A Guide to Migraine Treatments and Their Side Effects

By Liz Neporent

Treatment Category Common Treatments Potential Side Effects Notes
Over the counter

Used mainly as an acute treadment but can be used as preventatives under direction of a physician.

  • Acetaminophen (Tylenol)
  • NSAIDs. (Nonsteroidal anti-inflammatory drugs) such as aspirin, ibuprofen (Advil, Motrin)
  • Naproxen sodium (Aleve, Anaprox), and ketoprofen (Actron, Orudis.)
If taken too often can cause ulcers, gastrointestinal bleeding and medication-overuse headaches. If you rely on these more than twice a week, see your doctor. If you experience gastrointestinal symptoms after taking, see your doctor.
Caffeine

Used as an acute treatment but can be used as a preventative.

  • Coffee, tea, soda, chocolate
  • OCT medications such as Excederin Migraine combine acetaminophen, aspirin and caffeine.
Overuse may cause headaches, gastrointestinal symptoms.Even limited use may be source of headache in some people.Caffeine containing OCTs may cause ulcers, gastrointestinal bleeding and medication-overuse headaches.May cause dependence. Limit to no more than 1-2 cups of coffee per day or equivalent amount of caffeine from other sources.
Triptans

Prescription only abortives that promote constriction of blood vessels and block pain pathways in the brain. Can effectively relieve the pain and other symptoms associated with migraines for some people.

  • Sumatriptan (Imitrex)
  • Rizatriptan (Maxalt)
  • Almotriptan (Axert)
  • Naratriptan (Amerge)
  • Zolmitriptan (Zomig)
  • Frovatriptan (Frova)
  • Eletriptan (Relpax)
  • combination of sumatriptan and naproxen sodium (Treximet)
Nausea, dizziness, drowsiness and muscle weakness.Not recommended for people at risk of strokes and heart attacks. Although usually taken by tablet, many medications also available in nasal spray or suppository form. Most effective if taken soon after onset of headache.You may have to try several different medications and medication delivery systems to find the one most effective.
Ergots

Prescription medication aborts migraine attacks by constricting blood vessels

  • Migergot
  • Cafergot
  • Dihydroergotamine (D.H.E. 45, Migranal)
Common side effects include anxiety, diarrhea, flushing, gastric upset. Nausea, restlessness, vomitingCauses narrowing of the blood vessels throughout the body. Not recommended for people with heart or vascular diseases or people over 60.May harm fetus. Should not be used by pregnant women.May cause rebound headaches that are difficult to treat.

May interfere with other prescription drugs.

These drugs are rarely used today due to dangerous side effects but may be prescribed for severe, throbbing, long-lasting headaches.Take longer to work than other drugs but can offer longer lasting relief.
Anti-Nausea Medications

Because migraine symptoms often include nausea and vomiting, these may be prescribed along with pain relievers.

  • Chlorpromazine
  • metoclopramide (Reglan)
  • Prochlorperazine (Compro)
Common symptoms include drowsiness, dizziness, lightheadedness, and feeling less alert.Can also cause blurred vision, and movement problems.Prochlorperazine makes some people sweat less, which can allow the body to overheat. May also heighten effects of alcohol and other drugs that slow down the central nervous system. May cause false positive pregnancy tests. For severe nausea, may be administered by injection or suppository.Do not drive or operate heavy machinery until you know how you react to these drugs.Stopping Prochlorperazine suddenly can cause dizziness, nausea, vomiting, tremors, and other side effects. It may be necessary to taper off gradually.
Opioid Medications

Sometimes used to treat migraines in people who do not respond well to other acute treatments.

Sometimes used as a rescue  medication when migraine does not respond to other types of treatment.

  • Codeine
  • Fentanyl (Duragesic)
  • Hydrocodone (Vicodin, Lortab)
  • Hydromorphone (Dilaudid)
  • Meperidine (Demerol)
  • Morphine (MS Contin, Kadian)
  • Oxycodone (OxyContin, Percocet)
Common side effects include, drowsiness, dizziness or light-headedness, euphoria or false sense of well-being, nausea, vomiting, dryness of mouth, constipation, slow shallow breathing, urine retention, lowered blood pressure, flushed skin, itching, confusion. Improper use can lead to increased tolerance, causing potential physical dependence and possible addiction.May also heighten effects of alcohol and other drugs that slow down the central nervous system. Narcotics are habit-forming and are usually used only as a last resort.
Glucocorticoids

May be used with other medications to improve pain relief.

  • Prednisone
  • Dexamethasone
Risk of steroid toxicity so should not be used frequently.Long-term side effects include weight gain, diabetes, stomach ulcers, glaucoma, high blood pressure, and osteoporosis. Often prescribed when no other drug works. Generally prescribed for short-term course; however, patients willing to accept side effects may take for longer term. May be given by injection in emergency settings to stop headache and reduce risk of recurrence.
Cardiovascular Drugs

Prescribed as a preventative for people who have four or more debilitating headaches per month.

  • Beta Blockers propranolol (Inderal La, Innopran XL) and timolol (Betimol), metoprolol tartrate (Lopressor)
  • Calcium channel blockers (Verapamil (Calan, Verelan)
Common side effects of beta blockers include:include fatigue, cold hands, headache, upset stomach, constipation, diarrhea.Less common side effects for beta blockers include shortness of breath, insomnia, loss of sex drive, depression.Beta blockers may trigger severe asthma attacks. In people who have diabetes, they may block signs of low blood sugar, such as rapid heartbeat. They can also temporarily affect cholesterol and triglyceride levels, causing a slight increase in triglycerides.

Common side effects of calcium channel blockers include constipation, headache, rapid heartbeat (tachycardia), dizziness, rash, drowsiness. Flushing. Nausea, swelling in the feet and lower legs.

Beta blockers: May be no improvement in symptoms for several weeks after taking these medications. Not recommended for people over age 60, smokers, or people who have heart or vascular disease.Abruptly stopping beta blockers may increase risk of heart attack or other heart problems.Calcium channel blockers should not be taken with grapefruit, grapefruit juice or any other grapefruit products as they can reduce ability to eliminate calcium channel blockers from the body, allowing the medications and serious side effects.
Antidepressants

May be prescribed as a preventative even for those who don’t suffer from depression.

  • Tricyclic antidepressants (Amitriptyline); others have not been proven as effective but may be given because they have fewer side effects
Dryness of mouth, constipation, weight gain
Anti-Seizure Drugs
  • valproate sodium (Depacon)
  • topiramate (Topamax)
Common side effects include nausea, tremor, weight gain or loss, hair loss, dizziness, tingling in extremities, memory difficulties, concentration problems, anxiety, irritability.Rare side effects include blood in the urine, loss of bladder control, nose bleeds, buzzing in the hearing and breathing troubles. Check in with your doctor frequently when taking these medications; some side effects may require dosage adjustment or medical attention.
Botox Injections
  • OnabotulinumtoxinA (Botox)
Common side effects are typically minimal but can be serious. They include depression, flulike symptoms.Approximately 2-3% of patients report droopy eyelids or muscle weakness.May exacerbate headaches, neck pain and respiratory infections. Study results for the effectiveness of Botox for migraine treatment are mixed. However, Rizzoli says a vast majority of his patients who use it to treat chronic versus episodic migraine report a dramatic reduction in the frequency and severity of their migraines.Some insurance companies will now cover this treatment if you meet certain criteria.Specific migraine injection protocol should be performed by a trained medical professional.
Relaxation Therapies
  • Massage
  • Physical Therapy
  • Chiropractory
  • Yoga
Some studies found these therapies can exacerbate migraines, particularly techniques that involve tapping or vibration near the head and neck. Reliable studies proving efficacy of these treatments are few and far between and inconclusive. However, Rizzoli says many patients report these treatments can be somewhat effective in relieving headache.
Migraine Diet
  • Migraine Diet
There is little downside to following a migraine diet. However, some patients find such diets limiting and hard to follow. Studies are highly inconclusive that following a migraine diet can bring about relief. However, Rizzoli reports that some patients find relief by limiting trigger food from the diet, especially alcohol, salt and caffeine. Patients report some migraine relief from eating at regular intervals.
Biofeedback / Meditation
  • Biofeedback
  • Meditation
  • Yoga
None Evidence is very strong for the effectiveness of both biofeedback and meditation. Some studies show effectiveness is comparable to medication.Treatment may be covered by insurance if administered or taught by a licensed professional.
Acupuncture
  • Acupuncture (with needles)
  • Acupressure (without needles)
Scientific results are mixed but Rizzoli says some patients experience dramatic results from this treatment.May be covered by insurance.
Electrical
  • TENS (transcutaneous electrical nerve stimulation)
  • Magnetic and vagal nerve stimulation
  • Vagal nerve stimulation
  • Deep brain stimulation
Deep brain stimulation carries the risk of serious side effects such as infection, bleeding or death. Unlikely to ever be considered a first-line treatment. Few studies have reviewed the effectiveness of these treatments. However, the few studies that have been done suggest they are effective to a varying degree.Some techniques such as deep brain stimulation are not generally available to the typical migraine patient.
Energy Treatments
  • Homeopathy
No physical side effects are common. Zero evidence of effectiveness. However, might induce relief by “placebo effect.”
Supplements
  • Magnesium
  • Riboflavin
  • Coenzyme Q10
  • Fish Oil
  • Herbal Supplements
  • Melatonin
Magnesium may cause gastrointestinal distress and diarrhea.Riboflavin may cause diarrhea, frequent urination and bright yellow-orange urine.Coenzyme Q10 may have drug interactions with high blood pressure medications, blood thinners and beta blockers.Fish oil may cause bad breath and burping. Serious side effects include increased bleeding and bruising.

Unregulated herbal supplements may contain toxins and allergens not listed on the label.

Minimal evidence of effectiveness. However, Rizzoli says that as long as you work with your physician and do not overdose, there is no harm in trying them.
Lifestyle Changes Other Than Diet
  • Sleep
  • Exercise
  • Stress reduction
Few if any side effects although, some studies show exercise may exacerbate migraines. There is also some debate in the literature whether high intensity or moderate intensity exercise is most effective. Rizzoli says he wishes there was more research on the effectiveness of lifestyle changes on reducing migraines. Anecdotally, patients report some improvement with lifestyle changes. They are certainly worth trying and can improve other aspects of health as well.
Emerging Therapy – Inhaled DHE

Prescribed as an acute treatment.

  • dihydroergotamine (DHE; Levadex)
Same side effects as other forms of this drug; however in studies, inhaled DHE resulted in fewer side effects and less severe side effects. Inhaled versus other methods of delivery of this ergot has been shown to be a superior treatment. Expected to be on the market by the end of 2013 – beginning of 2014.Rizzoli says there are few treatments under review that show good promise for migraine treatment or prevention.


Liz Neporent is a health reporter for ABC News National and the co-author of 15 books on health, including The Migraine Solution with Elizabeth Loder, MD, and Paul Rizzoli, MD.


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