Neurology

Medicines for Migraine

A common cause of recurrent, often disabling headache, frequently with nausea and sensitivity to light and sound — managed with treatments to stop attacks and, where attacks are frequent, separate medicines to prevent them.

Education and reference only. This explains which medicines are used and why, in plain language — it deliberately contains no doses and is not a substitute for advice from your doctor or pharmacist. Always discuss your own treatment with a qualified clinician, and check the BNF and the product labelling for prescribing detail.

Written by Meds Global Health Clinical Team · Clinically reviewed by Dr Muhammad Suffyan, MB BS, Founder & Clinical Director · Last reviewed · How we review

Quick answer

What is Migraine?

Migraine is far more than an ordinary headache. It is a neurological condition causing recurrent attacks of moderate-to-severe head pain, often throbbing and on one side, commonly with nausea, vomiting and sensitivity to light and sound.

  • How it is treated: There are two distinct sides to migraine treatment, and it is important to keep them separate.
  • Self-care: Keeping a regular routine for sleep, meals and hydration, managing stress, limiting caffeine and alcohol, and identifying personal triggers using a headache diary all help reduce attacks.
  • When to seek help: Seek urgent help (call 999) for a sudden, severe "thunderclap" headache that peaks within seconds, a headache with fever and a stiff neck, weakness, confusion, slurred speech, a fit, or after a head injury.

What it is

Migraine is far more than an ordinary headache. It is a neurological condition causing recurrent attacks of moderate-to-severe head pain, often throbbing and on one side, commonly with nausea, vomiting and sensitivity to light and sound. Some people experience an "aura" beforehand — visual disturbances, tingling or speech changes — that warns an attack is coming. Attacks can last from hours to a few days and can be genuinely disabling, forcing people to stop their usual activities. Migraine tends to run in families and may be set off by triggers such as stress, missed meals, poor sleep, dehydration, certain foods or hormonal changes. Diagnosis is usually clinical, based on the pattern of attacks, with scans reserved for unusual features.

How it is treated

There are two distinct sides to migraine treatment, and it is important to keep them separate. First is acute (abortive) treatment, taken to relieve an attack once it starts — the earlier in the attack, the better it tends to work. Second is preventive treatment, taken regularly to make attacks less frequent and less severe; this is considered when attacks are frequent, long or disabling, or when acute treatments are being used too often. A key safety point is medication-overuse headache: using acute painkillers or migraine-specific treatments on too many days can paradoxically cause more frequent headaches, so acute treatment is limited to a small number of days per month and a headache diary helps track this. Preventive medicines are built up slowly and given a fair trial of some weeks before judging whether they help.

For this condition, these medicines

Medicine classes used for Migraine

Each links to a full, dose-free guide — what it is, how it works, who can and cannot use it, side effects, interactions and FAQs.

Paracetamol Pain A simple acute pain reliever, useful for milder attacks and often a sensible first step. NSAIDs Pain & inflammation Anti-inflammatory painkillers used to relieve an acute attack. Triptans Neurology Migraine-specific acute treatments that act on the mechanisms of an attack; taken when an attack starts. Antiemetics Gastrointestinal Added during an acute attack to ease the nausea and vomiting of migraine, and they may help the painkillers work. Beta-blockers Cardiovascular A first-choice preventive medicine (for example propranolol) taken regularly to reduce how often attacks occur. Tricyclic antidepressants Mental health Used at low intensity as a preventive option (for example amitriptyline), particularly where sleep or tension-type headache also feature. Anti-CGRP migraine treatments Neurology A specialist preventive option considered when several other preventive medicines have been tried without success.

Symptom checker

Symptoms that can point to Migraine

Migraine can be one cause of these symptoms. Each guide explains the other possible causes and the red-flag warning signs that mean you should get urgent help:

HeadachePain anywhere in the head — from a tight band of tension to a throbbing migraine or sinus …VomitingBringing up the contents of the stomach — usually a short-lived response to a tummy bug, m…Double visionSeeing two images of a single object — a symptom that can come from the eye muscles, the n…Slurred speechSpeech that becomes slurred, slow or hard to understand — and when it starts suddenly, one…Sensitivity to lightDiscomfort or pain in the eyes when exposed to light — most often part of a migraine or an…Scalp tendernessSoreness, sensitivity or pain of the scalp, often noticed when brushing the hair or touchi…Seizures or fitsA sudden burst of abnormal electrical activity in the brain that can cause shaking, stiffe…Travel sicknessThe nausea, dizziness, cold sweats and queasiness that some people feel when travelling by…

By active ingredient

Specific medicines used for Migraine

Dose-free guides to individual active ingredients used in migraine — what each is, how it works, how to take it, and its advantages and disadvantages:

PropranololA non-selective beta-blocker with broad uses — blood pressure, migraine prevention and the…NaproxenA common anti-inflammatory painkiller (NSAID) for musculoskeletal pain, gout attacks and s…IbuprofenA widely used anti-inflammatory painkiller for pain, inflammation and fever — effective, b…AmitriptylineAn older antidepressant that, at low intensity, is one of the most useful treatments for n…SumatriptanA triptan taken to stop a migraine attack once it has started — fast and effective for man…DiclofenacA strong anti-inflammatory painkiller (NSAID) for pain and inflammation, with a comparativ…NortriptylineA tricyclic antidepressant used for depression and, at lower intensity, for nerve pain and…ZolmitriptanA triptan taken at the start of a migraine attack to ease the headache and the sickness, l…RizatriptanA fast-acting triptan taken at the start of a migraine attack, including as a melt-in-the-…NaratriptanA slower-acting but longer-lasting triptan taken at the start of a migraine, often chosen …EletriptanA fast-acting, effective triptan taken at the start of a migraine attack to relieve the he…AlmotriptanA triptan that relieves a migraine attack once the headache begins; it is taken at the ons…FrovatriptanA long-acting triptan for migraine attacks; its longer duration makes it useful for migrai…ErenumabA monthly self-injection that prevents migraine attacks by blocking the CGRP pathway invol…PizotifenA migraine-prevention medicine taken regularly to reduce how often migraine attacks happen…FlunarizineA medicine taken regularly to help prevent migraine and for some forms of vertigo.…FremanezumabAn under-the-skin injection given monthly or every three months to prevent migraine attack…GalcanezumabA monthly self-injection given under the skin to prevent migraine and cluster headache.…EptinezumabA drip (infusion) given into a vein every three months to prevent migraine attacks.…RimegepantAn oral melt tablet that both treats an acute migraine and, taken every other day, helps p…UbrogepantAn oral tablet taken during a migraine attack to relieve it, as an alternative to triptans…AtogepantA daily oral tablet taken regularly to prevent migraine attacks.…LasmiditanAn oral tablet taken during a migraine attack that works on serotonin without narrowing bl…BuclizineAn antihistamine used for nausea and vomiting, often included in a combination product tak…MethysergideAn older ergot medicine used short-term, under specialist care, to prevent severe migraine…Botulinum toxin type AAn injection that relaxes overactive muscles or glands, used for several medical condition…NadololA non-selective beta-blocker used for high blood pressure, angina and the prevention of mi…TopiramateA medicine used to help control epilepsy and to prevent migraine attacks.…DihydroergotamineAn ergot medicine used to treat acute attacks of migraine and cluster headache.…ButorphanolAn opioid painkiller, including a nasal spray, used for moderate to severe pain and migrai…ParacetamolThe everyday first-choice painkiller for mild-to-moderate pain and fever — effective, well…

Beyond medication

Lifestyle and self-care

Keeping a regular routine for sleep, meals and hydration, managing stress, limiting caffeine and alcohol, and identifying personal triggers using a headache diary all help reduce attacks. Staying within recommended limits for acute medicines is itself an important preventive measure.

When to get help

When to see a doctor

Seek urgent help (call 999) for a sudden, severe "thunderclap" headache that peaks within seconds, a headache with fever and a stiff neck, weakness, confusion, slurred speech, a fit, or after a head injury. See your GP for a first severe headache, headaches that change in pattern, or those that are becoming more frequent — and review treatment if you are needing acute medicines on many days each month.

999Emergency — call 999 or go to A&E
111Urgent advice — call NHS 111 or use 111 online
GPNon-urgent — see your GP or pharmacist

Not sure how urgent it is? It is always OK to call NHS 111 for advice, day or night.

Answers

Migraine: frequently asked questions

What medicines are used for migraine?

For stopping an attack, options include simple painkillers such as paracetamol, anti-inflammatory painkillers (NSAIDs), migraine-specific triptans, and anti-sickness medicines for the nausea. To prevent frequent attacks, regular medicines such as beta-blockers (for example propranolol) or low-intensity tricyclics (for example amitriptyline) are used, with specialist anti-CGRP treatments considered when these have not worked.

What is the difference between acute and preventive migraine treatment?

Acute (abortive) treatment is taken to relieve an attack once it has begun, and works best taken early. Preventive treatment is taken regularly, whether or not you have a headache, to make attacks less frequent and severe. Many people with frequent migraine need both, but they are different medicines used for different purposes.

Can taking too many painkillers make migraines worse?

Yes. Using acute painkillers or migraine-specific treatments on too many days each month can cause medication-overuse headache — a pattern of more frequent, persistent headache driven by the treatment itself. This is why acute treatments are limited to a small number of days per month, and a headache diary is helpful. If you are using them often, speak to your GP rather than simply taking more.

Do migraine preventers work straight away?

No. Preventive medicines are usually started gently and built up, and need a fair trial of several weeks before you can tell whether they are helping. The aim is fewer and less severe attacks rather than instant relief, so it is worth persevering and reviewing with your prescriber.

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Sources

Where this is drawn from

  • NICE CG150: Headaches in over 12s: diagnosis and management.
  • NICE CKS: Migraine.

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