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OTC: Wrapping Your Mind Around Migraine Medications


By Debra Kamin   |   April 25, 2019

​Migraines. If you’ve ever had one, you know how debilitating they can be. The crushing pain, often accompanied by sensitivity to light, overwhelming nausea and distressing disturbances in vision, can knock a patient off their feet. More than 38 million Americans each year get migraine headaches — it’s the second most commonly reported type of headache — and with so many sufferers, it’s no surprise that pharmacies carry dozens of different medications, all claiming to help ease the agony.

But if you’re among the unlucky hordes who endure migraines, which purported remedy should you pick? And how do you know when to ask your doctor about a prescription treatment rather than an over the counter one?

woman with hands on face

According to Dani Maria, PharmD, pharmacy supervisor at UC San Diego Health, it’s important to understand the differences that exist within the wide range of both prescription and over-the-counter medications available, and to know when to ask your doctor to upgrade you from over-the-counter treatments to something stronger.

Which OTC drugs are commonly recommended to treat migraine headaches?

NSAIDS — or nonsteroidal anti-inflammatory drugs — are the first line of treatment when it comes to migraines. These include ibuprofen, which is known by the brand names of Motrin and Advil; and naproxen, which is known as Aleve. People can also choose to take aspirin or acetaminophen (Tylenol) for migraines, but since the mechanism of a migraine headache involves inflammation and Tylenol doesn’t have the anti-inflammatory properties, it’s less effective in this case.

Are there over-the-counter pain medications specifically for migraines?

There are. Excedrin is a good example — it has a combination of acetaminophen, aspirin and caffeine. Caffeine is particularly useful in battling a migraine because caffeine will cause blood vessels that have been inflamed by the migraine headache to constrict and shrink back down.

When should a migraine sufferer consider asking for prescription treatment?

The key to knowing when to move to stronger treatment is frequency and intensity. Are you getting several migraine headaches a month? And when you get them, are you finding that Advil, Aleve or other over-the-counter medications aren’t strong enough to truly kick them to the curb? If so, it’s definitely time to talk to your doctor about moving to a prescription.

What are the different types of prescription medications available to treat migraines?

The most commonly prescribed class of drugs for migraine are the triptans. These are all meant to be taken on an as-needed basis, at the first sign of headache, and they include Sumatriptan (Imitrex); Zolmitriptan (Zomig); Rizatriptan (Maxalt); and Eletriptan (Relpax). These are the most popular and the best working drugs, with the best evidence and safety. And all four are fairly similar — the drug your doctor chooses to prescribe you will most likely depend on your insurance and what the cost would be.

How are the drugs administered?

Most of the triptan medications are administered in pill form, but some are also available in a nasal spray or by injection. These methods are particularly helpful for migraine sufferers who get nausea and vomiting along with their headaches; taking medication via injection or nasal spray ensures the medication will stay in your system even if you do become sick.

What about medications that are taken daily for migraine prevention?

For patients who prefer to take medication to prevent migraines rather than treat them as they come, a range of drugs is also available for what’s called off-label use, meaning they were initially designed to treat a different ailment. These include beta blockers, like Propranolol, which is a medication to treat high blood pressure; anti-depressants from the tricyclic family, like Amitriptyline, Amoxapine and Desipramine; and Valproic acid, an anticonvulsant seizure medication. But beware: Beta blockers and anti-seizure medications tend to have severe side effects, so doctors will almost always start their patients on these drugs after other medications don’t work.

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