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Finding the Right Chronic Migraine Treatment

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Chronic Migraine Treatments: A Complete Guide

Medically Reviewed By Philip Ngo, PharmD

Chronic migraine treatment often involves medications such as NSAIDs, triptans, and magnesium. Other approaches include botulinum toxin (Botox) injections, biofeedback, and relaxation training. There are many treatment options that can be effective at improving or preventing chronic migraine.

Still, finding the best treatment for chronic migraine can take trial and error. You may have to try a combination of treatments to prevent or improve symptoms, and doctors may also recommend self-care approaches.

Talk with your doctor if you have questions about chronic migraine treatment or would like to review your current treatment plan.

Read on for more about treatment options for chronic migraine, including how they work and their effectiveness.

1. Antiemetics or anti-nausea medication

Someone lies down and covers their eyes next to a bottle of pills.
Marc Tran/Stocksy United; Kseniya Ovchinnikova/Getty Images

Nausea and vomiting can accompany migraine, so your doctor may recommend anti-nausea medications.

Many different types of anti-nausea medications are available over the counter (OTC) or via prescription. Examples include Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source :

  • metoclopramide (Reglan)
  • prochlorperazine (Compro)
  • promethazine (Phenergan)

Your doctor may recommend anti-nausea medications as a stand-alone treatment or with other migraine medications.

What to know about chronic migraine treatment

  • All medications and treatments have a risk of side effects or complications. Talk with a doctor to discuss the benefits and risks.
  • The best chronic migraine treatment can vary per person and may take time to find.
  • Your doctor may recommend a combination of medications and treatment approaches for migraine.
  • Always talk with a doctor or pharmacist before starting a new medication, supplement, or remedy.

2. Calcitonin gene-related peptide receptor (CGRP) antagonists

CGRP antagonists can block a molecule that causes pain. Depending on the type, CGRP antagonists can prevent or treat Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source migraine, and some may even do both.

For example, options like rimegepant (Nurtec) and ubrogepant (Ubrelvy) treat migraine once it has started.

Some CGRP antagonists can also work quickly and stay active for a long time. One example is eptinezumab (Vyepti), which helps prevent migraine episodes.

You can take CGRPs orally, nasally (via a nasal spray), or by injection.

3. Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs block the production Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source of certain chemicals called prostaglandins that can cause pain and inflammation.

Types of NSAIDs include ibuprofen, naproxen, and diclofenac. Some are OTC medications, but your doctor can also prescribe these medications in higher doses.

Excessive use of NSAIDs may cause Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source side effects such as abdominal discomfort, diarrhea, and kidney problems.

4. Triptans

Triptans are a common prescription medication for chronic migraine. They work by attaching to Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source certain brain chemicals on the muscles lining the brain’s blood vessels. This helps constrict the blood vessels and block pain signals. 

Types of triptans include:

  • sumatriptan (Imitrex, Alsuma)
  • naratriptan (Amerge)
  • zolmitriptan (Zomig)

5. Dihydroergotamine

Dihydroergotamine (D.H.E. 45, Migranal, Trudhesa) can block inflammatory substances in the brain, providing quick and sustained relief Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source during a migraine episode.

However, it may cause nausea, diarrhea, and other side effects with prolonged use. It is not recommended for people who:

  • take triptans
  • use any of the following medications:
    • macrolide antibiotics, such as erythromycin (Robimycin, E-Mycin, E.E.S.) or clarithromycin (Biaxin)
    • protease inhibitors, a type of antiviral medication
  • have a history of ischemic heart disease, such as:
    • silent ischemia
    • history of myocardial infarction or heart attack
    • angina pectoralis

Talk with a doctor if you have questions about dihydroergotamine or its side effects.

6. Ditans

Ditans are a new prescription medication for migraine. They stimulate Trusted Source International Journal of Obesity Peer reviewed journal Go to source the release of neuropeptides, brain chemicals that can quickly reduce headache symptoms. This differs from medications that work by affecting blood vessels, such as triptans.

Currently, the only ditan the Food and Drug Administration (FDA) has approved for migraine is lasmiditan (Reyvow) Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source .

Lasmiditan may be particularly helpful for people who:

  • cannot take triptans or don’t find them effective
  • haven’t found NSAIDs to be effective
  • have risk factors for cardiovascular disease

7. Antidepressants

Some antidepressants may help prevent migraine, although it is unknown how exactly this works.

Experts believe Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source that antidepressants can affect the levels of two brain chemicals: serotonin and norepinephrine. These changes can prevent migraine by affecting signals in the brain.

Antidepressant options for migraine include:

  • tricyclic antidepressant amitriptyline (TCA), such as amitriptyline (Elavil, Vanatrip)
  • selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac, Sarafem)

Read more about the types of antidepressants and their side effects.

8. Blood pressure medications 

Some blood pressure medications can help prevent migraine.

Options include some beta-blockers and angiotensin II receptor blockers, such as:

  • the angiotensin receptor blocker candesartan (Atacand)
  • beta-blockers, such as:
    • atenolol (Tenormin)
    • bisoprolol (Zebeta)
    • metoprolol (Lopressor, Toprol)
    • nadolol (Corgard)
    • propranolol (Hemangeol, Inderal, InnoPran)

9. Antiseizure medications

Antiseizure medications can be used off-label to help treat or prevent migraine. Off-label use is when doctors prescribe a drug for a purpose other than what it’s approved for

Examples of antiseizure medications used for migraine include Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source :

  • valproic acid (Depakene, Depakote, Stavzor)
  • topiramate (Eprontia, Qudexy, Topamax)
  • gabapentin (Gabarone, Gralise, Neurontin)
  • zonisamide (Zonegran, Zonisade)

Read more about medications to prevent migraine.

10. Botox injections

According to a 2022 research review Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source , Botox can suppress brain chemicals that carry pain signals, reducing inflammation and pain.

Botox can also relax the muscle contractions in the head. This may reduce the frequency and severity of migraine. 

Your doctor can treat migraine with Botox by injecting the medication into: 

  • your forehead
  • the bridge of your nose
  • the back of your head
  • your neck and other nearby areas

11. Magnesium supplements

Taking magnesium may help prevent migraine and reduce aura symptoms, as research suggests some migraine diagnoses are linked to low magnesium levels. Magnesium can also help reduce Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source inflammatory protein levels in the body.

For migraine, doctors may recommend taking 400–600 milligrams of magnesium oxide daily, but this can vary per person. Always talk with a doctor before taking a new supplement, even if it is available OTC.

Learn more about magnesium, including its types, safety, and dosage.

12. Neurostimulation 

Neurostimulation is a technique that involves sending small electrical pulses to specific nerves to change their activity, reducing Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source migraine pain and preventing episodes.

Some neurostimulation devices are permanent implants placed with surgery. Others are noninvasive and work with external electrodes. Types include:

  • noninvasive options, such as:
    • external trigeminal nerve stimulation with a Cefaly device
    • noninvasive vagus nerve stimulation with a gammaCore device
    • single-pulse transcranial magnetic stimulation for migraine
  • options that implant devices with surgery, such as:
    • occipital nerve stimulation
    • deep brain stimulation

A doctor may recommend neurostimulation for migraine if other treatments have not worked.

13–15. Supportive therapies

Other therapies use behavioral changes to improve medical concerns. The American Migraine Foundation suggests the following therapies may help prevent some migraine episodes:

  • Relaxation training: This therapy uses techniques such as deep breathing and muscle relaxation to reduce stress and prevent triggering a migraine.
  • Biofeedback: Biofeedback uses sensors such as lights or sounds to help you increase awareness or improve your control of certain body functions, such as muscle contractions and skin temperature. A clinician will help you learn how to use biofeedback at home.
  • Cognitive behavioral therapy (CBT): CBT is a type of psychotherapy that can help you manage certain problems by addressing your thoughts and behaviors.

The American Migraine Foundation suggests that around 30–60% of people who use some of these therapies experience fewer headaches than before they started. 

Summary

While chronic migraine can seem difficult to manage, many treatment options can help prevent or treat migraine episodes.

Types of chronic migraine treatments include NSAIDs, triptans, and magnesium. Other options include Botox injections, biofeedback, and nerve stimulation.

Talk with your doctor if you have questions about chronic migraine treatment or symptoms. Also, speak with them before trying any new medications, even if they’re OTC medications.

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Medical Reviewer: Philip Ngo, PharmD
Last Review Date: 2024 Apr 8
View All Finding the Right Chronic Migraine Treatment Articles
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