List of Migraine Medications: How To Pick The Best One

Written and verified by Holly Hazen

The long list of migraine medications below gives you many treatment choices. Don't let it overwhelm you, think of it as having an arsenal of pain relief within reach. You will learn about the medications approved to target migraines and get more effective relief. If you take the wrong thing... it won't work!

The latest medications to hit the market are the Calcitonin gene-related peptide (CGRP) monoclonal antibodies and Gepants. Aimovig (CGRP) is FDA approved and should you be able to afford it, it could hold the key to prevent your episodic attacks. You can read about that here >> Aimovig for Migraine

Besides the new CGRP meds there are basically three categories that I have broken down so you can easily see what’s FDA approved and recommended specifically for the treatment of migraine headaches.

Here they are:

Over the Counter (OTC), Abortive and Preventative.

Headache tablets are not recommended for migraines as they perform the wrong action. I have clients that say they take Mersyndol for the pain and then take too many when they don't work. There is a risk of overdose.

Let's get clear on what works for migraines then you can discuss these with your doctor to find what will work best for you.

A recent Cochrane review (2015) of evidence based acute migraine treatments showed the top 9 treatments researched to abort attacks. If you were to try each one separately at the onset of a migraine attack, the statistics show over a 90% chance that one of the treatments could reduce your pain levels from moderate/severe to NO pain within 2 hours. _(source)

For Moderate/Severe to NO pain within 2 hours: Sumatriptan Injection ranks the highest at 59%. This fell by half using oral delivery at the 100mg dose but patients still experienced a reduction to mild pain effectively within 2 hours. Then comes Zolmitriptan 2.5mg oral, Ibuprofen 200 or 400mg oral, Sumatriptan Nasal Spray, Aspirin 1000mg oral, Diclofenac 50mg oral, Paracetamol 100mg oral, and last is Naproxen 500mg or 825mg oral. Naproxen is not a good drug to treat migraines, it was only slightly more effective than the placebo.

The takeaway: Sumatriptan via injection is found to be one of the most effective (and more expensive) migraine treatments, and then Sumatriptan in oral form and Zolmitriptan in oral form. According to this data, the most effective over the counter medication (NSAID) to use is Ibuprofen. For the fastest action try the soluble formulations that dissolve in water. 

Now let's get to the list of migraine medications. You can scroll down or just click on a link to go straight to that section:

Over the Counter (OTC) and Abortives

1. Three Over the Counter Products Are Approved

That’s right – three. Only three OTC products are currently on my list of migraine medications because they are approved by The USFDA to specifically treat migraines. These are:

• Excedrin Migraine®

• Advil Migraine®

• Motrin Migraine Pain®

The ingredients for Excedrin combine: acetaminophen, aspirin and caffeine. It is recommended for reducing migraine pain and the accompanying symptoms.

Both Advil and Motrin contain ibuprofen. They are recommended to treat headaches and the associated pain.

This is what drugs.com says about Motrin Migraine Pain: "This medicine may cause life-threatening heart or circulation problems such as heart attack or stroke, especially if you use it long term."

Always discuss the side effects with your doctor before you take anything, or the pharmacist. Remember Non-steroidal anti-inflammatory agents or NSAIDs carry risks too, even though you can get them over the counter.

I never found any of these OTC combinations by themselves to help reduce my severe migraine pain. Not even a little bit!

It was not until I combined ibuprofen with the triptan Naramig that I found effective relief from the attacks and symptoms.

Please work with your doctor on finding a combination that works for you.

2. Abortive Medications

Here is the approved A-Z list of migraine medications called Triptans, with my accompanying results.

My research reveals these are all potent serotonin 5HT1 agonists:

• Almotriptan (Axert®)

• Eletriptan (Relpax®)

• Frovatriptan (Frova®)

• Naratriptan (Amerge®, Naramig®) seems to be working the best for me long term.

• Rizatriptan (Maxalt®) is available as a rapidly dissolving tablet. This one is peppermint flavored and the wafer dissolves on your tongue. It didn't even feel like I took anything. Fantastic for those of us who experience nausea as a symptom.
  
  However, it was not long enough acting for my long episodes, so taking four just for one migraine made me nervous. And then waiting to take more in the recommended time ironically resulted in more nausea and vomiting.

• Sumatriptan (Imitrex®, Imigran®) is available in many delivery forms: nasal spray, self-injection, tablets and fast dissolving pills. I found the 50mg tablet really strong. My heart attack like side effects were just too much to bear. But it aborted the migraine and boy did I feel euphoric after that.

• The combination of Sumatriptan and Naproxen Sodium (Treximet™) is a (NSAID) non-steroidal anti-inflammatory drug. It is used frequently with great success, but there are some strong warnings with this medication. This medicine can greatly increase your risk of stroke or heart attack. 

• Zolmitriptan (Zomig®) available in tablets and nasal spray. Too strong for me! I experienced hot flushes and heart attack like side effects.
  
  

Some common side effects of these Triptans - and these are only a few - are: high cholesterol, heart disease, increased susceptibility to strokes, uncontrolled hypertension and diabetes.

I recommend asking your pharmacist for the full print out that has the other contra indicated medications and side effects for what you have been prescribed.

For example, you can’t take a triptan with another form of triptan, ergotamine, or SSRI’s (selective serotonin re-uptake inhibitors).

And just FYI - I am very skeptical of the Triptan drugs being sold over the internet. Please use a reputable local pharmacy and be safe.

I've written more about Triptans here >> Best Triptan for Migraine: Abort Attacks with the Right Medication.

3. Ergotamine Medications

Ergot Alkaloids relieve migraine or cluster headache symptoms by stimulating the chemical serotonin which is needed to transmit various nerve signals to the brain.

It decreases inflammation and reverses blood vessel dilation surrounding the brain.

Here are just a few to add to the list of migraine medications:

• Dihydroergotamine (DHE-45) is available by self injection and as a nasal spray called Migranal.

• Methysergide (Sansert)

• Ergotamine Tartrate (Bellamine, Cafergot, Ergostat)
  
  

Ergotamine preparations are normally made up by a compounding chemist making them more expensive and potentially hard to get. Ergotamine is the oldest "first line" of treatment. It is also known to have more severe side effects than some of the more recent medications.

Watch out for stomach or chest pain, tingling in your fingers and toes, blurred vision or any weakness experienced in your limbs. Please note - these drugs must not be taken for prolonged periods over weeks or months due to these high risks.

My body severely rejected Cafergot on a number of occasions. The suppository made me vomit almost instantly for hours. So much for that! This was not a good medication for me. I wish you better luck with this one. My doctor takes this for her migraines because of its track record of successes.

4. Other Medications Recommended for Acute Migraine Attack Treatment

• Acetaminophen – isometheptene - dichloralphenazone (Midrin®). This combination constricts blood vessels, is a pain reliever and a mild sedative.
  

Current research shows that this is not an effective treatment for aborting migraine headaches. Because it is ineffective, migraine sufferers end up taking too many and can then suffer from rebound headaches. 

I have not added it to my personal use list of migraine medications. If you do use it, use it for mild migraine headaches only.

• Corticosteroids may be used due to their anti-inflammatory effects.

• Alternative medical treatments that use medications in the Phenothiazine group have proved effective. These non-analgesic options treat severe migraine headaches and attacks lasting longer than 24 hours (these long attacks are called status migraines).

• And Excedrin Migraine, Advil Migraine, and Motrin Migraine Pain as mentioned above. 
  
  

Always check with your Doctor first before taking anything new. And work with him/her to develop a treatment plan ahead of time to manage your attacks. My Migraine Pain Management Course goes through this step-by-step. Click here to have a look, the whole first module is free.

AND I have a book that will help you work your way through which ones you might prefer, given your circumstances, that you can print out and take to your doctor. Here it is...

Preventatives - The First Line of Treatment

The goal of preventative treatment medications is to decrease the regularity and severity of your migraine attacks.

The FDA has approved four drugs for migraine prevention – these are considered the “first line” of treatment medications (what doctors' should try first):

• Divalproex sodium (Depakote®) an anti-seizure medication

• Propranolol (Inderal®, Timolol®) a beta-blocker

• Timolol (Blocadren®) a beta-blocker

• Topiramate (Topamax®) an anti-seizure medication
  
  

It is essential that you take the adequate dose of the medicine for a sufficient length of time in order to determine its effectiveness for your migraine. If you are experiencing side effects, talk with your doctor to titrate or reduce your dose. 

Unfortunately finding what works the best can be trial and error. But with the numerous options in this list of migraine medications, you are off to a great start. If you can... start with testing the family of triptans for acute attacks. Then if they don't work, you can consider these other options.

Don't Give Up Hope - Here Are More Alternatives

If none of the four preventatives above work for you, don't give up hope. Here is a list of prevention alternatives:

Lithium Carbonate - Lithium affects the flow of sodium through nerve and muscle cells in the body to reduce the intensity of excitation and mania.

P.S. Try this full spectrum magnesium... I LOVE it.

My #1 Choice - Magnesium Breakthrough by BiOptimizers - combines 7 types of magnesium in a humic/fulvic monoatomic blend to optimize absorption. This is by far the best product I have found so far in terms of results.

Other Things to Try

Metoclopramide (Reglan®)

Prochlorperazine (Compazine®)

Promethazine (Phenergan®)

Some drugs are used in the treatment for headaches but are not specific for migraines.

These include analgesics, narcotics, and barbiturates. Since they can be addictive, they are less desirable than specific headache drugs listed above.

If you are not at risk of addiction, and Codeine or Tylenol#3 or Fioricet work for you on their own, they could be considered as a backup or rescue medication when one of the above medications don’t work. 

And we must not forget Botox injections on the list of migraine medications. You can read about that here - Is Botox for Migraines Safer Than Aspirin. 

Let this long list of migraine medications motivate you to find what works.

• New Migraine Medications

• Acute Treatment Strategies

• Medications for Migraines: What Else You Need to Know
  
  

Use Migraine Meds That Have Been Through Randomized Controlled Clinical Trials

My research for a list of migraine medications uncovered over 100 different ones available on prescription. In most cases, one drug will have a number of different brand names in different countries. 

No matter what you read or what you decide to take as your migraine treatment, always consult your doctor first. Ask for migraine medicine that has been through randomized controlled clinical trials, and not just clinical testing. You want something with good evidence behind it. And remember, you can print this list of migraine medications and take it to your next appointment.

Migraine is a serious medical condition and the medications used must not be taken lightly.

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Until next time, be well.

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<sub>List of Migraine Medications References:
1. The National Headache Foundation (NHF 2016) Headache Fact Sheets: Migraine.
2. The USFDA (2016) Patient Information Medication Guide: Treximet™ at: www.fda.gov/downloads/Drugs/DrugSafety/ucm089804.pdf.
3. Evidence Based Migraine Treatments (2016) Available [Online]: http://www.blog.migrainepal.com/blog/evidence-based-migraine-treatments</sub>