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Medication for migraines

Last Update: November 19, 2015; Next update: 2018.

Migraine attacks can be treated with painkillers or migraine medication. If needed, medicine for nausea and vomiting can be taken as well. But if painkillers are taken too often they themselves may cause headaches.

Lying down in a dark, cool room may be enough to relieve mild migraines. Migraines are usually very painful, though, so most people take medication to get through them. Over-the-counter painkillers may be effective enough for moderate pain. Stronger medication is sometimes needed for severe migraines.  If you often have migraines, it is a good idea to have different kinds of medicine on hand.

The following medications can be used to treat migraine:

Can painkillers like acetylsalicylic acid or acetaminophen (paracetamol) help?

NSAID painkillers have been shown to effectively relieve migraine pain. The most commonly used painkillers in Germany are acetylsalicyclic acid (ASA, used in medicines like Aspirin), diclofenac, ibuprofen and acetaminophen (paracetamol). Research has shown that these drugs are effective in treating migraine:

  • Without painkillers, migraine pain disappeared within two hours in about 10 out of 100 people.
  • With painkillers, it disappeared within the same time in about 20 out of 100 people.

In other words, the pain was gone in an extra 10 out of 100 people two hours after taking the medicine. Another 20 out of 100 people can expect some pain relief. The effectiveness of a drug will depend on things like the severity of the migraine and the dose used.

How effective are painkillers at relieving migraine headaches?

Effectiveness of painkillers

The following table shows the usual doses for adults with migraines:

MedicationDose taken for a migraine attackMaximum daily dose for adults
Acetylsalicylic acid1000 mg3000 mg
Diclofenac50 mg150 mg
Ibuprofen400 mg2400 mg
Acetaminophen
(paracetamol)
1000 mg4000 mg

What are the side effects?

Side effects are rare since painkillers are usually only used for a short time in migraine treatment. In studies, ibuprofen caused stomach ache in less than 1 out of 100 people. Other drugs showed no side effects. But taking painkillers may be a problem for people who already have certain conditions, such as kidney damage.

NSAIDs also affect the stomach lining, so they are not suitable for people who have stomach ulcers. Acetylsalicylic acid can reduce the blood's ability to clot and increase the risk of bleeding. Usually the bleeding is slight, for instance a nosebleed or bleeding gums. In rare cases it may be more serious, for example in the gastrointestinal tract. High doses of NSAIDs can also increase the risk of complications in people who have cardiovascular disease.

Acetaminophen (paracetamol) is not suitable for people with impaired liver function because it is broken down in the liver. At high doses it can even cause liver damage in people who are otherwise healthy. So it is important not to exceed the maximum recommended daily dose.

What drugs provide effective nausea relief?

If you feel nauseous during migraine attacks, you can take domperidone or metoclopramide in addition to pain medication. It is estimated that these drugs relieve nausea and vomiting in about 40 out of 100 people. Combination drugs are also available. They combine a painkiller with a drug for nausea relief, for instance acetaminophen with metoclopramide.

How do migraine medications like triptans and ergotamines work?

Triptans

Triptans were developed specifically for the treatment of migraine. All of the triptans act to narrow the blood vessels in the brain and release less of the chemical messenger substances that contribute to inflammation. Triptans can relieve pain and help with nausea and sensitivity to light. Seven different triptans are currently available in Germany:

Some of these drugs can be used in different forms: tablets, capsules, nasal sprays, suppositories, injection solutions or lozenges that are placed under the tongue. Injections can be given using a pre-filled pen that your doctor can prescribe. Most triptans are prescription-only. Almotriptan and naratriptan are available without a prescription.

Because of chemical differences between the triptans, they are sometimes taken in different doses. For instance, sumatriptan tablets have 50 or 100 mg of sumatriptan in them, whereas zolmitriptan tablets contain 2.5 or 5 mg of zolmitriptan. Some of them start working more quickly, while others have a longer-lasting effect. This means that if one triptan does not provide enough relief, it might be worth trying another.

All triptans are effective against migraine. Studies on the most commonly prescribed triptan, sumatriptan (50 mg), for example, show the following:

  • Without sumatriptan, migraine pain went away within two hours in about 10 out of 100 people.
  • With sumatriptan, the pain disappeared in the same time in 20 to 30 out of 100 people.

So an additional 10 to 20 people had no pain two hours later. And it offered at least some pain relief in another 25 out of 100 people.

How quickly and effectively a drug works will also depend on the severity of the migraine, the dose and how it is administered. For instance, injections are faster and more effective than other forms of administration, but they also have more side effects.

Possible side effects of triptans include drowsiness, unusual sensations such as tingling, weakness, heat or cold, and sometimes mild nausea as well. Using a suppository or injection might help avoid nausea. But triptans are not suitable for people who have cardiovascular (heart and blood vessel) diseases. But triptans are not suitable for people who have cardiovascular (heart and blood vessel) diseases. This is because triptans can narrow the blood vessels and increase blood pressure, although this is rare.

Ergotamines

Prescription migraine drugs may also contain ergotamines, which are derived from a grain fungus called ergot. For nearly one century it was the only migraine-specific drug. Ergotamines are used less nowadays because they have more side effects than the triptans. The use of ergotamines for the prevention of migraines has not been approved in Germany since 2014.

Which medications are suitable for children and teenagers?

Medications sometimes have different effects in children and teenagers than they do in adults. They need other doses, and some of the side effects are also different. So drugs are approved separately for young people. The following medications are approved in Europe for the treatment of migraines in children and teenagers:

Ibuprofen and acetaminophen can provide relief from migraine attacks in young people. Both drugs showed similar effectiveness in studies, but the effect of ibuprofen lasted a little longer. There were no serious side effects. About 1 out of 100 study participants who used ibuprofen had a stomach ache.

The sumatriptan nasal spray also helped relieve migraine attacks in children and teenagers. But it caused more side effects: About 25 out of 100 participants said they had an unpleasant taste in their mouth. Other, less common, side effects included drowsiness and a stiff jaw.

Children and teenagers can also be prescribed medication that has not been approved for their age group in what is called "off-label use." If your doctor prescribes a medication off-label, then he or she needs to explain why and tell you about the associated risks.

What can happen if you take painkillers too often?

Painkillers and triptans can themselves cause chronic headaches if used too often. These headaches are known as medication overuse headaches or rebound headaches. The pain gets worse after you stop taking the medicine and  withdrawal symptoms occur. Headaches are considered to be chronic if you have them on more than 14 days per month.

It is estimated that 2 out of every 100 people in Germany have chronic headaches because they take painkillers too frequently,  i.e. on more than ten days per month. Medication overuse headaches are similar to migraines. People who have them need to stop taking the medication completely for a while to allow their body to adjust.

Various options for preventing migraines can help stop them and limit the need for painkillers in the first place.

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