Headache medications are prescribed to alleviate the immediate pain and to prevent additional headaches.
Your doctor will recommend one or more headache medications depending on the following factors:
- the type of headache
- the frequency of headaches
- the severity of headaches
- other symptoms experienced during the headaches
- responses to other headache medications
- other medical problems
Medications for Migraine Headaches
Medications prescribed for the treatment of migraine headaches may be categorized as "acute" or "preventive" treatments.
Acute medications, also called "abortive" medications, are taken as soon as symptoms occur to relieve pain and restore function. Preventive treatment are taken daily to reduce the severity of future attacks or keep them from happening in the first place.
Acute Migraine Medications
Medications that provide acute treatments for migraine headaches include the following:
- Triptans. Triptans are one of the most commonly prescribed medications for the treatment of migraine headaches. Triptans increase levels of the neurotransmitter serotonin in the brain. (Serotonin causes blood vessels to constrict and lowers the pain threshold.) Triptans ease moderate to severe migraine pain and are available as tablets, nasal sprays, and injections. Some brands of triptans include Imitrex® (sumatriptan), Maxalt® (rizatriptan), Treximet® (sumatriptan and naproxen), and Zomig® (zolmitriptan).
- Ergotamines. Ergot derivative drugs, such as Cafergot®, bind to serotonin receptors on nerve cells and decrease the transmission of pain messages along nerve fibers. They are most effective during the early stages of migraine and are available as nasal sprays and injections.
- Aspirin and NSAIDs. Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce inflammation and alleviate pain. These include ibuprofen, aspirin, acetaminophen and naproxen.
- Combination analgesics. These medications combine active ingredients, such as acetaminophen plus caffeine and/or a narcotic, for the treatment of migraine that may be resistant to simple analgesics.
- Nausea relief. Some medications may be prescribed to ease queasiness brought on by various types of headache.
- Narcotics. Narcotics, such as hydrocodone (Vicodin®) may be prescribed in special circumstance for short periods of time for the relief of pain. These drugs have many side effects and should not be used to treat chronic headaches.
Taking headache medications more than three times a week may lead to medication overuse headache (previously called rebound headache), in which the initial headache is relieved temporarily but reappears as the drug wears off. Taking more of the drug to treat the new headache leads to progressively shorter periods of pain relief and results in a pattern of recurrent chronic headache. Headache pain ranges from moderate to severe and may occur with nausea or irritability. It may take weeks for these headaches to end once the drug is stopped.
Preventive Migraine Medications
Some people with frequent and severe migraine may also benefit from using a preventive medication. Preventive medications are considered if the migraines occur one or more times per week, or if the migraines are particularly disabling. Preventive medicines are also recommended for individuals who use other headache medications more than three times a week.
A preventive medication may be used for a trial period of two to three months to assess its effectiveness and determine if it is tolerable.
There are several medications available to help prevent migraines. Most were initially marketed for medical conditions other than migraine. These include the following:
- Antiepileptics (AEDs). Medications for the treatment of epilepsy (Valproic acid) may be helpful for people with other types of headaches in addition to migraine. Although developed for treating epilepsy, these drugs increase levels of select neurotransmitters and dampen pain impulses.
- Beta-blockers. These medications for treating high blood pressure, such as propranolol, are also effective for reducing the risk of developing a migraine.
- Calcium channel blockers. These medications, such as verapamil, are usually prescribed to treat high blood pressure. But their ability to stabilize blood vessel walls also appears to prevent the blood vessels from either narrowing or widening, which also affects blood flow to the brain.
- Antidepressants. Antidepressants are medications that work on different chemicals in the brain; their effectiveness in treating migraine is not directly related to their effect on mood. Antidepressants may be helpful for individuals with other types of headaches because they increase the production of serotonin and may also affect levels of other chemicals, such as norepinephrine and dopamine. The types of antidepressants used for migraine treatment include selective serotonin reuptake inhibitors (Prozac®), serotonin and norepinephrine reuptake inhibitors, and tricyclic antidepressants (amitriptyine), which are also used to treat tension-type headaches.
Medications for Tension-Type Headaches
Medications used for the treatment of tension type headaches include the following:
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Antidepressants, such as tricyclic antidepressants (amitriptyline)
- Triptans (Imitrex®, Treximet®, Zomig®) and ergot derivatives may be considered for people suffering from both migraine and tension-type headaches.
Medications for Cluster Headaches
Treatment options for cluster headache include:
- Oxygen therapy-in which pure oxygen is breathed through a mask to reduce blood flow to the brain
Certain antipsychotic drugs, calcium-channel blockers (verapamil), and anticonvulsants (valproic acid) can reduce pain severity and frequency of cluster headache attacks. In extreme cases, electrical stimulation of the occipital nerve to prevent nerve signaling or surgical procedures that destroy or cut certain facial nerves may provide relief.
Take your headache medication exactly as directed.
Reference: National Institute of Neurological Disorders and Stroke (NINDS)