If you have chronic migraine, it can be helpful to
understand your treatment options. As you explore different types of
medication, consider what will best fit your lifestyle and improve your
quality of life.
If you experience migraine episodes, you know how symptoms can change your plans for hours or days.
Migraine headaches are chronic when you have 15 or more headache days per month. If migraine headaches happen less often, they’re called episodic.
Up to 5% of people in the United States get chronic migraine headaches.
Each year, about 3% of people who have episodic migraine shift into chronic migraine. Risk factors for developing chronic migraine can include:
anxiety or depression
asthma
head or neck injuries
obesity
overusing caffeine or migraine medications
snoring or other sleep problems
stress
Treating these risk factors may help prevent migraine headaches from
becoming chronic. It may also help reduce how often chronic migraine
episodes occur.
A chronic migraine headache needs acute medications to treat headache
pain and other symptoms. There’s also a strong need for preventive
medications to help keep headaches away.
The goal of acute medications is to stop the headache. There are multiple goals of preventive medications, including reducing:
the need for acute medications, which helps avoid overusing them
how often headaches happen
how severe headaches are
how long headaches last
disability from headaches
Both acute and preventive medications are available as oral and injectable drugs.
Oral medications for chronic migraine
There are several classes of oral medications for treating chronic migraine. They each have benefits and drawbacks you can consider.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Examples of drugs in this class include ibuprofen (Advil, Motrin) or
naproxen (Aleve, Naprosyn). These drugs are usually the first choice for
treating migraine episodes. They’re acute migraine medications.
They come in prescription and over-the-counter forms. They’re usually
effective for mild to moderate headaches without other symptoms.
Triptans
Examples of drugs in this class include sumatriptan (Imitrex) or
zolmitriptan (Zomig). These drugs can treat more severe headaches and
may work when NSAIDs do not help.
It’s recommended to limit how often you use a triptan to less than 10
days per month. This can be a challenge with chronic migraine.
Also, some people should not take triptans, including people with heart or blood vessel conditions.
Gepants
This class includes rimegepant (Nurtec ODT) and ubrogepant (Ubrelvy). These drugs work as well as triptans but with some advantages, including:
They can work as an acute treatment to stop a migraine episode.
They can also work to prevent migraine.
There’s less concern about how often you need to use them.
Most people can use them, even those with heart or blood vessel problems.
Because they are oral medications, you may take them regularly (every day or every other day) to prevent chronic migraine.
Ergots
Ergotamine in combination with caffeine (Cafergot) is an oral medication
in this class. While it’s an option to stop a migraine headache, it
often causes side effects.
Other oral medications for preventing chronic migraine
There are other classes of oral medications that help prevent chronic
migraine. Their main drawback is that they’re not specific to migraine.
Instead, they are drugs for other conditions that may also help with migraine. These include:
antidepressants
anti-seizure medications
beta-blockers
calcium channel blockers
You usually have to take these drugs every day. They can also cause side effects.
Injectable medications for chronic migraine
The triptans and ergots mentioned above also come in injectable forms.
Both of these classes are for stopping a migraine attack. The injectable
forms have the same drawbacks as the oral forms.
However, there are other classes of injectable medications for preventing chronic migraine.
Onabotulinumtoxin A (Botox)
Onabotulinumtoxin A was the first injectable
drug with approval for preventing chronic migraine. And it still is
likely to be the most effective treatment. It has the potential to
reduce your number of headache days per month by 50%.
The main drawback of this option is that it requires 31 injections in the head and neck every 12 weeks at a doctor’s office.
CGRP inhibitors
These are the newest injectable drugs for preventing chronic migraine. This class includes:
erenumab (Aimovig), which you give yourself once a month
eptinezumab (Vyepti), an injection you get in a doctor’s office every 3 months
fremanezumab (Ajovy), which you give yourself with dosing once a month or every 3 months
galcanezumab (Emgality), which you give yourself once a month
These are biologic drugs that are also very effective in preventing
chronic migraine. You may have 6–8 fewer headache days with these
drugs.
Takeaway
Research suggests
that people are more likely to stick with newer injectable CGRP
inhibitors. However, the best choice for you will likely come down to
your personal preference.
Some people want the convenience of oral medication. Others like the
freedom from a daily medication to prevent chronic migraine. Talk with a
doctor to find the right fit for you.
