Migraines are chronic severe headaches often accompanied by nausea. The appropriate drug treatment for your migraines depends on the frequency and severity of your attacks, as well as your other medical conditions. For some people, over-the-counter (OTC) pain relievers like ibuprofen and anti-nausea medications might be good enough when a migraine strikes; others might need prescription-strength pain relievers like the triptans (Imitrex). If you suffer frequent, debilitating migraines, your doctor might recommend migraine-preventing drugs, such as beta blockers or antidepressants.
OTC Pain Relievers
Over-the-counter (OTC) pain relievers contain non-steroidal anti-inflammatory drugs (NSAIDS). Acetaminophen (Tylenol), ibuprofen (Advil, Motrin) or aspirin can sometimes ease migraine pain if you take them at the first sign of a migraine. The drugs that are marketed specifically as migraine treatments, like Excedrin Migraine, contain a combination of acetaminophen, aspirin and caffeine. Many migraine sufferers find that these drugs are not strong enough for migraine pain, and they can worsen nausea. If you take them too often, they can cause stomach problems or rebound headaches.
Prescription Pain Relievers
The triptan medications are a good class of drugs for people with severe migraines because they effectively treat both headache pain and nausea. There are a number of triptans, including zolmitriptan (Zomig) and sumatriptan (Imitrex).
Ergotamines (Cafergot) contain the plant fungus, ergot. They are inexpensive but might not be as effective as triptans.
If you cannot take triptans or ergot, as a last resort, your doctor might prescribe opiates, such as codeine.
Cardiovascular Preventives
Preventives reduce the frequency and severity of attacks, but they do not completely control pain. They can also have serious side effects. Although how they work is not clear, drugs that treat cardiovascular problems are often helpful for migraine sufferers. Beta blockers and calcium channel blockers are both commonly prescribed for migraines. The calcium channel blocker verapamil (Calan, Isoptin) relieves migraines and the accompanying visual disturbances or "aura."
Antidepressant Preventives
Commonly prescribed antidepressants, such as the tricyclics (amitriptyline or protriptyline, among others), and serotonin and norepinephrine reuptake inhibitors (SNRIs, like Cymbalta) might prevent migraines by controlling the level of the nerve chemical serotonin. However, another common class of antidepressants, the serotonin reuptake inhibitors (SSRIs, like Prozac or Zoloft), are not effective for migraines. SNRIs or SSRIs and triptans should never be mixed because of the potential for a rare but life-threatening reaction called "serotonin syndrome."
Other Possibilities
Some doctors believe that injections of botulinum toxin type A (Botox) into the forehead and neck, repeated several times a year, are helpful for preventing migraines.
Processed dried leaves of the herb feverfew, also known as bachelor's button, can be effective in preventing migraines, but the preparations are not consistent or standardized. The herb butterbur also might be effective. High doses of Vitamin B-2 (riboflavin) and supplements of coenzyme Q have their proponents as well.
