Over-the-counter medications are the first line of defense for mild migraine, but advances in prescription drugs for interrupting serious migraine pain have changed the face of migraine treatment. Migraine medications include:
- OTC Treatments: Many mild migraines can be treated successfully with over-the-counter medications, particularly those combining acetaminophen, aspirin and caffeine, such as Excedrin Extra Strength, the first OTC medication approved specifically for migraine treatment. Naproxen (e.g., Aleve) is somewhat more effective than aspirin or ibuprofen (e.g., Advil). High doses of these nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen or naproxen, combined with metoclopramide (Reglan) to reduce nausea and vomiting, have been effective in several studies. Long-term use of NSAIDs can lead to gastrointestinal problems, including gastrointestinal bleeding.
- Triptans: These raise the level of serotonin in the brain, reducing the dilation of blood vessels, the source of the pain. Sumatriptan, the first drug developed for migraine, has been joined by several other triptans available in oral form and nasal sprays. Particularly when taken at the first sign of headache, these can be effective in as little as 15 minutes, and offer relief to most migraine sufferers. Side effects: nausea, dizziness, muscle weakness. Not recommended for women who are pregnant or for people with uncontrolled diabetes or cardiovascular conditions.
- Ergotamine: These drugs contract smooth muscles, including those in blood vessels, reducing the dilation of the blood vessels, which cause the headache pain. Dihydroergotamine (DHE), administered as a nasal spray, injection, as a suppository or orally, is particularly effective. It can be toxic at high levels. Pregnant women, those over 60, and those with chronic health problems should avoid these.
- Lidocaine: Nasal drops of this local anesthetic have been found to be effective in stopping or reducing headaches within a few minutes. In fact, in one study, it was effective in more than half the sufferers. Relapses are common, but the temporary relief can act as a bridge while other drugs take effect.