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Chronic Migraine: 8 Common Treatments

Medically reviewed by Angelica Balingit, M.D.
Written by Emily Wagner, M.S.
Posted on February 20, 2024

When living with chronic migraine, more than half of your days every month are filled with throbbing or pulsing headache pain. Your doctor may have already prescribed a treatment plan for managing your chronic migraine, or you may be just starting one. There are several options available to treat ongoing migraine pain and help prevent it from occurring.

In this article, we’ll discuss eight common migraine treatments, how they work, and side effects to be aware of. If you’re interested in learning more about your current treatment plan, talk to your doctor or neurologist (brain specialist). They can also make adjustments if you’re still having several migraine attacks per month. Together, you’ll work to find the best medication for treating and preventing your chronic migraine.

Rescue Medications for Chronic Migraine

If you start experiencing symptoms of an oncoming migraine attack, you will want to take rescue medication as soon as possible. These treatments help shorten migraine attacks and reduce severe symptoms. It’s important to follow your doctor’s treatment instructions. This is because some rescue medications can make chronic migraine worse.

1. Pain Relievers

When experiencing a breakthrough migraine attack, some people use over-the-counter (OTC) pain relievers found in grocery and drug stores. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) and naproxen sodium (Aleve) are common treatment options. It’s worth noting that acetaminophen (Tylenol) isn’t an NSAID, but it’s another option for pain relief.

Certain migraine medications — like Excedrin Migraine — combine pain relievers with aspirin and caffeine. When asked about their favorite OTC treatment, some MyMigraineTeam members prefer Excedrin Migraine. “I’ve been using it for years and so far it still works!” wrote one member.

Be sure to take a close look at the ingredients list on OTC migraine medications before taking them. Some people may not be able to safely take medications containing caffeine or aspirin. It’s always a good idea to check with your doctor before starting a new OTC treatment.

Doctors also prescribe NSAIDs for chronic migraine, including diclofenac potassium (Cambia) and indomethacin (Indocin). According to the American Migraine Foundation, NSAIDs are typically used in people with mild migraine attacks and for those who can’t take other migraine medications.

Common side effects of NSAIDs include:

  • Nausea
  • Constipation or diarrhea
  • Bloating and gas
  • Abdominal pain
  • Lightheadedness or dizziness
  • Heartburn

Taking NSAIDs too often can lead to medication-overuse headaches, making your symptoms worse. NSAIDs are also associated with an increased risk of bleeding and stomach ulcers. Talk to your doctor if you’re taking NSAIDs frequently to treat your chronic migraine.

2. Calcitonin Gene-Related Peptide Antagonists

Calcitonin gene-related peptide (CGRP) is a protein released in the body during migraine attacks. CGRP causes blood vessel dilatation (widening) and inflammation in the brain, leading to intense pain. Doctors and researchers have found that blocking CGRP helps treat migraine attacks.

The U.S. Food and Drug Administration (FDA) recently approved two oral CGRP antagonists (gepants) for treating migraine. Rimegepant (Nurtec ODT) and ubrogepant (Ubrelvy) are taken at the first sign of an oncoming migraine attack to treat it as soon as possible. Additionally, the FDA approved an internasal (nasal spray) CGRP antagonist in 2023 called Zavzpret, a formulation of zavegepant.

Large studies known as clinical trials have found that oral gepants work within two hours to relieve migraine pain. Clinical studies found that zavegepant provided relief from migraine pain in 15 minutes. Gepants also treat other symptoms like sensitivity to sound and light and nausea.

Side effects of gepants include:

  • Nausea
  • Dry mouth
  • Fatigue or tiredness
  • Dizziness

Zavegepant may also cause some nasal side effects, including nasal discomfort and taste disorders.

It’s also worth noting that rimegepant and atogepant (Qulipta) are gepants for preventing migraine attacks. Ubrogepant can’t be used to prevent migraine attacks. If you have any questions about gepants for treating or preventing migraine, talk to your doctor.

3. Triptans

During a migraine attack, the brain’s blood vessels dilate and cause extreme pain. Triptans work by binding to serotonin receptors in the brain. This constricts or narrows the blood vessels to help reduce the severity of a migraine attack. Triptans also block pain signals and stop the release of proteins that make migraine attacks worse. Triptans are available as oral tablets, rapid disintegrating tablets, nasal sprays, and injections.

Examples of FDA-approved triptans your doctor may prescribe include rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zolmig). One MyMigraineTeam member shared their experience with triptans: “When I had chronic migraines, 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:

  • Dizziness
  • Nausea
  • Sweating and flushing
  • Weakness
  • A pins and needles sensation in your hands or feet
  • Neck pain
  • Fatigue or drowsiness

Like NSAIDs, triptans can also cause medication-overuse headaches. Some doctors choose not to prescribe triptans to people with chronic migraine because they can trigger more migraine attacks. Additionally, triptans carry a risk for people with certain health conditions, including cardiovascular problems and high blood pressure.

If you currently use a triptan to stop migraine attacks, talk to your doctor about how often you should take it.

Preventive Treatments for Chronic Migraine

If you have chronic migraine, you've had at least 15 headache days per month for three months or more. You may also have eight headache days with migraine symptoms for at least three months. Preventive medications help put a stop to migraine attacks before they occur. This helps decrease the number of headache days you have per month. Most preventive medications are taken daily.

4. Blood Pressure Medications

Your doctor may prescribe certain blood pressure medications to help prevent migraine attacks. Doctors and researchers aren’t quite sure why these drugs work for preventing migraine, but they have some theories. Some blood pressure medications block serotonin receptors and prevent blood vessel dilation. Others may interfere with pain signals sent in the brain.

Examples of blood pressure medications for preventing migraine attacks include:

  • Beta-blockers — Propranolol (Inderal) and metoprolol (Lopressor)
  • Calcium channel blockers — Verapamil (Calan, Verelan)
  • Angiotensin-receptor blockers (ARBs) — Candesartan (Atacand)

These types of medications generally don’t cause side effects, though some people experience mild ones including:

  • Dizziness
  • Headaches
  • Swelling in the legs or feet
  • Stomach issues

5. Botox Injections

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. Botox injections block nerves from releasing chemicals that trigger migraine pain. You’ll need treatment around every three months.

“I’ve been using Botox for nearly two years. It cut down my almost daily migraines by half,” shared one MyMigraineTeam member.

Side effects you may experience with Botox treatment include:

  • Injection site pain and bruising
  • Dry mouth or eyes
  • Muscle aches and pain
  • Drooping eyelid
  • Headaches

If you begin experiencing an allergic reaction, chest pain, trouble breathing, or other alarming side effects, call your doctor immediately.

6. Monoclonal Antibody Drugs

Monoclonal antibody drugs are treatments for reducing the frequency and severity of migraine attacks. These drugs block CGRP proteins and prevent blood vessel dilation. Monoclonal antibodies are protein drugs that need to be injected subcutaneously (under the skin) or infused into a vein.

The FDA has approved four CGRP monoclonal antibodies for migraine prevention. Eptinezumab-jjmr (Vyepti) is given as an intravenous infusion once every three months. The other three monoclonal antibodies are given as subcutaneous injections and include:

Studies have found monoclonal antibodies cause fewer side effects compared to other preventive treatments. The most common include injection site pain and constipation.

7. Tricyclic Antidepressants

Tricyclic antidepressants (TCAs) are an older class of medications used to help prevent chronic migraine. Researchers don’t exactly understand how TCAs work, but they think these drugs may affect certain chemical messengers in the brain.

There are several TCAs used for migraine prevention, including:

TCAs are taken by mouth on a daily basis. Doctors typically prescribe a lower dose of TCAs than what’s used to treat depression. Like many antidepressants, TCAs can take several weeks to start working.

Side effects of TCAs to be aware of include:

  • Dry mouth
  • A pins and needles sensation in your hands
  • Drowsiness
  • Weight gain
  • Blurry vision
  • Difficulty urinating
  • Changes in your blood pressure, pulse, and heart rhythm

8. Anticonvulsants

Anticonvulsants medications for treatment of seizures are effective for reducing the frequency of migraine headaches. These are not used to treat a migraine attack in progress, but work preventively over time.

Types of anticonvulsants a doctor may prescribe include:

  • Topiramate (Epronita, Topamax, Trokendi XR, Qudexy XR) — This anticonvulsant is considered a first-line preventive option for migraine, alongside medications like propranolol. Research suggests it may work by calming hyperexcitable nerve signaling in the brain.
  • Sodium valproate (Depakote, Depakene) — This drug may be especially helpful for people with prolonged migraine attacks or those that present with unusual features.

Some anticonvulsants carry serious risks for birth defects and should not be taken by people who are pregnant or trying to become pregnant. Side effects of anticonvulsants can include:

  • Fatigue
  • Dizziness
  • Nausea
  • Changes in thinking or concentration

Talk With Others Who Understand

MyMigraineTeam is the social network for people with migraine and their loved ones. On MyMigraineTeam, more than 81,000 members come together to ask questions, give advice, and share their stories with others who understand life with migraine.

Do you currently take medications to treat your chronic migraine? What has your migraine treatment journey been like? Share your experience in the comments below, or start a conversation by posting on your Activities page.

Posted on February 20, 2024
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Angelica Balingit, M.D. is a specialist in internal medicine, board certified since 1996. Learn more about her here.
Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here.

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