Over the Counter Medications and Supplements

If you experience occasional migraine attacks that don’t knock you to your knees, you may find sufficient relief by taking an over the counter (OTC) pain reliever when you feel an attack coming on. “No specific OTC pain reliever has proven to be more effective than others,” Dr. Bernard says. “You can experiment to find the one you prefer.” Nonprescription pain relievers with “migraine” in the name usually contain caffeine, which may help alleviate pain. Drinking coffee or caffeinated tea can also be effective.

There are also supplements researchers have studied and found to help migraine sufferers:

• Feverfew (herb)
• Magnesium
• Coenzyme Q10
• B Vitamins: B2 (riboflavin), B6 (pyridoxine) alone and with B12 (cobalamin), B9 (folic acid or folate)
• Vitamin E

“Be careful not to overdo it on the supplements,” Dr. Bernard says. “More is not necessarily better and some supplements, especially vitamin B6, can be toxic at high doses.”

You also want to limit your use of over-the-counter medications. Pain medications taken more than once or twice a week can create a rebound effect that results in more headaches. If you’re taking OTC pain medications frequently, it’s time to talk to your doctor about other options.

Medications for Migraine Relief

If you’re dealing with migraine attacks more than twice a week or if the attacks are severe, acute relief medications might help. You take these medications when a migraine begins to stop it from developing.

• Triptans have been used for more than 20 years and have a proven track record for reducing migraine headache pain and decreasing nausea and vomiting. Triptan formulations are available under many names and are available in a pill, nasal spray or injection. If your doctor prescribes a triptan medication, you should keep it with you at all times and take it at the first hint of a migraine.
• Ergotamines were the first medication used to stop migraine attacks. They’re not as effective as triptans and can cause side effects, but doctors may prescribe them if you can’t take triptans.
• Calcitonin gene-related peptides (CGRP) inhibitors, the first class of medications specifically for migraines, was approved by the FDA in 2018. These work well for patients who can’t take triptans and tend to be well tolerated.

As with over-the-counter medications, be careful not to overuse acute treatment medications. Using these medications more than once or twice a week can cause rebound headaches. They can also contribute to a condition called “transformed migraines,” when migraine attacks become chronic, and the cycle of pain becomes difficult to stop.

Preventive Migraine Medications

If acute or abortive medications don’t work, or if you need to take them more than twice a week, your doctor might suggest preventive medication. These medications can lower your chances of experiencing migraine attacks. The FDA has approved a few of these drugs for migraine prevention:

• Inderal® and Blocadren® — Beta blockers also used to treat heart disease and high blood pressure.
• Depakote®, Depakote® ER, and Topamax® — Anti-seizure medications also used to treat epilepsy and other seizure disorders.
• CGRP inhibitor — The first medication class specifically for migraine.
• Onabotulinumtoxin A (Botox®) injections – Also used to treat facial wrinkles, muscle spasms and other conditions.

Starting a preventive medication requires time, patience and effort. You’ll need to take it as prescribed and be careful not to miss a dose. It may also take a few tries before you find a preventive medication that strikes a good balance between side effects and relief.

Other Medication Options

The FDA allows doctors to prescribe legally approved drugs “off-label.” This means doctors can use their knowledge and judgment to prescribe a drug to treat conditions different from those it was originally approved to treat. Migraine prevention drugs commonly prescribed for off-label include:

• Blood pressure medications
• Antihistamines
• Antidepressants
• Anti-inflammatory medications
• Muscle relaxers
• Asthma medications
• Attention deficit disorder medications

Doctors prescribe more than a hundred drugs for migraine prevention. Each medication has benefits and side effects. The wide array of choices and cautions is one of the best reasons to work with a neurologist who specializes in headache treatment.

“There are many great doctors who can treat migraine, but doctors who see a high volume of patients with migraine gain the kind of knowledge you can only get by treating patients with migraine every day,” Dr. Bernard says.

Applying that knowledge to each patient’s situation — sex, age, lifestyle, other medical conditions and medications, and willingness to tolerate side effects — allows headache specialists to quickly narrow down the treatment options. With good medical care, you can look forward to a life with far fewer and less severe attacks.