Migraines are more than just headaches; they’re a complex neurological condition that can cause intense pain, nausea, and sensitivity to light or sound, disrupting work, family time, and daily life.
At Neurology One, our board-certified neurologists offer personalized migraine treatment plans. We focus on helping you find the right medication faster, reducing trial-and-error frustration, and restoring your quality of life.
This guide covers the most commonly used migraine medications, how they work, and when they may be right for you.
Two Main Goals of Migraine Treatment
- Stop symptoms during an attack (acute/abortive treatment).
- Prevent future attacks (preventive/prophylactic treatment).
Acute Migraine Medicines (Pain-Relieving)
Acute migraine medications are taken at the first sign of migraine pain (or when you’re certain an aura will lead to an attack). Early treatment can shorten the migraine, reduce severity, and speed recovery.
- Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Examples: Ibuprofen, naproxen, and diclofenac.
NSAIDs block chemicals called prostaglandins, reducing inflammation in migraine pain pathways. Most effective for mild to moderate attacks. Overuse can lead to medication overuse headache (MOH), so use only as directed by your doctor.
- Triptans
Examples: sumatriptan, rizatriptan, and zolmitriptan.
Triptans activate serotonin (5-HT1B/1D) receptors, constricting certain brain blood vessels and reducing the release of pain-triggering neuropeptides. Available as tablets, nasal sprays, or injections for faster relief. Not suitable for patients with certain heart or vascular conditions.
- Antiemetics (Anti-Nausea Medicines)
Examples: Metoclopramide, prochlorperazine, and ondansetron.
Relieve migraine-associated nausea/vomiting and can help other migraine medications absorb better. Available as oral tablets, dissolvable forms, injections, or suppositories.
- Ditans
Example: Lasmiditan.
A newer option for patients who can’t take triptans. Works on 5-HT1F receptors without constricting blood vessels. Can cause significant drowsiness, no driving or operating machinery for 8 hours after use.
- Gepants (CGRP Receptor Antagonists)
Examples: Rimegepant, ubrogepant.
Block the CGRP receptor, interrupting migraine pain transmission. Effective for acute treatment, and some (rimegepant, atogepant) are also approved for prevention.
Preventive (Prophylactic) Migraine Medicines
Preventive treatment is considered if you:
- Have ≥4 migraine days/month
- Have long-lasting or disabling migraines
- Can’t tolerate or overuse acute medicines
- Have migraine complications (e.g., hemiplegic migraine, prolonged aura)
Preventive medications are taken daily or monthly to reduce frequency, severity, and need for acute drugs.
- Beta-Blockers
Examples: Propranolol, metoprolol, atenolol.
Reduce nervous system excitability and stabilize blood flow. Good option for patients with migraine plus high blood pressure or rapid heartbeat.
- Antidepressants
Examples: Amitriptyline, venlafaxine.
Balance serotonin and norepinephrine, improving pain regulation. May also improve sleep, anxiety, or depression linked to migraine.
- Anticonvulsants (Anti-Seizure Medicines)
Examples: Topiramate, valproate.
Calm overactive nerve cells and stabilize brain electrical activity. Valproate is not recommended in women of childbearing potential due to pregnancy risks.
- CGRP Monoclonal Antibodies
Examples: Erenumab, fremanezumab, galcanezumab, and eptinezumab.
Target the CGRP pathway, which drives migraine pain and inflammation. Given as injections once a month or every 3 months. Often well tolerated and effective within the first few doses.
- OnabotulinumtoxinA (Botox®)
Approved for chronic migraine (≥15 headache days/month). Injected every 12 weeks in specific head and neck muscles using the PREEMPT protocol.
- Calcium Channel Blockers
Example: Verapamil.
Occasionally used in migraine prevention, particularly with aura or certain rare subtypes.
Other Considerations in Migraine Care
- Combination therapy: Many patients use both acute and preventive treatments.
- Medication overuse headache (MOH): Overusing acute medicines can make headaches more frequent.
- Non-drug therapies: Devices like Cefaly®, Nerivio®, and gammaCore® can be part of the plan.
- Lifestyle & trigger management: Sleep, hydration, nutrition, and stress reduction are essential for long-term control.
When to Reconsider Your Migraine Plan
It’s time to adjust your treatment if:
- Your migraines aren’t improving with current therapy.
- Your medication has stopped working as well.
- Side effects are limiting your quality of life.
- You have new health concerns or life changes (e.g., pregnancy).
Expert Migraine Treatment in Central Florida
Migraines don’t have to control your life. At Neurology One, our fellowship-trained headache specialists use the latest evidence-based treatments, from standard medicines to cutting-edge therapies, tailored to your unique needs.
Call (407) 706-3060 or visit NeurologyOne.com to schedule your consultation and take the first step toward lasting relief.
