HOW THEY’RE ADMINISTERED tablet, capsule
TYPES amitriptyline (Amitid, Amitril, Elavil, Endep, Vanatrip), nortriptyline (Aventyl, Pamelor)
Blood-Pressure Medications
WHAT THEY ARE Anti-hypertensive medications used to treat cardiovascular conditions like high blood pressure are also commonly prescribed for migraine prevention. This includes beta blockers like propranolol (the most commonly recommended), timolol, and metoprolol tartrate. Calcium channel blockers such as verapamil (Verelan) may be even more effective than beta blockers in preventing migraine with aura. There is also evidence from clinical trials that lisinopril, a different kind of blood-pressure medication known as an ACE inhibitor, helps in preventing migraines.
HOW THEY WORK These drugs reduce blood-vessel dilation, which is a factor that contributes to migraine, and also calm the nervous system by reducing electrical activity.
HOW THEY’RE ADMINISTERED oral tablets, capsules
TYPES atenolol (Tenormin), candesartan (Atacand), metoprolol tartrate (Lopressor), nadolol (Corgard), lisinopril (Qbrelis, Prinivil, Zestril), propranolol (Inderal, InnoPran XL), timolol (Timoptic, Timoptic-xe, Istalol), verapamil (Verelan)
Botulinum Toxin
WHAT IT IS A purified version of a neurotoxin produced by the bacteria that causes botulism. Injected in targeted microdoses, these neuromodulating drugs temporarily relax muscle contractions for up to three months. Generally used cosmetically to treat and prevent wrinkles, this drug can also help prevent migraine attacks and was FDA-approved for this purpose in 2010.
HOW IT WORKS When administered via tiny needle by a neurologist or headache specialist, botulinum toxin enters nerve endings near the injection point and interrupts the pathway of chemicals in the brain and spinal-cord nerves that cause migraine pain. It generally takes two or three treatments to see a difference in the frequency and severity of migraine attacks, with benefits increasing over time.
HOW IT’S ADMINISTERED multiple injections into the head and neck every few months
TYPES onabotulinumtoxinA (Botox), abobotulinumtoxinA (Dysport), incobotulinumtoxinA (Xeomin), prabotulinumtoxinA-xvfs (Jeuveau), daxibotulinumtoxinA-lanm (Daxxify)
CGRP Inhibitors
WHAT THEY ARE Relatively new drugs—the first was FDA approved in 2018—designed specifically to prevent migraine attacks, with few serious side effects. There are two types of CGRP inhibitors: monoclonal antibodies, which are administered via injection or IV, and the newer gepants, which are taken orally or nasally.
HOW THEY WORK CGRP inhibitors (also known as CGRP antagonists) interfere with the production of calcitonin gene-related peptide (CGRP), a molecule within the brain/spinal cord that’s involved in pain transmission and blood-vessel dilation and has been pinpointed as a trigger for migraine symptoms.
HOW THEY’RE ADMINISTERED oral medication or nasal spray, in the case of gepants, or via monthly or quarterly self-injections (using a pre-filled pen or syringe) or IV infusions, in the case of monoclonal antibodies.
TYPES atogepant (Qulipta), eptinezumab (Vyepti), erenumab (Aimovig), fremanezumab (Ajovy), galcanezumab (Emgality), rimegepant (Nurtec), ubrogepant (Ubrelvy), zavegepant (Zavzpret)
Ergots
WHAT THEY ARE The oldest migraine-specific medications, released in 1926, are still in use because they can quickly relieve severe headache pain and other migraine symptoms, including sensitivity to light and sound. However, ergots (also known as ergot alkaloids) can have serious side effects, including reducing blood flow to various parts of the body, so doctors usually reserve them for patients whose severe migraine symptoms don’t respond to other pain relievers like triptans.
