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:
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 Name | Generic Name | Prescription required | Brand Name | Formulation 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: Pink tablets – codeine, paracetamol & buclizine Yellow tablets - codeine & paracetamol Paracetamol & metoclopramide | Tablets, dispersible tablets, suppositories, enteric coated tablets. |
| Ibuprofen | No | Tablets, modified release tablets, suspension, granules. |
| Diclofenac | Yes | Tablets, modified release tablets, dispersible tablets, injection, suppositories. |
| Naproxen | Yes | Tablets, enteric coated tablets. |
| Tolfenamic acid | Yes | Clotam® rapid tablets. |
| Flurbiprofen | Yes | Tablets, modified release tablets, suppositories. |
| Other | Paracetamol | No | Tablets, soluble tablets, capsules, suppositories, suspension. |
| Codeine phosphate | Depends 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 Name | Generic Name | Prescription required | Brand Name | Formulation type |
| Phenothiazines | Domperidone | Some preparations are OTC | Generic form | Tablets |
| Motilium® OTC | Tablets, suppositories, suspension. |
| Metoclopramide | Yes | Generic form | Tablets, solution, injection. |
| Maxolon® | Tablets, syrup, injection. |
| Maxolon SR® | Capsules |
| Paramax® - Metoclopramide combined with paracetamol | Tablets, sachets containing effervescent powder. |
| MigraMax® - Metoclopramide combined with aspirin | Sachets containing powder. |
| Prochlorperazine | Yes | Generic form | Tablets |
| 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 Name | Generic Name | Prescription required | Brand Name | Formulation type |
Serotonin (5-HT1) agonists or
‘Triptans’ | Sumatriptan | Yes, tablets available on prescription and OTC after assessment by pharmacist. | Imigran® | Tablets, injection, nasal spray. |
| Almotriptan | Yes | Almogran® | Tablets |
| Eletriptan | Yes | Relpax® | Tablets |
| Frovatriptan | Yes | Migard® | Tablets |
| Naratriptan | Yes | Naramig® | Tablets |
| Rizatriptan | Yes | Maxalt®, Maxalt Melt® | Tablets, wafers. |
| Zolmitriptan | Yes | Zomig®, 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 Name | Generic Name | Prescription required | Brand Name | Formulation type |
| Ergot Alkaloids | Ergotamine tartrate | Yes | Cafergot® - Ergotamine and caffeine | Tablets |
| | | Migril® - Ergotamine, cyclizine and caffeine | Tablets (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 Name | Generic Name | Prescription required | Brand Name | Formulation type |
| Other | Isometheptene mucate | Yes, but also available OTC - packs of 15 and under may be sold under the supervision of the pharmacist. | Midrid® - Isometheptene with paracetamol | Capsules |
Section 2: Prophylactic – treatment to prevent an attack
Beta-blockers
Action - These drugs have several actions:
| Group Name | Generic Name | Prescription required | Brand Name | Formulation type |
| Beta-blockers | Propranolol | Yes | Generic form and several brands available | Tablets, capsules, solutions (Modified release available) |
| | Metoprolol | Yes | Generic form | Tablets |
| | | | Betaloc® | (Modified release also available) |
| | | | Lopressor® | |
| | Atenolol | Yes | Generic form | Tablets |
| | | | Tenormin® | Tablets |
| | Nadolol | Yes | Corgard® | Tablets |
| | Timolol | Yes | Betim® | 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 Name | Generic Name | Prescription required | Brand Name | Formulation type |
| Anti-serotonergic (Anti 5-HT) | Pizotifen | Yes | Generic form | Tablets |
| Sanomigran® | Tablets, Elixir |
| Methysergide | Yes | Deseril® | 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:
The products shown are most commonly used for the prevention of migraine.
| Group Name | Generic Name | Prescription required | Brand Name | Formulation type |
| Tricyclic antidepressants (TCAs) | Amitriptyline | Yes | Generic form | Tablets, oral solution. |
| Dosulepin (Dothiepin) | Yes | Generic form | Capsules, tablets. |
| Prothiaden® | Capsules, tablets. |
| Nortriptyline | Yes | Allegron® | 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 Name | Generic Name | Prescription required | Brand Name | Formulation type |
| Anti-convulsants | Sodium valproate | Yes | Generic form | Tablets, solution. |
| Epilim® | Tablets, syrup, liquid. |
| Epilim chrono® | Tablets |
| Topiramate | Yes | Topamax® | Tablets |
| Gabapentin | Yes | Neurotonin® | Tablets, capsules. |
Non-steroidal anti-inflammatory drug (NSAID)
Action - NSAIDs reduce inflammation by inhibiting the production of certain chemicals in the body.
| Group Name | Generic Name | Prescription required | Brand Name | Formulation type |
| Non-steroidal anti-inflammatory drug (NSAID) | Naproxen | Yes | Generic form | Tablets, 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 Name | Generic Name | Prescription required | Brand Name | Formulation type |
| Calcium channel blockers (calcium channel antagonists) | Flunarizine - this is not widely available in the UK and is usually only prescribed by a specialist. | Yes | Sibelium® | Tablets |
Anti-histamines
Action - Anti-histamine with 5-HT antagonist and calcium channel blocking activity. Mode of action is unclear.
| Group Name | Generic Name | Prescription required | Brand Name | Formulation type |
| Anti-histamines | Cyproheptadine hydrochloride | No | Periactin® | 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 Name | Generic Name | Prescription required | Brand Name | Formulation type |
| 'Centrally acting anti-hypertensive drug' | Clonidine | Yes | Dixarit® | Tablets |