Since the exact causes of migraine are not fully understood, a wide range of medications is used. In this chapter, we focus on the risks and side effects of the most common migraine drugs.
The Most Accessible Option: Pills
The easiest and most common option is taking pills. Many people choose this approach because of the intense, recurring pain that disrupts daily functioning. However, it is important to remember that medications may carry side effects and a tendency toward dependency. The body can also develop tolerance to active substances, creating a constant need to increase dosage.
Main Categories of Migraine Medication
Acute (symptomatic) treatment: drugs taken during an attack to relieve pain and associated symptoms.
Preventive treatment: drugs taken regularly to reduce the frequency and severity of attacks.
Acute Treatment
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Common pain relievers
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Acetaminophen (Paracetamol): often used for mild to moderate pain. Acts on the central nervous system to reduce pain perception.
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Side effects: liver damage when overused or taken in high doses.
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Paracetamol with caffeine (e.g., Acamol Focus): combines acetaminophen with caffeine, which enhances effectiveness.
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Side effects: nervousness, restlessness, sleep disturbances, rapid or irregular heartbeat, withdrawal symptoms.
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Nonsteroidal anti-inflammatory drugs (NSAIDs): include ibuprofen, naproxen, diclofenac, and aspirin. These reduce pain and inflammation by inhibiting COX-1 and COX-2 enzymes.
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Side effects: stomach irritation, ulcers, bleeding, kidney damage, increased blood pressure.
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Mild opioids: codeine, tramadol. Used for moderate to severe pain when other drugs are insufficient.
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Side effects: drowsiness, dizziness, nausea, constipation, risk of dependency, and respiratory depression in high doses.
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Triptans: act on serotonin receptors, constrict blood vessels in the brain, and reduce the release of pain-related chemicals.
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Examples: sumatriptan, rizatriptan, almotriptan.
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Side effects: chest pressure or heaviness, flushing, dizziness, drowsiness.
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Preventive Treatment
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Antidepressants
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Tricyclics: amitriptyline, nortriptyline.
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SSRIs and SNRIs: fluoxetine, venlafaxine.
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Side effects: dry mouth, weight gain, drowsiness, nausea, sleep disturbances, changes in sexual function.
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Antiepileptic drugs
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Examples: topiramate, valproate.
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Side effects (topiramate): dizziness, fatigue, weight loss, tingling sensations.
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Side effects (valproate): weight gain, tremor, hair loss, liver damage.
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Monoclonal antibodies (Anti-CGRP): an advanced biological approach that directly targets CGRP, a protein involved in migraine pain.
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Examples: erenumab, fremanezumab, galcanezumab.
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Side effects: injection-site reactions, constipation, rare allergic responses.
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Botox: used for chronic migraine (15 or more headache days per month).
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Side effects: pain or swelling at the injection site, localized muscle weakness, eyelid drooping, adaptation to the active compound.
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Non-Drug Approaches
Alongside medication, non-invasive and drug-free approaches also exist, aiming to support relief from migraine symptoms and improve quality of life.
