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.
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.
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.
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.
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.
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.
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.
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.
Tricyclic antidepressants can prevent migraines in some patients.
Valproate and topiramate can decrease the frequency of migraines.
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.