Migraine Medicines

Name: Migraine Medicines
Creator: Dr Zamiel Hussain

Migraine is a neurological condition characterised by recurrent headache episodes, often accompanied by nausea, light sensitivity, or visual disturbance.

Migraine differs from tension-type headache and requires different treatment strategies.

Medication choice depends on:

Attack frequency
Severity
Presence of aura
Hormonal triggers
Other medical conditions
Medication overuse risk

Effective migraine management often includes both acute treatment and, in some cases, preventative strategies.

These articles are intended as educational sources, not diagnostic nor taking place of a proper medical assessment. If you need help, please book an appointment with one of our GP’s.

Book a GP appointment

Recognising Migraine

Migraine may involve:

Throbbing or pulsating headache
Pain typically on one side of the head
Nausea or vomiting
Sensitivity to light or sound
Visual changes (aura)
Temporary speech or sensory symptoms

Not all migraines include aura.

Correct diagnosis is important before treatment.

Before discussing migraine-specific medicines, it’s helpful to understand how migraines differ from other types of headaches.

Headaches: a quick guide

“Headache” can describe several different conditions. Understanding the pattern helps decide whether symptoms are more consistent with migraine, tension-type headache, or a headache that needs assessment.

Migraine features Often throbbing, may be one-sided, with nausea and sensitivity to light or sound. Some people experience aura (visual or sensory changes).

Tension-type features Often feels like a tight band or pressure, usually both sides, without nausea. Stress, poor sleep, and posture can contribute.

Cluster headache features Severe one-sided pain around the eye, often with watering eye or blocked nose. Attacks occur in clusters (daily for weeks or months), typically at the same time each day. Less common but very severe.

Medication overuse headache Using painkillers or migraine medicines frequently can make headaches more regular over time. Review is advised if headaches are becoming more frequent.

When headaches need review New onset after age 50, progressively worsening pattern, headache with fever or visual changes, or associated neurological symptoms (weakness, confusion, speech changes) need urgent assessment.

Seek urgent medical help for a sudden severe headache, headache with weakness or confusion, fever and neck stiffness, or a new headache pattern that feels significantly different from usual.

Related: Pain relief medicines | Anxiety | High Blood Pressure (Hypertension)

Acute Migraine Medicines

Acute medicines are taken at the start of a migraine attack.

Simple Analgesics

Paracetamol or NSAIDs may help mild to moderate attacks.

These are often most effective when taken early in the attack.

Triptans

Triptans are migraine-specific medicines.

Examples include:

sumatriptan
rizatriptan
zolmitriptan

They work by targeting serotonin receptors involved in migraine pathways.

Triptans are usually taken at the onset of headache rather than during aura alone.

Important considerations

Not suitable for individuals with certain cardiovascular conditions
Should not be overused
May cause temporary chest tightness or flushing

Medical assessment is recommended before first use.

Anti-Sickness Medicines

Medicines such as metoclopramide or prochlorperazine may be used where nausea is prominent.

These can also help improve absorption of pain medication.

Migraine management during pregnancy or breastfeeding requires individual assessment. Some treatments may not be suitable.

Learn more: Pregnancy, Breastfeeding, and Medicines

Preventative Migraine Medicines

Preventative (preventive) migraine treatment aims to reduce how often migraines happen, how severe they feel, and how much they disrupt work, family life, and sleep. It is usually considered when migraines are frequent, prolonged, difficult to control with acute treatments, or when there is a risk of medication overuse headache from repeated painkiller or triptan use.

A preventative plan is typically started alongside lifestyle trigger management such as sleep regularity, hydration, caffeine reduction, and stress support. Most preventatives take time to work, so they are usually reviewed after a trial period to see if there is meaningful improvement.

Common preventative medicine options

Beta blockers
These can help some people by stabilising migraine pathways and reducing attack frequency. They may be particularly useful where migraine overlaps with anxiety-type physical symptoms, palpitations, or high blood pressure.

Amitriptyline and other medicines used for nerve pain
Some medicines used for neuropathic pain are also used as migraine preventatives. Amitriptyline may be helpful when migraine is linked with poor sleep, chronic pain, or coexisting tension-type headaches.

Anti-epileptic medicines
Certain anti-epileptic medicines are used in migraine prevention for selected patients. Suitability depends on medical history and potential side effects, and these options may not be appropriate for everyone.

Newer migraine-specific preventatives
Some newer treatments are initiated under specialist care, particularly for more severe or refractory migraine patterns.

💡 GP insight: A practical note on expectations

Preventative medicines are not instant fixes. The goal is often a clear reduction in frequency and impact rather than eliminating migraine completely. If migraines are changing pattern, becoming more frequent, or affecting day-to-day functioning, a GP review can help decide whether preventative treatment is appropriate and which option is safest.

Printable headache diary (helps your GP assess triggers and patterns)

Keeping a short diary for 2 to 4 weeks can help identify patterns, triggers, and medication overuse.

Tip: Use your browser’s print function (Ctrl+P or Cmd+P) to print this page, then record timing, associated symptoms (nausea, light sensitivity), and any medicines taken.

Date	Start time / duration	Severity (0 to 10)	Symptoms (eg nausea, aura)	Possible triggers (eg stress, sleep)	Medicines taken	Relief / notes

If headaches are sudden and severe, associated with weakness, confusion, fever and neck stiffness, or a new pattern that feels significantly different, seek urgent medical advice.

Medication Overuse Headache

Frequent use of acute migraine medicines may lead to medication overuse headache.

This can occur if:

Triptans are used repeatedly
Painkillers are taken most days
Headaches become more frequent over time

If headaches worsen or become more regular, review is important.

Migraine and Hormones

Hormonal fluctuations can trigger migraine in some individuals.

This may occur:

Around menstruation
During perimenopause
With certain contraceptive methods

Migraine with aura may influence contraception choice.

Medical review is important when hormonal triggers are suspected.

Learn more: Painful or Heavy Periods | Women’s Health and Hormonal Medicines

When Migraine Needs Urgent Assessment

Seek urgent medical attention if headache is:

Sudden and severe (“worst headache ever”)
Associated with weakness or confusion
Accompanied by fever and neck stiffness
New after age 50
Progressively worsening
Following head injury

Most migraines are not dangerous, but new or unusual symptoms should be assessed., or rapidly worsening neurological symptoms require urgent medical assessment.

Frequently Asked Questions

1. What is the best medicine for migraine?

The most suitable medicine depends on the severity and frequency of attacks. Some people respond to simple pain relief, while others benefit from migraine-specific treatments such as triptans. Individual assessment and management is required.

2. Can I take triptans regularly?

Triptans are intended for acute migraine attacks. Frequent use may increase the risk of medication overuse headache. Review is recommended if migraines become more frequent.