What Should You Know About Migraine Medications?
There’s no cure for migraine, but treatment can help manage it. Preventive medications aim to reduce how often attacks happen, while rescue medications treat symptoms when an attack begins.
"With migraine, taking the right medication at the right time is essential," says Jaclyn Rosencutter Duvall, MD, a neurologist and headache specialist with Headache Specialists of Oklahoma in Tulsa. "Understanding the difference can help you use them correctly and more effectively."
Rescue (Acute) Migraine Medications
Migraine attacks can cause painful symptoms that may last for hours or days. Whether you get them often or just every once in a while, rescue medication (sometimes called acute treatment) is important to have on hand.
What are rescue migraine meds?
"Rescue medications are taken once a migraine begins, or sometimes, if you can anticipate that a migraine is starting — what we call the prodrome," Duvall says.
Everyone is different, but signs of a prodrome include:
- Feeling tired for no reason
- Yawning a lot
- Feeling cranky
- Food cravings
- Peeing more than usual
How do they work?
"Rescue medications work by interrupting migraine processes already underway to stop the attack or reduce its severity," Duvall says.
That helps reduce symptoms like throbbing head pain, vomiting, and how sensitive you are to noise and lights.
How long does it take for rescue meds to work?
"Many begin working within 30 minutes to two hours, especially when taken early," Duvall says.
The form of your treatment can play a part. Some types, like nose spray, shots, or pills that dissolve on your tongue, are absorbed more quickly into your body than pills that you swallow.
Types of rescue meds
Acute migraine treatment includes:
Over-the-counter pain relievers. You don't need a prescription for many kinds of nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen, but if you use them too often, they can start causing more headaches. If you have another health issue or are pregnant, check with your doctor first to confirm the safest kind of OTC pain reliever for you to take.
Triptans. These headache treatments change how your brain interprets pain signals, as well as how blood flows through your brain. One study found that triptans were five to six times more helpful than ibuprofen in treating migraine. They can be prescribed as pills, shots, or a nose spray.
CGRP receptor antagonists (gepants). If triptans don't help or you don't like their side effects, your doctor may prescribe this newer kind of rescue treatment. It works by blocking a special protein, calcitonin gene-related peptide (CGRP), from carrying pain signals along your nerves. It's not advised to take gepants if you're pregnant or nursing.
Ditans. This type of treatment works a lot like triptans, but it doesn't affect your blood vessels. Ditans can make you sleepy or dizzy, so it's not safe to drive for at least eight hours after you take them.
Nausea medications. These drugs can stop you from throwing up and help with vertigo (dizziness). They can also help your body better absorb pain-relieving medication.
Dihydroergotamine (DHE). You get this kind of rescue medication as a shot. DHE can stop a migraine attack by blocking pain signals and narrowing the blood vessels in your brain so less blood gets through. When you take DHE, your migraine may also be less likely to come back within the next 24 hours.
Nerve blocks. Shots of an anesthetic, like lidocaine, in your neck and head can reduce pain signals from your nerves. You may start to feel relief within minutes, and this effect could last up to several months.
Preventive Migraine Medications
If you have four or more migraines in a month or two headaches that make it hard for you to go about your usual day, you may benefit from preventive medication.
What are preventive migraine meds?
These treatments, when taken regularly, may lessen how often you have an attack and how intense your symptoms are. Your doctor will try to find a preventive medication that can reduce your headache days by at least 50%.
How do they work?
A lot of the drugs that are used to prevent migraine were first used to treat other health issues, like high blood pressure, depression, or epilepsy. According to Duvall, the goal is to help the brain react less strongly to migraine triggers.
How long does it take for preventive meds to work?
These treatments don't help right away. It can take up to three months for them to have an impact.
No matter which kind of preventive treatment you're prescribed, your doctor will probably start you on a low dose and increase it over time. Being slowly introduced to your new medication can help reduce any side effects.
Common preventive medications
Some treatments that your doctor could suggest you try include:
Blood pressure medications. Beta-blockers are often the first preventive treatment for migraine that's prescribed. They calm your nervous system and increase activity in your hypothalamus, a part of your brain that may lose control during a migraine. Other high blood pressure drugs that can help prevent migraine include angiotensin II receptor blockers (ARBs) and ACE inhibitors. Both these medications constrict blood vessels in your brain and help lower inflammation.
Antiseizure medication. These drugs can help calm overactive nerve cells in your brain. They're not safe to take if you're pregnant or nursing. They can also make birth control pills taken by mouth less effective.
CGRP monoclonal antibodies. During a migraine attack, high levels of CGRP protein can add to inflammation, blood vessel swelling, and increased pain signals to your brain. These newer drugs are able to block the CGRP pathway. They're given as shots or in an IV (through your vein.)
Antidepressants. Clinical trials show that some types of antidepressants can help prevent migraine attacks. None are FDA-approved for this use, but your doctor could prescribe them "off-label" if they think they can help you. Tricyclic antidepressants like amitriptyline and nortriptyline work by increasing neurotransmitters like serotonin and norepinephrine in your brain.
Vitamins and supplements. Regular use of a supplement like magnesium, riboflavin, melatonin, vitamin D, feverfew, omega-3, or coenzyme Q-10 may help stave off migraine attacks. Don't take any of these without first talking to your doctor. They can explain which type is best for you to try. Many supplements can also interfere with other medications that you take.
Botulinum toxin. Botox shots are well known for reducing wrinkles, but tiny amounts injected into your head and neck can also help prevent migraine attacks. They work by relaxing your muscles and blocking your nerves from sending pain signals. You'll probably need to get shots every three months.
Some acute treatments, like nerve blocks, triptans, and a few types of gepants, can also used be used to try to prevent migraine attacks.
Nondrug treatments to prevent migraine
Your doctor could also suggest a nondrug treatment, like a neuromodulation device. These FDA-approved devices try to prevent migraine attacks by changing the activity of your nerve pathways. Some neuromodulation devices are worn, while others are put under your skin during a short procedure.
How Do Doctors Decide Between the Two?
Migraine attacks can be difficult to manage. You can feel like your life is forced to come to a screeching halt.
Because of that, "everyone with migraine should have a rescue treatment available to treat an attack once it starts," Duvall says.
Whether or not you need a preventive treatment depends on many different factors, including:
- How often you have headaches and migraine attacks
- How severe the attacks are
- How well your rescue treatment works
- How often you use your rescue medication
- Other health issues you live with
- Other medications that you take
It can also be helpful for your doctor to know what's going on in your life; for instance, if you're trying to get pregnant.
Starting a preventive medication doesn't mean that you'll stay on it for the rest of your life. If it works well, your doctor may want you to take it for six months to a year. Then, they may try to wean you off it (give you lower and lower doses until you stop it completely) and see if your symptoms come back.
Creating Your Personalized Migraine Treatment Plan
It can take some trial and error to find the right migraine treatment.
"Migraine is a complex neurologic disease, and no two people experience it the same way," Duvall says. "Differences in genetics, medical history, triggers, symptoms, and medication tolerance mean that a treatment effective for one person may not be ideal for another."
A good relationship with your doctor is key. Be open with them about:
- Your treatment goals (What do you hope will get better?)
- Your preferences (For instance, do you prefer trying a natural supplement before a prescription drug?)
- Your lifestyle (Including how likely you are to take a regular medicine)
- Any financial concerns
Rescue vs. Preventive Migraine Medications at a Glance
| Rescue Medications | Preventive Medications | |
| When to use | As soon as migraine symptoms begin or during the early warning signs | On a regular basis |
| Used for | Fast relief of symptoms like pain, nausea, and sensitivity to lights and sounds | Breaking the cycle of frequent migraines |
| Common types | OTC pain relievers, ditans, triptans, gepants, anti-nausea drugs, DHE, nerve blocks | Antiseizure medications, blood pressure medications, antidepressants, CGRP monoclonal antibodies, vitamins and supplements, Botox injections |
| When you could see a difference | Within 2 hours | Up to 8 weeks |
When to Talk to Your Doctor
Migraine treatment isn't a "one and done" deal. Stay in touch with your doctor to let them know how you're doing and ask questions as they come up. Your doctor can explain how to keep a headache diary so you can track your triggers and symptoms. They can help you better understand the different stages of a migraine attack, learn relaxation techniques that could offer some relief, and refer you to a counselor, nutritionist, or physical therapist if you need more support.
Reach out to your doctor right away if:
- Your medications aren't helping enough
- You're using rescue medication more than two days a week
- Your migraine attacks are getting more severe or happening more often
- You're having side effects from your medication
Your treatment may need to be changed.
Finding the right treatment plan can take some time, which can be frustrating. "Lack of relief doesn't mean treatment has failed," Duvall says. "Many effective migraine therapies are now available that didn't exist even a few years ago. With the right combination of treatment, lifestyle support, and follow-up, most people can achieve meaningful improvement. There is still hope."
Takeaways
There's no cure for migraine, but treatment can help you manage this disorder. Preventive medications can try to reduce how often painful attacks happen, and rescue treatments can lesson or stop your symptoms once they start. Finding the best treatment plan can take some time. Keep in touch with your doctor so they can monitor your progress and adjust your medication as needed.
FAQs on Rescue vs. Preventive Medications for Migraine
What is the first-line treatment for migraines?
The first-line treatment for migraines is often a class of medications called triptans. Doctors commonly prescribe triptans as an acute treatment to help stop a migraine attack once it starts. These medications are considered very safe, are not habit-forming, and tend to have fewer side effects than some other migraine treatments.
What’s in a migraine cocktail?
A migraine cocktail is a combination of medications that can help treat a severe migraine attack. You might be given one if your symptoms don't respond to your usual treatment or have lasted more than 72 hours. What's in a migraine cocktail can vary. For instance, in some hospitals, you might be prescribed an NSAID, anti-nausea medication, DHE, diphenhydramine, magnesium, and fluids so you don't get dehydrated.
What's the strongest OTC medication for migraines?
Aspirin and ibuprofen are OTC medications that work well for migraine, but they're not the best choice for everyone. For instance, acetaminophen may be a safer option if you:
- Are pregnant or breastfeeding
- Have certain health conditions, like high blood pressure, stomach ulcers, or kidney or heart failure
Aspirin is also not safe for kids or teens.
If you're not sure which OTC medication to take for migraine, check with your doctor.
