Information for sufferers

Medication for Migraine

Download Medication for Migraine Chart PDF

The information below accompanies our Medication for Migraine fact sheet.  We suggest you read the fact sheet first, which is a general guideline about the types of medication in the treatment of migraine. 

Information is provided here about the specific drugs available for the treatment of migraine, split into two sections:

  • Section 1 - acute (treatment when the attack begins)
  • Section 2 - prophylactic (treatment to prevent an attack)

The following information is provided on the medications: Group name, generic name (the name of the basic active ingredient(s)), prescription required (yes or no), brand name, formulation type (eg. tablets, suppositories, injection) and action.

Caution

Drugs and new treatments for migraine are changing all the time.  If you are on long term medication you should ensure that your treatment is regularly reviewed by your doctor. 

For a small percentage of people with headache, frequent use of drugs particularly ergotamine, triptans, codeine, paracetamol, NSAIDs and caffeine have been implicated in chronic daily headache and rebound headache.  If you are experiencing 4 or more migraine attacks per month you should consider the use of preventative treatment to avoid attacks.

Key

  • POM - Prescription only medication
  • OTC - over the counter medication
  • ® - registered
  • Enteric coated - tablets can be coated with a substance that enables them to pass through the stomach and into the intestine unchanged.
  • IV – intramuscular injection
  • BNF – British National Formulary is the joint publication published by the British Medical Association and the Royal Pharmaceutical Society which is distributed to NHS doctors by the Department of Health.

Section 1: Acute – Treatment when the attack begins

Analgesics (painkillers)

Action - Analgesic drugs relieve pain and reduce stiffness associated with migraine.  The non-steroidal anti-inflammatory drugs (NSAIDs) also reduce inflammation by inhibiting the production of certain chemicals in the body. 

Analgesics tend to be more effective when taken as soluble, effervescent or liquid formulations because they are absorbed quicker (not all drugs are available in these forms).

Enteric coated preparations are less suitable for treating migraine attacks because they are absorbed more slowly and therefore may take longer to work.

Codeine is an analgesic which blocks pain signals in the spinal cord and brain.

Caffeine is a weak stimulant that is often combined in small amounts with analgesics to enhance their effect.  However, there is evidence that caffeine can provoke headache and may result in headaches following its withdrawal after long term treatment.

 Group NameGeneric NamePrescription requiredBrand NameFormulation type 

Non-steroidal anti-inflammatory drugs (NSAIDs)

Asprin

No

There are many different preparations of analgesics so the brand names are too numerous to mention.

Several combination preparations are available.  The most commonly used contain aspirin or paracetamol combined with codeine, caffeine and/or an antiemetic.

Combinations specifically licensed for migraine include:

  • Migraleve® - OTC

Pink tablets – codeine, paracetamol  & buclizine

Yellow tablets - codeine & paracetamol

  • Paramax® - POM

Paracetamol & metoclopramide

Tablets, dispersible tablets, suppositories, enteric coated tablets.
IbuprofenNoTablets, modified release tablets, suspension, granules.
DiclofenacYesTablets, modified release tablets, dispersible tablets, injection, suppositories.
NaproxenYesTablets, enteric coated tablets.
Tolfenamic acidYesClotam® rapid tablets.
FlurbiprofenYesTablets, modified release tablets, suppositories.
OtherParacetamolNoTablets, soluble tablets, capsules, suppositories, suspension.
Codeine phosphateDepends on formulation (may be OTC when combined with aspirin or paracetamol)

Tablets, injection, syrup.  Combinations also available as dispersible tablets, tablets, capsules, sachets.

Anti-emetics (anti-sickness)

Action - Anti-emetics relieve the nausea associated with migraine attacks. 

Metoclopramide and domperidone also promote normal activity of the gut and can accelerate the absorption of analgesics. 

Anti-emetics should be taken before or at the same time as analgesics.

Metoclopramide is associated with serious side effects (resulting in symptoms very like Parkinson’s disease) and should be avoided in children and young adults.

Group NameGeneric NamePrescription requiredBrand Name Formulation type
PhenothiazinesDomperidoneSome preparations are OTCGeneric formTablets
Motilium® OTCTablets, suppositories, suspension.
MetoclopramideYesGeneric formTablets, solution, injection.
Maxolon®Tablets, syrup, injection.
Maxolon SR®Capsules
Paramax® - Metoclopramide combined with paracetamolTablets, sachets containing effervescent powder.
MigraMax® - Metoclopramide combined with aspirinSachets containing powder.
ProchlorperazineYesGeneric formTablets
Buccastem®Buccal tablets (dissolve in the mouth).
Stemetil®Tablets, syrup, effervescent granules, injection, suppositories.

Specific anti-migraine drugs

Serotonin (5-HT1) agonists or 'Triptans':

Action - Selective 5-HT1 agonists relieve pain by narrowing blood vessels in the head and blocking the transmission of pain in sensory nerves supplying the skin and structures of the face.

Sumatriptan has been available for the longest period of time and is often compared to the newer triptans in trials.  If one triptan doesn’t work for you then it is worth trying a different one.

Group NameGeneric NamePrescription requiredBrand NameFormulation type
Serotonin (5-HT1) agonists or
‘Triptans’
SumatriptanYes, tablets available on prescription and OTC after assessment by pharmacist.Imigran®Tablets, injection, nasal spray.
AlmotriptanYesAlmogran®Tablets
EletriptanYesRelpax®Tablets
FrovatriptanYesMigard®Tablets
NaratriptanYesNaramig®Tablets
RizatriptanYesMaxalt®, Maxalt Melt®Tablets, wafers.
ZolmitriptanYesZomig®, Zomig Rapimelt®Tablets, nasal spray, wafers.

Ergot Alkaloids:

Action - The BNF (British National Formulary - see the key above for explanation) states: "The value of ergotamine for migraine is limited by difficulties in absorption and by its side effects particularly nausea, vomiting, abdominal pain and muscle cramps.  It is best avoided." 

Recommended doses of ergotamine preparations should NOT be exceeded and treatment should not be repeated at intervals of less than 4 days.  To avoid tolerance, the frequency should be limited to no more than twice a month.  Patients should be warned to stop treatment if numbness or tingling of the extremities develops.  It is most effective if taken at the onset of a migraine attack.

Group NameGeneric NamePrescription requiredBrand NameFormulation type
Ergot AlkaloidsErgotamine tartrateYesCafergot® - Ergotamine and caffeineTablets
  Migril® - Ergotamine, cyclizine and caffeineTablets (Medihaler® discontinued) 

Other - Isometheptene mucate:

Action - Acts by constricting blood vessels in the head and the rest of the body. The BNF (British National Formulary) state that as more effective preparations are now available it is not widely used.

Group NameGeneric NamePrescription requiredBrand NameFormulation type
OtherIsometheptene mucateYes, but also available OTC - packs of 15 and under may be sold under the supervision of the pharmacist.Midrid® - Isometheptene with paracetamolCapsules

Section 2: Prophylactic – treatment to prevent an attack

Beta-blockers

Action - These drugs have several actions:

  • They block or prevent the dilation (widening) of arterial blood vessels in the body
  • They reduce activity of the brain cells involved in migraine

Group Name Generic Name Prescription required Brand Name  Formulation type 
Beta-blockersPropranololYesGeneric form and several brands availableTablets, capsules, solutions (Modified release available)
 MetoprololYesGeneric formTablets
   Betaloc®(Modified release also available)
   Lopressor® 
 AtenololYesGeneric formTablets
   Tenormin® Tablets
 NadololYesCorgard® Tablets
 TimololYesBetim®Tablets

Anti-serotonergic (Anti 5-HT) drugs

Action - Serotonin (5-HT) is a chemical occurring in the body, which is thought to play a key role in migraine.  These drugs block 5-HT2 receptors to stop the effects of 5-HT.

Pizotifen also has anti-histamine properties and is related to the Tricyclic antidepressants.

Methysergide is a semi synthetic ergot alkaloid.  It should only be administered under hospital supervision because of the side effects (retroperitoneal fibrosis and fibrosis of heart values and pleura).

Group NameGeneric NamePrescription requiredBrand NameFormulation type
Anti-serotonergic (Anti 5-HT)PizotifenYesGeneric formTablets
Sanomigran®Tablets, Elixir
MethysergideYesDeseril®Tablets

Tricyclic antidepressants (TCAs)

Action - These drugs are primarily used for depression, however, they are also effective at preventing migraine. 

Serotonin (5-HT) is a chemical occurring in the body, which is thought to play a key role in migraine.  TCAs are thought to:

  • Block the re-uptake of 5-HT
  • May block 5-HT2 receptors

The products shown are most commonly used for the prevention of migraine.

Group NameGeneric NamePrescription requiredBrand NameFormulation type
Tricyclic antidepressants (TCAs)AmitriptylineYesGeneric formTablets, oral solution.
Dosulepin (Dothiepin)YesGeneric formCapsules, tablets.
Prothiaden®Capsules, tablets.
NortriptylineYesAllegron®Tablets

Anti-convulsants

Action - Mode of action in migraine is unclear.  They may reduce the capacity of the nerves to transmit pain signals in the brain.

Group NameGeneric NamePrescription requiredBrand NameFormulation type
Anti-convulsantsSodium valproateYesGeneric formTablets, solution.
Epilim®Tablets, syrup, liquid.
Epilim chrono®Tablets
TopiramateYesTopamax®Tablets
GabapentinYesNeurotonin®Tablets, capsules.

Non-steroidal anti-inflammatory drug (NSAID)

Action - NSAIDs reduce inflammation by inhibiting the production of certain chemicals in the body.

Group NameGeneric NamePrescription requiredBrand NameFormulation type
Non-steroidal anti-inflammatory drug (NSAID)NaproxenYesGeneric formTablets, enteric coated tablets.
Naprosyn®Tablets
Synflex®Tablets

 

Calcium channel blockers (calcium channel antagonists)

Action - Reduces calcium entry into neurons making them less 'excitable'.  Blocks dopamine receptors in the brain.

Group NameGeneric NamePrescription requiredBrand NameFormulation type
Calcium channel blockers (calcium channel antagonists)Flunarizine - this is not widely available in the UK and is usually only prescribed by a specialist.YesSibelium®Tablets

 

Anti-histamines

Action - Anti-histamine with 5-HT antagonist and calcium channel blocking activity.  Mode of action is unclear.

Group NameGeneric NamePrescription requiredBrand NameFormulation type
Anti-histaminesCyproheptadine hydrochlorideNoPeriactin®Tablets

'Centrally acting anti-hypertensive drug'

Action - Licensed for hypertension but has been used for migraine.  Controlled trials show it is not effective for migraine.  The BNF (British National Formulary - see the key above for explanation) states that this drug is not recommended and may aggravate depression or produce insomnia.

Group NameGeneric NamePrescription requiredBrand NameFormulation type
'Centrally acting anti-hypertensive drug'ClonidineYesDixarit® Tablets

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