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When you’re living with chronic migraine, headaches happen at least 15 days each month. At least eight of those headaches have migraine features, such as throbbing or pulsing headache pain or sensitivity to light or sound. Your doctor may have already prescribed a treatment plan, or you may be just starting one. Several options are available to treat ongoing migraine pain and help prevent future migraine attacks.
In this article, we’ll discuss nine common migraine treatments, how they work, and possible side effects. If you’d like to better understand your current treatment plan, talk with your doctor or neurologist (a specialist in brain and nerve conditions). If you’re still having several migraine attacks per month, they may adjust your treatment. Together, you can find the medication plan that works best to treat and prevent your chronic migraine.
If you notice symptoms of a migraine attack starting, take your rescue medication as soon as possible. These treatments help shorten an attack and reduce severe symptoms. It’s important to follow your doctor’s treatment instructions. Using some rescue medications too often can make chronic migraine worse.
For a breakthrough migraine attack, some people use over-the-counter (OTC) pain relievers. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen sodium, are commonly used. Acetaminophen isn’t an NSAID, but it’s another OTC option for pain relief.
Some products combine pain relievers with aspirin and caffeine. When asked about their favorite OTC treatment, some MyMigraineTeam members have named Excedrin Migraine. “I’ve been using it for years, and so far it still works!” one member said.
Be sure to take a close look at the ingredients list before taking any OTC migraine medications. Some people should avoid products that contain caffeine or aspirin. It’s also a good idea to check with your doctor before starting a new OTC treatment.
Doctors may also prescribe NSAIDs for chronic migraine, including diclofenac potassium and indomethacin. According to the American Migraine Foundation, NSAIDs are often used by people with mild migraine attacks or those who can’t take triptans (described below).
Common side effects of NSAIDs include:
Taking NSAIDs too often can lead to medication-overuse headaches and make migraine symptoms worse. NSAIDs are also linked to a higher risk of bleeding and stomach ulcers. If you take NSAIDs often, talk with your doctor about the risks and benefits.
Dihydroergotamine (DHE) is another rescue treatment for migraine, including severe or persistent attacks. Dihydroergotamine mesylate has been used for decades and is available as an injection, an infusion (given through a vein), or a nasal spray.
DHE works quickly and may have a lower risk of medication overuse headaches compared with other treatments. Like other rescue medications, it works best when taken at the first sign of symptoms, although it may still help later in an attack.
Side effects depend on the type of DHE used. This medication shouldn’t be used by some people with medical conditions such as heart or vascular disorders or during pregnancy.
Calcitonin gene-related peptide (CGRP) is a small protein released during a migraine attack. CGRP dilates blood vessels and causes inflammation in the brain, leading to intense pain. Doctors and researchers have found that blocking CGRP can help treat migraine attacks.
Oral CGRP antagonists, also called gepants, approved by the U.S. Food and Drug Administration (FDA) to treat migraine include:
In 2023, the FDA also approved zavegepant (Zavzpret), a CGRP antagonist nasal spray, as a rescue treatment.
Large studies called clinical trials show that oral gepants can relieve migraine pain within about two hours. Studies found that zavegepant may start working within 15 minutes. Gepants also help with other symptoms such as nausea and sensitivity to sound and light.
Common side effects of gepants include:
Zavegepant may also cause nasal discomfort or changes in taste.
During a migraine attack, the brain’s blood vessels dilate and cause severe pain. Triptans bind to serotonin receptors in the brain. This action constricts or narrows the blood vessels and helps reduce migraine pain. Triptans also block certain pain signals involved in migraine.
Triptans are widely used for migraine and come as tablets, orally disintegrating tablets, nasal sprays, and injections. Examples of FDA-approved triptans include:
One MyMigraineTeam member shared, “When I had chronic migraine, I took triptan medication tablets. They were the only thing that worked during a migraine attack that gave me relief.”
Commonly reported side effects of triptans include:
Triptans may not be safe for people with certain health conditions, including cardiovascular problems and high blood pressure. Like NSAIDs, triptans can cause medication-overuse headaches if taken too often. If you use a triptan, talk with your doctor about how often you should take it.
For people living with chronic migraine, preventive treatments aim to reduce how often migraine attacks happen and how severe they are. These medications can lower the number of headache days each month. Most preventive medications are taken daily, although some are given monthly or every few months.
Current guidelines recommend CGRP-targeting preventives as first-line options for migraine prevention. This means you can start these newer treatments without trying older medications first and finding out they don’t work.
Monoclonal antibody drugs help reduce the frequency and severity of migraine attacks. These protein-based drugs work by blocking CGRP or its receptor (the docking site where CGRP attaches). This helps prevent blood vessel dilation. Monoclonal antibodies are given either as a subcutaneous injection (under the skin) or an IV infusion (into a vein).
The FDA has approved four CGRP monoclonal antibodies for migraine prevention:
Studies have found that monoclonal antibodies cause fewer side effects than other preventive treatments. The most common side effects include:
Some blood pressure medications are also used to help prevent migraine attacks. Doctors and researchers don’t fully understand why these drugs work for migraine, but they have some theories. Some blood pressure medications may affect serotonin, a brain chemical involved in migraine. Others may help stabilize blood vessels or reduce pain signaling in the brain. Examples used for migraine prevention include:
Side effects depend on the type of medication. Beta-blockers can cause a slow heart rate, dizziness, fatigue, constipation, and weight gain. Calcium channel blockers may cause constipation, heartburn, dizziness, and headache. If you notice side effects, talk with your doctor. They can help decide whether to adjust your dose, switch medications, or try a different preventive option.
OnabotulinumtoxinA (Botox) isn’t just for smoothing wrinkles. The FDA has also approved this drug for preventing chronic migraine. Botulinum toxin is a chemical produced by bacteria that prevents muscle contractions. The injections block nerves from releasing chemicals that trigger migraine pain. Treatment is given every three months.
“I’ve been using Botox for nearly two years. It cut down my almost daily migraine headaches by half,” one MyMigraineTeam member shared.
Possible side effects of onabotulinumtoxinA include:
In rare cases, the medication can spread beyond the injection site. This may lead to hoarseness, trouble swallowing, or loss of bladder control.
If you experience symptoms such as trouble breathing, chest pain, fever, or signs of an allergic reaction, call your healthcare provider right away or seek emergency medical care.
Tricyclic antidepressants (TCAs) are an older group of medications sometimes used to help prevent chronic migraine. Researchers don’t fully understand how TCAs work for migraine, but these drugs may affect brain chemicals involved in pain, including serotonin. TCAs used for migraine prevention include:
Among these, amitriptyline has the strongest research support for preventing migraine attacks. There are far fewer high-quality studies on the other TCAs.
Doctors typically prescribe TCAs at lower doses for migraine than for depression. These medications are taken by mouth each day. Like many antidepressants, TCAs can take several weeks to start working. Possible side effects include:
Studies show that anti-seizure medications, which are used to treat seizures, may also help reduce the frequency of migraine headaches. These medications are not used to stop a migraine attack once it starts. Instead, they work over time as preventive treatments.
One type of anti-seizure medication, topiramate (Eprontia, Qudexy XR Sprinkle, Topamax, Trokendi XR), is FDA-approved and considered a first-line preventive treatment for reducing headache frequency, along with medications such as propranolol. Research suggests it may work by calming overactive nerve signaling in the brain.
Another option, divalproex sodium (Depakote), is also FDA-approved for migraine prevention. This medication may be especially helpful for some people with prolonged or complex migraine attacks. A closely related medication, valproic acid, is sometimes prescribed off-label for chronic migraine prevention.
Some anti-seizure drugs, such as divalproex sodium, carry serious risks of birth defects and should not be taken if you’re pregnant or trying to become pregnant. Possible side effects include:
Talk with your doctor about the potential benefits and risks of anti-seizure medications — or any medication — to decide whether this treatment option may be right for you.
On MyMigraineTeam, people share their experiences with migraine, get advice, and find support from others who understand.
Do you currently take medications to treat your chronic migraine? Let others know in the comments below.
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A MyMigraineTeam Member
I wanted to add that if you use Quilipta and/or Ubrelvy, the manufacturer will work with you. They have a savings card that helps some people. For those of us who have Medicare or Medicaid the… read more
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