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Migraine headaches can be marked by debilitating pain, light sensitivity, and nausea. While there is currently no cure for migraine, many treatment options are available that can help prevent migraine headaches before they start and treat them once they do.
Your health care provider will recommend specific treatments for migraine based on the specifics of your condition and factors such as your age, overall health, and medical history.
Most migraine treatments fall into two categories: preventive treatment — drugs that prevent migraine attacks — and abortive treatment, used to treat migraine attacks after they’ve started. Some people try lifestyle changes, clinical trials, and alternative pain-relief techniques to manage migraine attacks.
Many people use multiple medications for treating migraine. However, researchers have found that taking multiple medications may be associated with a number of unwanted side effects.
Some migraine medications must be used within strict limits. When overused, they increase the risk for progressing to chronic migraine — defined as experiencing migraine attacks 15 or more days in each month.
Some prescription drugs help prevent or reduce the frequency of migraine attacks. Many medications used to treat migraine are not approved specifically for migraine by the U.S. Food and Drug Administration (FDA). However, doctors frequently prescribe them off-label for this purpose.
Approved by the FDA to prevent migraine attacks in adults, erenumab-aooe (Aimovig) was the first member of a newer class of drugs called calcitonin gene-related peptide receptor (CGRP-R) antagonists. Aimovig is a biologic drug — a genetically engineered antibody (protein) used by the immune system to identify and neutralize substances. Researchers believe the medication works by interfering with CGRP, a substance that dilates (widens) blood vessels and contributes to pain signals and inflammation.
Shortly after the release of Aimovig, the FDA approved several other drugs of this class (also injectable medications) including:
In 2020, the FDA approved a new CGRP-R antagonist called rimegepant (Nurtec ODT, in which ODT stands for “orally disintegrating tablet) for both the prevention and acute treatment of migraine in adults. Rimegepant is the first drug in this class to be available as a fast-acting ODT.
In 2024, the American Headache Society issued new migraine prevention guidelines supporting the use of CGRP-targeting therapies as first-line treatments for migraine prevention.
Doctors sometimes prescribe medications for migraine that aren’t technically indicated by the FDA for the condition. This is referred to as “off-label.” These medications represent several different drug types.
Beta-blockers are believed to help prevent migraine by relaxing blood vessels and reducing inflammation. Drugs that fall into this category include propranolol (sold under brand names including Inderal and InnoPran XL) and metoprolol (Lopressor). Beta-blockers are not recommended for use in people with various underlying conditions such as low blood pressure or asthma or with heart conduction issues.
Antidepressants of several different classes can be effective in preventing migraine attacks. Antidepressants are believed to work in cases of migraine by changing the balance of neurotransmitters — chemical messengers — in the brain. One such neurotransmitter is serotonin, which delivers messages between the brain and the rest of the body and influences mood, brain function, reward, and bodily processes.
Venlafaxine (Effexor) — a member of the serotonin-norepinephrine reuptake inhibitor (SNRI) class — is one of the antidepressants most frequently prescribed to help prevent migraines. Sometimes doctors prescribe medications in the tricyclic antidepressant class, which include amitriptyline and nortriptyline (Pamelor). Amitriptyline is the only tricyclic that has proven efficacy for migraine.
Although used less commonly for prevention of migraine, drugs in the selective serotonin reuptake inhibitor (SSRI) class include fluoxetine (Prozac) and sertraline (Zoloft).
Anticonvulsant (also called anti-seizure or antiepileptic) drugs are believed to help prevent migraine attacks by inhibiting nerve signals. Anticonvulsants prescribed for the prevention of migraine attacks include:
Topiramate and valproate sodium have established efficacy in reducing the frequency of migraine attacks. Although sometimes used, there’s no evidence supporting gabapentin’s use for migraine prevention. Considering these medications are associated with side effects, they must be chosen carefully.
Doctors may prescribe calcium channel blockers such as verapamil (sold under the brand names Calan SR and Verelan) to prevent migraine. Calcium channel blockers are believed to help with migraine by preventing calcium from entering the cells of the blood vessel walls. This allows the vessels to relax and widen, thereby preventing the symptoms that result from vessel constriction.
ACE inhibitors such as lisinopril (Prinivil, Qbrelis, Zestril) may help prevent migraines by relaxing the blood vessels. Research on the use of ACE inhibitors for preventing migraine is limited, and there is not enough evidence to show that they are effective for this purpose.
Magnesium is an essential mineral that supports many bodily functions, and levels of the mineral are low in some people living with migraine. A form of magnesium called magnesium oxide can be taken in pill form for migraine prevention. Studies have shown that daily magnesium may be especially beneficial for people who experience migraine attacks before and during their menstrual cycles.
Some drugs are prescribed to be taken when a migraine attack begins. Called abortive treatments, most work best when taken as early as possible in the attack. They work best when taken in one large, single dose rather than spaced out in smaller doses.
Like other CGRP-R antagonists used for migraine, zavegepant works by inhibiting vasodilation (the widening of blood vessels). Unlike preventive CGRP-R antagonists, zavegepant is designed to be taken at the onset of a migraine. The zavegepant nasal spray (Zavzpret), approved by the FDA in 2023, begins working within 15 minutes to stop or mitigate a migraine. Other abortive CGRP-R antagonists include ubrogepant (Ubrelvy) and rimegepant (as noted previously).
Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the first treatments people use to relieve migraine pain. Some NSAIDs like aspirin (such as Bayer), ibuprofen (e.g., Advil), and naproxen (such as Aleve) are available over the counter (OTC). Others require a prescription, including:
NSAIDs are thought to work by blocking the chemicals in your body that cause inflammation and make blood clots. Taken regularly or at high doses, some NSAIDs can cause gastrointestinal problems, swelling, and abnormal bleeding, and they may increase blood pressure. Additionally, taking NSAIDs too often can cause chronic migraine headaches.
Acetaminophen (such as Tylenol) is an OTC analgesic (pain reliever) and antipyretic (fever reducer). Acetaminophen is believed to work by altering the body’s perception of pain. Some OTC products, such as Excedrin Migraine and Excedrin Tension Headache, combine acetaminophen and caffeine. Caffeine is a stimulant and a vasoconstrictor — a drug that causes the blood vessels to narrow. Caffeine is believed to work for migraine headaches by narrowing the blood vessels in the brain. Excedrin Migraine also contains aspirin, which is an NSAID.
Triptans are a class of drugs approved specifically for use in acute migraine, they’re one of the most commonly used classes of medication for abortive therapy for migraine. Triptans are believed to work by constricting blood vessels, reducing inflammation, and blocking pain pathways in the brainstem. Triptans include:
Treximet — a formulation of sumatriptan and naproxen — combines a triptan drug with an NSAID.
Ergot alkaloids are also FDA approved for the treatment of acute migraine. Doctors typically prescribe these when triptans aren’t effective and when the migraine is difficult to treat with other medications. Scientists believe ergot alkaloids work by constricting blood vessels in the brain and blocking the transmission of brain signals.
Dihydroergotamine (Migranal, Trudhesa) is an ergot alkaloid. Cafergot is a formulation of the ergot alkaloid ergotamine and caffeine. This class is associated with side effects, and doctors avoid prescribing these drugs if other treatments are effective.
Doctors have a range of other drugs to choose from for treating acute migraine symptoms.
Lasmiditan (Reyvow) is an oral medication that was approved in 2019 for acute migraine treatment, and it can be used by people who can’t take the triptans due to having cardiovascular risk factors. Somewhat similar to antidepressants, the drug works on one specific type of serotonin receptor.
Antiemetics (anti-nausea drugs) can help treat nausea and migraine pain in people with migraine. They are used mostly in combination with other acute treatments.
Antiemetics include:
In some cases, doctors will prescribe corticosteroids, such as prednisone or dexamethasone, in combination with other medications to treat migraine. Corticosteroids work by suppressing inflammation, and they can help reduce early headache recurrence. They’re relatively safe for short-term use, but long-term use can cause serious side effects such as high blood glucose, bone problems, mood swings, and weight gain.
People living with migraine pain that’s resistant to other treatments may require opioids, such as codeine or combinations of hydrocodone and acetaminophen, such as Norco and Vicodin. Scientists believe opioids work by altering the body’s ability to perceive pain.
According to the National Institute on Drug Abuse, regular use of opioids — even as prescribed by a doctor — can lead to dependence. If misused, opioids can cause overdose and death. Many health experts, in fact, believe that opioids should not be used to treat migraine. Practice guidelines do not recommend opioids as first-line treatment. Opioid use for acute migraine headaches have been associated with returns to the emergency department within seven days of the original visit.
In addition to any side effects specific to each drug, medications used to treat acute migraine have the potential to cause medication-overuse headaches, also known as rebound headaches. Researchers also believe that overusing these drugs can raise the risk for progressing to chronic migraines — migraine attacks that occur 15 or more days out of each month. The risks of overuse are believed to be highest with aspirin/acetaminophen/caffeine combinations, opioids, and possibly triptans. Discuss with your doctor how to use acute migraine treatments safely.
Read more about specific medications in this list of treatments for migraine.
Some people find migraine medications to be ineffective or intolerable. Several types of nondrug treatments can be effective for treating or preventing migraines.
Botox, a formulation of onabotulinumtoxinA, is approved by the FDA to help prevent migraine attacks in people with chronic migraine. Botox is an injectable form of the neurotoxin produced by the bacterium Clostridium botulinum.
Botox is believed to work by inhibiting the release of certain molecules, such as acetylcholine, and preventing the movement of nerves and muscles. Other nerve-blocking techniques are used to treat some people with chronic migraine, including sphenopalatine ganglion block. This type of block is taken intranasally (through the nose. It contains local anesthetic (medication resulting in numbness or loss of sensation).
Some people with migraine find neurostimulation (nerve-stimulating) devices effective for relieving symptoms. There are various neurostimulation devices, each designed to stimulate specific nerves in unique ways. Neurostimulation devices are believed to work by using electricity to interfere with pain signals. Devices from companies such as Cefaly, Relivion MG, gammaCore, and Nerivio are all approved by the FDA for the treatment of migraines. Some devices are indicated for treating acute migraine pain, while others can be used to prevent migraine attacks.
Cognitive behavioral therapy (CBT) or other forms of psychotherapy can help people with migraine better manage stress, which can be a major trigger for migraine. CBT is goal-oriented, focusing on specific problems and how to improve them.
Studies show that, over six to 12 months, CBT offers small but significant improvements in pain and disability and moderate improvements for mood in those with chronic pain. Psychotherapy such as CBT has even been shown to help with pediatric migraine (migraine in children).
Tracking diet, sleep, activity, and headaches in a journal can allow you to identify your migraine triggers. Making changes to your lifestyle may help you avoid these migraine triggers and reduce the frequency of attacks. Some people with migraine feel better when they improve their nutrition in general or try a specific diet such as the anti-inflammatory diet.
The American Migraine Foundation recommends five lifestyle changes to reduce migraine triggers and manage symptoms:
Complementary and alternative medicine therapies are popular with many people who experience migraine attacks. Natural or complementary treatments for migraine may include:
Researchers have studied some alternative or natural therapies in clinical studies, but in many cases, there is limited or inconsistent evidence that they are beneficial for migraine.
A few natural treatments can worsen migraine or result in dangerous interactions with migraine medications. Talk to your doctor before trying any natural or complementary treatments for migraine.
Some people with migraine participate in clinical trials. Clinical trials may test new drugs, new procedures, new dosages of existing drugs, or new combinations of existing drugs. Other clinical studies test the safety and efficacy of alternative treatments such as herbal supplements or ketamine.
If you have headache pain, regardless of what type of headache you think it is, schedule an appointment with your health care provider. They can rule out other health conditions, diagnose you with migraine, if applicable, and refer you to a doctor specializing in neurology, if necessary.
Some people also find comfort in connecting with others who understand what they are going through.
MyMigraineTeam is the social network for people with migraine and their loved ones. On MyMigraineTeam, more than 82,000 members come together to ask questions, give advice, and share their stories with others who understand life with migraine.
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Marie Dorsey, Pharm.D., BCPS, AAHIVP
is currently a clinical pharmacist at Bridgewell Medical, specializing in medication therapy management and holds a certification as an HIV pharmacist through the American Academy of HIV Medicine.
Learn more about her here.
Brooke Dulka, Ph.D.
is a freelance science writer and editor. She received her doctoral training in biological psychology at the University of Tennessee.
Learn more about her here.
Kelly Crumrin
is a senior editor at MyHealthTeam and leads the creation of content that educates and empowers people with chronic illnesses.
Learn more about her here.
Suzanne Mooney
writes about people, pets, health and wellness, and travel.
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Has she tried steriod injections to her head? I get these every other month. For me they last 15days. Others get more days
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