Medicines and Products for Migraine

Migraine medicines fall into two groups: those taken during an attack and those taken daily to reduce attacks. A doctor should choose and adjust them.

For an attack (acute treatment)

• Simple painkillers: paracetamol, ibuprofen, naproxen or aspirin for mild to moderate attacks, taken early
• Triptans: such as sumatriptan and rizatriptan, which act on serotonin receptors. They are not for people with some heart or blood vessel conditions or in some types of aura.
• Anti-nausea medicines: such as domperidone or metoclopramide, which also help painkillers work
• Newer options: gepants and ditans, in some countries, for people who cannot use triptans

To reduce attacks (preventive treatment)

Considered when attacks are frequent or severe. Options a doctor may use include:

• Beta-blockers such as propranolol
• Some antiepileptic medicines such as topiramate
• Amitriptyline
• Candesartan and others
• CGRP antibody injections for some patients
• Botulinum toxin for chronic migraine

Each has side effects and cautions. A preventive is usually tried for about 2 to 3 months to judge its effect.

Cautions

• Do not take painkillers more than 2 to 3 days a week. Overuse can cause more headaches.
• Valproate and topiramate can harm an unborn baby. Women who may become pregnant must discuss this with a doctor.
• Do not give aspirin to children and teenagers
• Tell your doctor about all other medicines and supplements, including herbal ones

Key point

Take acute medicine early, limit how often you use it, and see a doctor about prevention if attacks are frequent.