Acute migraine therapies relieve migraine assaults which can be in progress, easing ache, nausea, and light-weight sensitivity. These embody over-the-counter (OTC) ache relievers, triptans, gepants, dihydroergotamine, steroids (normally for assaults that don’t reply to different therapy), and antinausea drugs.
Others are preventive, which means that individuals taking them goal to scale back what number of assaults they’ve and the way extreme they’re. Individuals who have frequent or extreme migraine assaults that disrupt each day life could also be candidates for preventive migraine drugs.
Preventive drugs embody antiseizure drugs, beta-blockers, calcium channel blockers, CGRP monoclonal antibodies, and sure antidepressants.
Individuals might must attempt totally different choices to choose a preventive drug that works for them, and it might take a couple of months to start out lowering migraine assaults.
Low doses will help individuals restrict unwanted side effects whereas discovering a therapy that works for them.
Over-the-Counter Ache Relievers
This class consists of nonsteroidal anti-inflammatory medication (NSAIDs), similar to ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin, in addition to acetaminophen (Tylenol). A mixture drug containing aspirin, acetaminophen, and caffeine (Excedrin Migraine) could also be efficient at lowering the ache related to delicate to average migraine. However it’s not as efficient for extreme assaults.
In case your physician recommends NSAIDs or merchandise containing aspirin, these medication have hyperlinks to unwanted side effects like ulcers and gastrointestinal bleeding. Day by day use may result in medication-overuse complications.
Triptans
Triptans are also referred to as 5-HT1B/1D receptor agonists as a result of they block the ache pathways within the mind by binding to particular serotonin receptors on neurons.
Docs typically prescribe them if different migraine therapies haven’t been profitable. Seven triptans can be found:
- almotriptan (Axert)
- eletriptan (Relpax)
- frovatriptan (Frova)
- naratriptan (Amerge)
- rizatriptan (Maxalt)
- sumatriptan (Imitrex)
- zolmitriptan (Zomig)
In keeping with On a regular basis Well being community website Migraine Once more, triptans are available in many kinds, together with oral tablets, nasal sprays, nasal powder, and injections. Non-oral strategies (nasal sprays and injections) may be simpler for individuals experiencing the migraine symptom of nausea or vomiting as a result of the digestive system tends to sluggish throughout an assault.
Frequent unwanted side effects of triptans embody nausea, dizziness, drowsiness, muscle tingling, numbness, and weak spot. As a result of one in every of their actions is to constrict blood vessels, docs don’t advocate triptans for individuals at a excessive threat of stroke or coronary heart assault, or for these with uncontrolled hypertension. Triptans aren’t really useful for some girls who’ve migraine with aura and take oral contraceptives.
Triptan Plus NSAID
In January 2025, the U.S. Meals and Drug Administration (FDA) permitted a mixture drug for the acute therapy of migraine containing the triptan rizatriptan and the NSAID meloxicam, a drug primarily used for arthritis ache.
The brand new mixture drug is called Symbravo and is taken as a pill.
Whereas combining triptans and NSAIDs for migraine reduction isn’t new, Symbravo makes use of a brand new formulation of meloxicam that will get absorbed — and begins working — quick, inside one hour. Rizatriptan acts shortly, too, but it surely additionally stops working comparatively shortly. In distinction, the results of the brand new formulation of meloxicam final for about 18 hours.
Collectively, the 2 medication promise fast ache reduction that lasts many hours.
Ergots
Ergots work together with the identical mind receptors as triptans. Nonetheless, docs typically prescribe triptans as an alternative of ergots as a result of extra analysis helps the effectiveness of triptans for treating migraine assaults.
An ergot known as dihydroergotamine (Migranal, Trudhesa) could also be used when triptans aren’t having the specified impact on ache.
Dihydroergotamine is best when delivered intravenously (IV), which requires a medical skilled to manage the dose. It’s additionally out there as a self-injection and as a nasal spray.
Gepants
CGRP is a peptide (or quick chain of amino acids) within the mind and nervous system that causes blood vessel dilation and performs a task in transmitting ache. Analysis reveals that blood and saliva ranges of CGRP enhance throughout migraine assaults.
CGRP antagonists, generally known as “gepants,” stop CGRP from binding to receptors in varied cell sorts within the mind.
FDA-approved gepants embody the next:
- atogepant (Qulipta)
- rimegepant (Nurtec ODT)
- ubrogepant (Ubrelvy)
- zavegepant (Zavzpret)
Completely different medication require totally different dosages. For instance, atogepant is obtainable in 10-milligram (mg), 30 mg, and 60 mg doses.
Zavgepant is a nasal spray out there as a single spray (10 mg) in a single nostril, as wanted. The utmost dose in 24 hours is one 10 mg spray.
In 2023, atogepant additionally obtained approval as a preventive therapy for power migraine primarily based on a research wherein individuals had roughly seven fewer migraine days over 12 weeks on both 30 mg twice a day or 60 mg as soon as a day in contrast with a placebo.
Antiemetics
In case your migraine assaults embody nausea and vomiting, your physician might prescribe an oral antinausea drug, also referred to as an antiemetic, to take together with a pain-relieving medicine. Antiemetics used for migraine reduction embody the next:
- chlorpromazine
- prochlorperazine (Compro)
- metoclopramide (Reglan)
- droperidol (Inapsine)
Metoclopramide will increase muscle contractions within the higher digestive tract to hurry up the speed at which meals within the abdomen strikes to the small gut.
Chlorpromazine, droperidol, and prochlorperazine, in distinction, management nausea by blocking chemical compounds within the mind linked to vomiting.
Antihypertensive Drugs
Individuals sometimes use beta-blockers to handle hypertension and coronary artery illness, however docs additionally generally prescribe them to stop migraine assaults.
These beta-blockers might assist deal with migraine:
- propranolol (Inderal LA or Innopran XL)
- metoprolol tartrate (Lopressor)
- timolol (Betimol)
Extra analysis is important to know how beta-blockers work for individuals with migraine.
Uncomfortable side effects may embody despair, insomnia, nausea, and excessive tiredness.
Calcium channel blockers are one other blood stress medicine which will assist stop migraine assaults.
One widespread instance is verapamil (Calan, Verelan).
Antidepressants
Tricyclic antidepressants work by altering the degrees of serotonin and different chemical compounds in your mind. So far, amitriptyline (Elavil) is the one tricyclic antidepressant confirmed to stop migraine assaults. Nortriptyline (Aventyl, Pamelor) will also be efficient for some individuals. Uncomfortable side effects can embody dry mouth, constipation, weight acquire, and sexual dysfunction.
Antiseizure Medicine
Sure antiseizure or antiepileptic medication, together with divalproex sodium (Depakote) and topiramate (Topamax), have been proven to scale back the frequency of migraine assaults. They’re out there as tablets, capsules, and sprinkle capsules (capsules filled with small beads of medicine designed to be sprinkled over mushy meals).
The precise manner wherein these drugs stop migraine assaults is unclear. You’ll take them as a each day or twice-daily dose.
Antiseizure medication have vital unwanted side effects, together with nausea, fatigue, surprising weight adjustments, hair loss, dizziness, diarrhea, and focus issues.
Docs advocate towards utilizing them in case you’re pregnant or plan to turn out to be pregnant.
Botox
The FDA has permitted onabotulinumtoxinA (Botox) to deal with adults with power migraine. Docs inject the drug into round 31 areas within the brow and neck, the place it reduces muscle contractions and blocks ache alerts within the nerves for round 12 weeks.
Botox injections can scale back the variety of migraine assaults by round half. They generally trigger neck soreness as a brief facet impact, which can really feel higher after making use of an ice pack.
You’ll have injections about each three months, and it’s possible you’ll not really feel the advantages till your second or third therapy. Within the meantime, you possibly can take different migraine drugs with out the chance of dangerous interactions.
CGRP Monoclonal Antibodies
CGRP monoclonal antibodies are lab-made proteins that particularly goal CGRP within the physique to scale back its impact on ache and irritation.
CGRP antibody medication embody the next:
- eptinezumab (Vyepti)
- erenumab (Aimovig)
- fremanezumab (Ajovy)
- galcanezumab (Emgality)
CGRP monoclonal antibodies are a preventive migraine therapy.
A assessment of information revealed in 2023 concluded that they diminished the variety of migraine days in contrast with placebo in each episodic and power migraine.
Individuals obtain CGRP antibodies both as an intravenous (IV) infusion as soon as each three months or as a month-to-month injection.
In August 2025 fremanezumab grew to become the primary FDA-approved medicine on this class for kids ages 6 to 17 years previous.
Every monoclonal antibody carries a threat of various unwanted side effects. For instance, erenumab might result in constipation, ulcers, larger blood stress, and hair loss. Eptinezumab may trigger a scratchy throat or stuffy nostril.
Corticosteroids (Steroids)
Docs might prescribe steroid drugs, together with methylprednisolone and dexamethasone, to deal with a migraine headache that hasn’t responded to different therapies or that has lasted greater than 72 hours, generally known as standing migrainosus. Most research on steroids for migraine reduction have proven that these medication are most helpful for migraine prevention, resulting in milder migraine assaults.
Docs prescribe steroids, particularly dexamethasone, along side different varieties of migraine medication, similar to triptans, to enhance ache reduction. They might administer steroids by IV in a hospital or clinic.
Steroids are solely appropriate for short-term use as a result of they’ve a threat of unwanted side effects, together with insomnia and excessive blood sugar.
Nerve Blocks for Acute Migraine Ache Reduction
A nerve block entails injecting small quantities of a numbing medication, similar to lidocaine or bupivacaine, into the bottom of the cranium, over the eyes, or within the temple to dam ache alerts from the nerves. Nerve blocks can relieve ache inside minutes, and the results might final for days, weeks, and even months.
A physician also can inject a nerve block into myofascial set off factors, which can relieve ache in these hypersensitive areas. Myofascial set off factors are nodules in skeletal muscle which can be painful beneath stress that may additionally trigger ache in different areas of the physique.
Urgent on myofascial set off factors might provoke a migraine assault in some individuals with migraine.
Emergency Remedy for Intractable Migraine
Docs normally consult with a extreme migraine assault that lasts for greater than 72 hours and doesn’t reply to an individual’s typical acute therapies as an intractable migraine, or standing migrainosus. It’s typically crucial to hunt extra therapy within the emergency division in these instances, the place quite a lot of medication may be administered intravenously to assist break the headache cycle.
These medication might embody these sorts:
- Antiepileptics
- Triptans
- NSAIDs
- Steroids
- Muscle relaxants
- Antipsychotic drugs
Intractable migraine may be debilitating and worrying, and also you won’t be capable to suppose clearly whenever you get to the ER. Think about asking your common physician to put in writing down and signal an emergency migraine therapy plan so that you can convey with you to the hospital or pressing care heart. This will help you entry the drugs which can be best for you.
Ideally, your emergency migraine therapy plan ought to embody these parts:
- Your analysis
- Any related details about your medical historical past
- Your physician’s suggestions for the most secure and best drugs for you
- Your physician’s signature and call data
