Migraine Prevention Medications: Drug types, preventive treatment & outlook

What is a migraine?

Migraine is a kind of headache, usually severe and debilitating. The main feature of a migraine is an intense pulsing or throbbing on one side of your head.

A person who has a migraine can be very sensitive to sound, light, and smell. Migraines also trigger visual disturbances and may cause vomiting or nausea. A migraine isn’t just a headache. It is more than that and can affect your activities of daily living.

Migraines are usually treated with a drug. There are two kinds of medications used in the treatment of migraines:

  • Acute treatment is designed for pain or other symptoms that characterize a migraine headache.
  • Preventive treatment helps to reduce the severity of migraines or the frequency at which they occur.

Drugs for acute treatment of migraine

Drugs in this category are taken once you notice the symptoms of migraine. They reduce the severity of the migraine or may relieve it outright.

However, if you take these drugs too often, you may end up with a rebound headache. A rebound headache is a headache arising from excessive use of a medication, which then requires you to take some extra medication.

If you have chronic migraine (that requires you taking drugs at least 9 times per month), then see your doctor ASAP! He or she will guide you on possible preventive treatments.

Painkillers

Migraines can be treated with certain over-the-counter painkillers. However, most painkillers are only available in prescription strength.

Most painkillers (except acetaminophen) are nonsteroidal anti-inflammatory drugs. They have analgesic and anti-inflammatory properties. Drugs in this category include:

Many painkillers used for the treatment of headaches or migraines combine one or more of the drugs listed above together with some caffeine. This makes them work faster, and also increases their efficiency, especially for mild migraines.

Long-term use of NSAID is associated with some side effects. These include:

Ergotamines

Ergotamines have been used for migraine treatment for a long time. they were the first class of drugs used for migraine treatment. Ergotamines cause contraction of your cranial blood vessels (blood vessels around your brain), leading to migraine relief within a few minutes.

Ergotamines are available in different forms including injections, suppositories, nasal sprays, tablets that can dissolve under your tongue, and pills. Ergotamines are usually taken once you notice the first symptoms of headaches. Some ergotamines can be taken every 30 minutes if the migraine persists.

Examples of ergotamines are:

  • Methylergonovine (methergine)
  • Methysergide (sansert)
  • Ergotamine and caffeine (wigraine, migergot, ercaf, cafetrate, cafergot, cafatine)
  • Ergotamine (ergomar)
  • Dihydroergotamine (DHE-45, migranal)

You should note that ergotamines have bad side effects. High doses are very toxic and can cause heart problems and birth defects.

It is contraindicated in pregnant women, breastfeeding mums, or people with heart disease. It is also important to note that ergotamines interact negatively with other medications, like antibiotics and antifungal medications.

Triptans

Triptans are a new class of drugs. They work by increasing the level of serotonin in your brain, constricting the blood vessels in your brain, and reducing inflammation, which brings the migraine to an end.

Triptans are available in many forms like injections, nasal sprays, tablets, and pills.

Examples of triptans include:

  • Zolmitriptan
  • Naproxen and sumatriptan (Treximet)
  • Sumatriptan (Imitrex)
  • Naratriptan (Amerge)
  • Rizatriptan (Maxalt-MLT, Maxalt)
  • Frovatriptan (Frova)
  • Almotriptan (Axert)
  • Eletriptan (Relpax)

Triptans have some side effects which include:

  • dizziness
  • drowsiness
  • nausea
  • numbness in your toes or a tingling sensation in them
  • discomfort or tightness in your throat or chest

Triptans are not good for people who have a high risk of stroke. People with heart problems should also avoid triptans.

You should also note that triptans can cause serotonin syndrome if taken alongside antidepressants, or other drugs that can increase serotonin levels.

Anti-nausea medications

Anti-nausea drugs reduce the vomiting and nausea that accompany migraines. These drugs are taken together with painkillers because they do not have any analgesic effect.

Examples of anti-nausea drugs include:

  • trimethobenzamide (Tigan)
  • promethazine (Phenergan)
  • Prochlorperazine (Compazine)
  • Metoclopramide (Reglan)
  • Dimenhydrinate (Gravol)

Anti-nausea medications can cause drowsiness, dizziness, make you be less alert, or cause other side effects.

Opioids

Doctors usually prescribe opioids when other painkillers fail to resolve your migraine. Opioids are also prescribed for people who cannot take triptans or ergotamines. Opioids are very powerful painkillers.

Examples of opioids include:

  • Morphine
  • Codeine
  • Meperidine
  • Oxycodone

The problem with opioids is that they have a very high risk of addiction, and that’s why doctors don’t prescribe them all the time.

Drugs for preventive treatment of migraine

Does your migraine come all the time? If yes, then your doctor may give you a preventive drug to ease the intensity or frequency of your migraines.

Preventive drugs for migraines are taken regularly, in most cases daily. Your doctor may prescribe these drugs alone or may combine them with other medications.

Preventive drugs don’t work at once. Sometimes, they may take a few weeks or in some cases, months, to become effective. Most migraine prevention medications treat other conditions as well as migraines.

Botulinum toxin Type A

It is also known as Botox. It is an FDA-approved medication usually administered as an injection in your neck muscles or your forehead. It treats chronic migraines.

Botox treatments are done every three months and are usually very expensive.

Anticonvulsants

Anticonvulsants work for epilepsy-induced seizures. They ease migraine symptoms by relaxing hyperactive brain nerves.

Examples of anticonvulsants include:

  • Gabapentin (Neurontin)
  • Divalproex-sodium
  • Levetiracetam (Keppra)
  • Valproate (Depakene)
  • Topiramate (Topamax)
  • Pregabalin (Lyrica)
  • Zonisamide

Anticonvulsants have many side effects which may include:

Antidepressants

Antidepressants affect the level of serotonin and other brain chemicals. A high serotonin level can cause blood vessel constriction and also reduce inflammation, thus alleviating migraines.

Examples of antidepressants that treat migraines include:

  • Venlafaxine
  • Sertraline
  • Paroxetine
  • Nortriptyline
  • Imipramine
  • Fluoxetine
  • Amitriptyline

Antidepressants also have some side effects such as decreased libido and weight gain.

Calcium channel blockers

Calcium channel blockers are drugs that treat blood pressure issues. It moderates the dilation and constrictions of your blood vessels. Note that dilation and constriction of your blood vessels are involved in migraine.

Examples of calcium channel blockers include:

  • Verapamil (Verelan, Isoptin, covera, and calan)
  • Nimodipine (Nimotop)
  • Diltiazem (Tiazac, dilacor, cartia XT, and Cardizem)

Calcium channel blockers have a few side effects. These include:

  • Weight gain
  • Low blood pressure
  • Constipation
  • Dizziness

Beta-blockers

Beta-blockers are commonly used for the treatment of high blood pressure. They ease the effects of stress hormones on your blood vessels and your heart, and also reduce the intensity and frequency of migraines.

Examples of beta-blockers include:

  • Atenolol
  • Nadolol
  • Metoprolol
  • Propranolol
  • Timolol

Side effects of beta-blockers include:

CGRP antagonists

They are the newest migraine prevention medications.

CGRP antagonists target the calcitonin gene-related peptide (CGRP). CGRP is a protein found in the brain region. It is involved in migraine pain.

Current CGRP antagonists include:

  • Fremanezumab
  • Erenumab

Outlook

There are many medications for treating migraines. However, you should use these drugs with caution, and be sure not to overdose on any to avoid rebound headaches. If the pain fails to resolve, consult your doctor for migraine preventive medications.