During your visit, he or she will walk you through the various medications currently available, discussing the benefits and possible side effects of each option. Although Dr. Lowenstein is not a neurologist, here is some information about current migraine prescription medications.
  • Is it safe to switch migraine medications?

    With the exception of over-the-counter pain relievers, these are prescription medications, and all of them have side effects at least for certain groups. Obviously, switching from an ineffective option to an effective one is paramount to successful treatment of your pain. However, these can only be done after discussions with your neurologist. He or she will know the potential side effects and timelines necessary before you should switch from one prescription medication to another. You cannot do this on your own.
  • Are there any risks taking migraine medications?

    All of these medications have potential side effects. For instance, triptans can have adverse effects if the person has uncontrolled high blood pressure, heart disease, or has had a stroke. Anti-seizure drugs can cause dizziness, weight changes, nausea, and more. Again, this is the realm of your neurologist. He or she will be well-versed in each potential medication and its possible side effects. It will be up to the two of you to then weigh the potential benefits against those risks.
  • What if my migraine medication is ineffective?

    When medications prove ineffective for helping with a patient’s migraines, Dr. Lowenstein can help. Dr. Lowenstein will use nerve blocks to determine if you are a good candidate for migraine surgery, which he does by using point injections. If your migraine headaches respond to nerve blocks in this injection technique, that points to likely success with migraine headache surgery. Migraine headache surgery is an effective, long-term solution for chronic migraine headaches, tension headaches and chronic headaches that don’t respond to more conservative treatment options, like medication. Dr. Lowenstein is a board-certified surgeon with extensive experience with these procedures. If your migraine medications have failed, or if you prefer a more permanent solution, contact Dr. Lowenstein today.

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