Medications for Headache

The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. Remember that all medications, including over-the-counter, can cause or worsen certain chronic headaches. It is essential that you become aware of the alternative treatments, including stress management, which are important part of the comprehensive treatment. If you have further questions about usage or side effects, contact your doctor.

Medications for Treating Migraines

Prescription Medications to Treat Migraines

Triptans (Serotonin Agonists)

Common names include:

  • Sumatriptan (Imitrex)
    • Combining sumatriptan with a nonsteroidal anti-inflammatory drug may be more effective than either medication taken separately. But, do not try this on your own. Talk to your doctor first.*1
  • Almotriptan (Axert)
  • Naratriptan (Amerge)
  • Rizatriptan (Maxalt)
    • For woman whose migraine headaches are associated with their menstruation cycles, rizatriptan may be beneficial.*2
  • Zolmitriptan (Zomig)
  • Frovatriptan (Frova)

Triptans are drugs that act similar to the brain chemical serotonin, which constricts blood vessels in the brain. For best results, these drugs should be taken at the first signs of migraine or cluster headache. Some are injectable and others are taken by mouth or by nasal spray. Some drugs in this class can be taken by mouth without water. Do not use within 24 hours of taking ergotamine tartrate or similar medications. Do not take with MAO inhibitors. Triptans should not be used if you have uncontrolled hypertension , coronary artery disease , angina , severe liver disease, or neurovascular disease.

Possible side effects include:

  • Dizziness
  • Warm or hot sensations
  • Anxiety
  • Chest pain or palpitations

Ergot-based Preparations (Ergotamine Tartrate)

Common brand names include:

  • Ergomar
  • Cafergot
  • Wigraine

Ergotamine tartrate constricts blood vessels. It helps offset blood vessel dilation (widening) during a migraine and also may be prescribed for cluster headaches if the pain occurs at a predictable time, such as at night. This drug is used to prevent migraines and offers the most relief if taken early in the headache process. Do not eat or drink while the tablet dissolves. Do not use within 24 hours of taking triptan drugs or serotonin agonists. Check with your doctor before stopping this drug. Ergot preparations should not be used if you have coronary artery disease, uncontrolled hypertension, kidney or liver disease, peripheral artery disease , peptic ulcer disease , or severe systemic infections.

Possible side effects include:

  • Nausea and vomiting
  • Feelings of coldness in hands and feet
  • Weakness and pain in the leg muscles

Dihydroergotamine

Common brand names include:

  • DHE 45
  • Migranal

Dihydroergotamine constricts dilated blood vessels. It is injected to prevent or stop a migraine headache. Do not take this drug long-term. Notify your doctor immediately if side effects occur. Headaches may worsen once this drug is stopped.

Possible side effects include:

  • Nausea and vomiting
  • Feelings of coldness in hands and feet
  • Weakness and pain in the leg muscles
  • Chest pain

Phenothiazines

Common names include:

  • Domperidone (Motilium) (available in Canada)
  • Prochloraperazine (Compazine)
  • Metoclopramide (Reglan)

Certain phenothiazines have been FDA-approved for the treatment of nausea and vomiting associated with migraines. These drugs should not be used if you have glaucoma , severe heart disease, or liver disease.

Possible side effects may include:

Over-the-Counter Medications to Treat Migraines

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Common names include:

  • Naproxen sodium (Aleve)
  • Ibuprofen (Motrin)
  • Aspirin (Bayer)

These drugs should not be used if you have peptic ulcer disease, recent bleeding from the gut, kidney disease, or heart disease. These drugs work to control pain and inflammation, which can produce pain. Possible side effects include:

  • Rebound headache if pain reliever is taken on a regular basis
  • Gastrointestinal bleeding
  • Stomach upset

Analgesic Combinations

  • Excedrin Migraine (contains aspirin , acetaminophen , and caffeine)
  • Advil Migraine (contains ibuprofen )
  • Motrin Migraine (contains ibuprofen)

These drugs also work to control pain and inflammation. Possible side effects include:

  • Rebound headache if pain reliever is taken on a regular basis
  • Gastrointestinal bleeding
  • Stomach upset
  • Acetaminophen can cause liver problems if taken with alcohol. Do not take more than the recommended dose.

Medications for Preventing Migraines

Beta-Blockers

Common names include:

  • Propranolol (Inderal)
  • Timolol (Blocadren)

Beta-blockers are commonly used to treat high blood pressure, but are also used to prevent migraine headaches. Beta-blockers work by affecting the response to some nerve impulses in certain parts of the body. They also decrease the heart's need for blood and oxygen by reducing its workload. These drugs should not be used if you have heart failure, asthma, or heart rhythm problems.

Possible side effects include:

  • Dizziness
  • Drowsiness
  • Nausea
  • Vomiting
  • Diarrhea

Anticonvulsants

Common name: Valproic acid (Depakene)

Valproic acid may be used to treat migraine or cluster headaches. Do not take aspirin while taking this drug. Your doctor will order periodic blood tests to check drug levels and liver function. This drug should not be used if you have severe liver disease or porphyria .

Possible side effects include:

  • Sedation
  • Nausea and vomiting

Topiramate

Common name: Topiramate (Topamax)

Topiramate may be used to treat migraine or cluster headaches. Do not abruptly discontinue this drug.

Possible side effects include:

  • Dizziness
  • Problems with coordination and concentration
  • Fatigue

Other Medications for Treating Migraines

Tricyclic Antidepressants

Common name: Amitriptyline (Elavil, Endep)

Antidepressants are given for their pain-relieving abilities. Do not stop taking antidepressants without first checking with your doctor. These drugs should not be used if you have glaucoma, are recovering from a recent heart attack, or have used MAO inhibitors within two weeks.

Possible side effects include:

  • Blurred vision
  • Dry mouth
  • Dizziness, lightheadedness when standing up

Calcium Channel Blockers

Common name: Verapamil (Calan)

Calcium channel blockers may be used to treat migraine or cluster headaches. The drugs relax and dilate the blood vessels. These drugs should not be used if you have a heart rhythm problem, heart failure, or porphyria .

Possible side effects include:

  • Low blood pressure
  • Dizziness, lightheadedness

Corticosteroids

Common name: Prednisone (Cordrol, Meticorten, Prednisone Intensol)

Corticosteroids may be given for short periods of time to people suffering from cluster headaches and to relieve inflammation for migraines lasting more than 24 hours. Do not suddenly stop taking this drug. It should be gradually decreased. These drugs should not be used if you have any active infection, especially fungal infection. They should be used with caution if you have diabetes, peptic ulcer, tuberculosis , hypertension, glaucoma, liver, or kidney diseases.

Possible side effects include:

  • Stomach ulcers
  • High blood pressure
  • Heart failure
  • Muscle weakness
  • High blood sugar

Medications for Treating Cluster Headaches

Lithium Carbonate

Lithium may be used to treat cluster headaches. Your doctor will monitor blood levels of this drug to make sure they remain in a therapeutic range. Do not take any other drugs without discussing them with the doctor. This drug must not be taken during pregnancy. Wear a medical alert tag or bracelet stating that you are taking lithium. This drug should be used with care if you have diabetes , seizure disorder , thyroid problem , Parkinson’s disease , or urination problems.

Possible side effects include:

  • Irregular heart beat
  • Hand tremors
  • Thirst
  • Frequent urination
  • Fluid retention
  • Weight gain

Other Medications

Capsaicin, which is administered to the nose, has also been effective in the treatment of acute attack in cluster headache. Other than unpleasant taste, there is no other side effect. Oxygen is the treatment of choice in acute cluster headache.

Medications for Preventing Cluster Headache

Medications for Treating Sinus Headache

Antibiotics

Common name: Amoxicillin (Amoxil)

Antibiotics may be ordered to treat a sinus infection caused by bacteria. Take with food to decrease stomach upset. It is very important that you finish the complete course of therapy. Do not stop taking the antibiotics even if you feel better.

Possible side effects include:

  • Upset stomach
  • Diarrhea
  • Vaginal yeast infections

Lidocaine

Common name: Xylocaine

Lidocaine nose drops may be used to treat cluster headaches.

Possible side effects include:

  • Dizziness
  • Nervousness

Decongestants

Common names include:

  • Pseudoephedrine hydrochloride (Sudafed)
  • Phenylephrine (Neo-Synephrine)

Decongestants may be given to treat sinusitis . Decongestants open clogged nasal passages, allowing the sinuses to drain. Do not use these drugs longer or more often than directed. Overuse of decongestant nose sprays may increase swelling and make your symptoms worse.

Possible side effects include:

  • Increased blood pressure and pulse
  • Anxiety
  • Palpitations

Special Considerations

Whenever you are taking a prescription medication, take the following precautions:

  • Take them as directed—not more, not less, not at a different time.
  • Do not stop taking them without consulting your doctor.
  • Don’t share them with anyone else.
  • Know what effects and side effects to expect, and report them to your doctor.
  • If you are taking more than one drug, even if it is over-the-counter, be sure to check with a physician or pharmacist about drug interactions.
  • Plan ahead for refills so you don’t run out.

References

Beck E, Sieber WJ, Trejo R. Management of cluster headache. Am Fam Physician. 2005;71:717-24.

Conn HF, Rakel RE. Conn's Current Therapy 2001. 53rd ed. Philadelphia, PA: WB Saunders Company; 2001.

Headache—frequently asked questions. National Headache Foundation website. Available at: http://www.headaches.org/education/Tools_for_Sufferers/Headache_-_Frequently_Asked_Questions. Accessed September 11, 2008.

NINDS headache information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/. Updated July 2008. Accessed September 11, 2008.

Nissen D. Mosby's Drug Consult. St. Louis, MO: Mosby Inc; 2002.

Pascual J, El Berdei Y, Gomez-Sanchez JC. How many migraine patients need prolonged (>1 year) preventive treatment? Experience with topiramate. J Headache Pain. 2007;8:90-93. Epub 2007 Jan 15.

*14/23/2007 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Brandes UK, Kurdrow D, Stark SR, et al. Sumatriptan-naproxen for acute treatment of migraine: a randomized trial. JAMA. 2007;297:1443-1454.

*27/5/2007 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Mannix LK, Loder E, Nett R, et al. Rizatriptan for the acute treatment of ICHD-II proposed menstrual migraine: two prospective, randomized, placebo-controlled, double-blind studies. Cephalalgia. 2007;27:414-421.



Last reviewed July 2008 by Rimas Lukas, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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