Migraine medication list
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Comprehensive List of Migraine Medications
Migraine is a prevalent and debilitating neurological condition that requires a multifaceted approach for effective management. This article provides a detailed overview of the medications used for both acute treatment and prophylaxis of migraines, based on recent research findings.
Acute Migraine Medications
Triptans
Triptans are a class of medications specifically designed to treat acute migraine attacks. They work by stimulating serotonin receptors, which leads to the constriction of blood vessels and reduction of inflammation. Common triptans include:
- Almotriptan
- Eletriptan
- Frovatriptan
- Naratriptan
- Rizatriptan
- Sumatriptan (available in oral, nasal spray, injectable, and transcutaneous patch forms)
- Zolmitriptan (available in oral and nasal spray forms)1 3 4 8.
Ergotamines
Ergotamines, such as dihydroergotamine (available as a nasal spray and inhaler), are another class of medications used for acute migraine treatment. They are effective but are generally considered when triptans are not suitable1 8.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs are commonly used for mild to moderate migraine attacks. Effective NSAIDs include:
Combination Analgesics
Combination analgesics, which include a mix of acetaminophen, aspirin, and caffeine, are also effective for acute migraine treatment. These combinations can provide enhanced pain relief compared to single-agent therapies1 8.
Opioids
While opioids like butorphanol nasal spray, codeine/acetaminophen, and tramadol/acetaminophen are probably effective, they are not recommended for regular use due to the risk of dependency and other side effects1 8.
Antiemetics
Antiemetics are used to manage nausea and vomiting associated with migraines. Effective antiemetics include:
Prophylactic Migraine Medications
Beta-Blockers
Beta-blockers are commonly used for migraine prevention. Effective beta-blockers include:
Anticonvulsants
Anticonvulsants are another class of medications used for migraine prophylaxis. Effective anticonvulsants include:
Antidepressants
Certain antidepressants are effective for migraine prevention. These include:
Calcium Channel Blockers
Calcium channel blockers, such as flunarizine, are also used for migraine prophylaxis2 4.
Angiotensin-Converting Enzyme (ACE) Inhibitors and Angiotensin Receptor Blockers (ARBs)
ACE inhibitors like enalapril and lisinopril, and ARBs like candesartan and telmisartan, have shown effectiveness in migraine prevention2.
Emerging Treatments
CGRP Receptor Antagonists
Calcitonin-Gene-Related Peptide (CGRP) receptor antagonists and monoclonal antibodies against CGRP or its receptor are promising new treatments for migraine. These medications have shown good efficacy in preventing migraines with minimal adverse effects10.
Other Emerging Drugs
Other emerging drugs target various pathways involved in migraine pathophysiology, including selective 5-HT1F receptor agonists and drugs targeting acid-sensing ion channels and transient receptor potential channels10.
Conclusion
The management of migraines involves a variety of medications tailored to the severity and frequency of attacks, as well as individual patient characteristics. Acute treatments primarily include triptans, NSAIDs, and combination analgesics, while prophylactic treatments often involve beta-blockers, anticonvulsants, and antidepressants. Emerging treatments like CGRP receptor antagonists offer new hope for more effective migraine management. Clinicians must consider the efficacy, side effects, and patient preferences when prescribing these medications.
Sources and full results
Most relevant research papers on this topic
The Acute Treatment of Migraine in Adults: The American Headache Society Evidence Assessment of Migraine Pharmacotherapies
Many acute migraine treatments have evidence supporting their efficacy, including triptans, dihydroergotamine, and various nonspecific medications.
Systematic Review
Rigorous Journal
Highly CitedA Comparative Effectiveness Meta-Analysis of Drugs for the Prophylaxis of Migraine Headache
Amitriptyline is more effective than candesartan, fluoxetine, propranolol, topiramate, and valproate for migraine prophylaxis, with fewer side effects.
Meta-AnalysisRigorous JournalHighly CitedMigraine Treatment: Current Acute Medications and Their Potential Mechanisms of Action
Acute migraine medications aim to rapidly restore function with minimal recurrence and avoid side effects, with individualized treatment choices based on attack characteristics, patient preferences, and drug properties.
Very Rigorous JournalHighly CitedEFNS guideline on the drug treatment of migraine – report of an EFNS task force
The EFNS guideline recommends oral NSAIDs and triptans for acute migraine treatment, with intravenous acetylsalicylic acid for severe attacks, and betablockers for migraine prophylaxis.
Systematic ReviewHighly CitedSelective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) for the prevention of migraine in adults.
SSRIs and SNRIs show limited efficacy and tolerability in preventing episodic and chronic migraine in adults, with limited evidence from small, inconclusive studies.
Systematic ReviewVery Rigorous JournalCurrent Prophylactic Medications for Migraine and Their Potential Mechanisms of Action
Current migraine preventive medications generally suppress excitatory nervous signaling, facilitate GABAergic inhibition, reduce neuronal sensitization, block cortical spreading depression, and/or reduce CGRP levels.
Very Rigorous JournalHighly CitedRole of Antiepileptic Drugs as Preventive Agents for Migraine
Valproate and topiramate are effective and well-tolerated in migraine prevention, while acetazolamide, lamotrigine, oxcarbazepine, and vigabatrin show no evidence of effectiveness.
Systematic ReviewAcute Migraine Treatment in Adults
Acetaminophen, NSAIDs, and triptans are effective acute migraine treatments, but individualized treatment plans are needed based on patient features and contraindications.
Literature ReviewRigorous JournalHighly CitedCurrent options for the prevention and treatment of migraine.
Triptans are effective and well-tolerated for acute treatment of moderate to severe migraines, while preventive migraine medications are less specific and effective than acute treatments.
Systematic Review