Pharmacological Therapy

Headache and Migraine Treatment Medications

Pharmacology goes well beyond prescribing medications to treat headache conditions. It is the study and understanding of drugs, the body's reaction to drugs, the sources of drugs, and their nature and properties. These are important distinctions in the well-rounded approach of the Diamond Headache Clinic. We use our detailed understanding of each drug to guide the medication component of our treatment program, which incorporates specific therapeutic agents and the close monitoring of your response to evaluate efficacy and minimize side effects.

stethoscope and migraine pill bottle

Your Medicinal Headache and Migraine Treatment Plan

Our team of specialists custom-tailors your individual treatment plan, which is influenced by your diagnosis as well as other key factors, including your age, other medical conditions, drug history, potential interactions with other drugs you’re taking, and your life situation. For instance, a patient anticipating pregnancy or who is already pregnant will be prescribed specific medications and non-medication therapies. Likewise, an older adult who may be at greater risk for drug interaction, or a child who requires heightened awareness for dosing restrictions, will be reassured by our physicians' concentrated focus in pharmacological planning and treatment.

Acute vs. Preventive Medications

In the past several decades, numerous new pharmaceutical agents have been approved for use in the treatment of various headache conditions. Those drugs include analgesics, ergot derivatives, beta blockers, antidepressants, antihypertensives, antiepileptics, triptans, onabotulinumtoxinA (BOTOX®), and calcitonin gene-related peptide (CGRP) blockers. How do you sort through all the different drugs and what they’re used for? Headache medications fall into two categories: acute and preventive.

  • Drugs for Acute Treatment
    These medications, taken to treat headache pain once the attack has begun, include both over-the-counter (OTC) and prescription drugs. Acute medications are:
    • Analgesics and NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
      These nonspecific medications work on pain in general, not just headache or migraine pain. Well-known, easily available analgesics include aspirin, acetaminophen, naproxen sodium and ibuprofen. They may be obtained over the counter or by prescription. Patients with gastrointestinal and other conditions should not take NSAIDs. Regular or daily use of these can make headaches worse due to medication overuse.
    • Ergotamines
      Ergotamines are migraine-specific drugs that work on activated pathways in migraine. They are available in various formulations, including oral, rectal or intranasal. These drugs include ergotamines, ergot combinations and ergot alkaloids (dihydroergotamine).
    • Triptans
      These migraine-specific medications come in oral tablets, orally disintegrating tablets, nasal spray and subcutaneous injection. Seven different triptans are prescribed for acute migraine attacks: almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan and zolmitriptan.
  • Drugs for Preventive Treatment
    Preventive medications are taken on a scheduled frequency, such daily, to help prevent the occurrence of some migraine attacks; they are not used for acute treatment of an existing headache. While these drugs may not immediately improve a migraine attack, they can reduce the frequency, duration and severity of your migraine attacks. Commonly prescribed preventive migraine treatment medications include:
    • Antihypertensives
      Beta blockers prescribed for migraine prevention include atenolol, metoprolol, nadolol, propranolol and timolol. Calcium channel blockers that may be prescribed are verapamil, diltiazem and nimodipine.
    • Antidepressants
      Tricyclic antidepressants for migraine include amitriptyline, nortriptyline and imipramine. You may be prescribed a selective serotonin reuptake inhibitor (SSRI/SSNRI) such as fluoxetine, paroxetine or sertraline.
    • Anticonvulsants
      These include divalproex sodium, gabapentin and topiramate.
    • Serotonin Antagonists
      These include methysergide and methylergonovine.
    • Supplemental Treatments
      • Magnesium salts (magnesium oxide, magnesium diglycinate, magnesium chloride-slow release)
      • Vitamins (riboflavin)
      • Herbals (Mig-99 or Feverfew, petasites)
    • Calcitonin Gene-Related Peptide (CGRP) Antagonists
      Calcitonin Gene-Related Peptide (CGRP) Antagonists are a new class of drugs that prevents migraines by blocking the activity of calcitonin gene-related peptide, a molecule that is involved in the occurrence of migraine attacks.

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What Medicinal Migraine Treatment Is Right for You?

Our goal is to help you manage your headache condition. Depending on how you respond to over-the-counter drugs, your doctor may feel that you need a prescription for acute treatment. If your migraine generally responds to acute treatment and you are pain-free and can function normally within a few hours, then continue taking your acute medication as directed. However, if your headaches occur more than once a week, your attacks are disabling despite acute treatment, your acute treatment is insufficient, or you have a history of analgesic overuse, then you should consider preventive treatment in addition to acute treatment.

When it comes to preventive medication, you can rely on the experienced doctors at the Diamond Headache Clinic to determine the best drugs and dosages for your unique headache symptoms and other health conditions. Your doctor may prescribe a single drug (monotherapy) or a combination of complementary medications (polytherapy). Preventive treatment may take months before you notice a difference. We begin with the lowest recommended dose and gradually build up to higher doses as needed, which helps minimize side effects. Do not stop taking your medications without telling your doctor; preventive drugs must be tapered off gradually. Remember to report any side effects that concern you. We are available to reassess your treatment at any time, not just during scheduled checkups.

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