Migraine Medications: Finding What Works for You
Living with migraine can be challenging, but today's medical landscape offers more treatment options than ever before. Understanding these medications and when to use them can help you have more productive conversations with your healthcare provider and find relief sooner.
Acute Medications: Stopping Migraine in Its Tracks
Acute medications are designed to stop migraine attacks once they've started. For best results, experts recommend taking these medications at the first sign of an attack - treating when pain is mild increases your chances of becoming pain-free and reduces the risk of the attack returning.
First-line options include:
- For mild to moderate attacks: Pain relievers like aspirin, acetaminophen (Tylenol), and NSAIDs like ibuprofen (Advil)
- For moderate to severe attacks: Triptans such as sumatriptan (Imitrex), which is typically prescribed first
Additional treatments include:
- Gepants (CGRP antagonists): rimegepant (Nurtec ODT), ubrogepant (Ubrelvy), zavegepant (Zaczpret)
- Ditans: lasmiditan (Reyvow)
If nausea is part of your migraine experience, consider anti-nausea medications like Dramamine (OTC) or prescription options like ondansetron (Zofran), which can not only reduce nausea but help your acute medication work better.
Preventive Medications: Reducing Frequency and Severity
Preventive treatments aim to reduce how often you experience migraines and how severe they are. Consider prevention if you:
- Have more than three migraine attacks or eight headache days monthly
- Experience debilitating attacks despite acute treatment
- Can't tolerate acute medications or their side effects
- Have developed medication overuse headache
Common preventive options include:
- Anti-seizure medications: divalproex (Depakote), topiramate (Topamax)
- Blood pressure medications: propranolol, verapamil
- Antidepressants: such as amitriptyline (Elavil)
- CGRP monoclonal antibodies: erenumab (Aimovig), galcanezumab (Emgality), fremanezumab (Ajovy), eptinezumab (Vyepti)
- Gepants: rimegepant (Nurtec ODT), atogepant (Qulipta)
- Botox injections
Beyond Medication: Other Treatment Approaches
Neuromodulation Devices FDA-approved devices like CEFALY, Nerivio, and gammaCore can be excellent options, especially if you:
- Experience medication side effects
- Need acute medication more than 10 days monthly
- Are under 18 years old (some devices are approved for adolescents)
Supplements Some supplements show promise for migraine management:
- Magnesium (most scientific evidence)
- Coenzyme Q10
- Vitamin B2 (riboflavin)
- Herbal options like feverfew and boswellia
Finding Your Path Forward
Remember that finding the right treatment often involves trial and error. Don't get discouraged if the first medication you try doesn't work - many people need to try multiple options or combinations before finding what works best.
Success shouldn't be measured just by a reduction in headache days but by improved quality of life and function.
Keep a migraine diary to track your attacks, symptoms, and medication effectiveness. This information is invaluable for you and your healthcare provider as you work together to find your optimal treatment plan.