Headache Medicine

What are headache medicines?

If you get headache pain, medications can bring relief. You can buy some headache medications right off the shelf at the store. These drugs are known as over-the-counter (OTC) pain relievers. With other headache medications, you need a medical prescription. Your healthcare provider can help you figure out the best medicine for your needs.

There are three types of headache medications:

• Relief for pain and other symptoms.
• Abortive therapies to stop the process behind headache pain.
• Preventive therapy to reduce how often and how severe your headaches are.

What are the types of headaches?

Primary headaches are headaches that aren’t caused by another condition. They include:

• Cluster headaches.
• Migraines.
• New daily persistent headaches (NDPH).
• Tension headaches.

A secondary headache is when head pain comes from another medical condition, such as a head injury, sinus infection or high blood pressure.

How can I increase the effectiveness of headache medicines?

Headache medications are most effective when you combine them with other recommendations for healthy living:

• Exercise.
• Hydration (at least six glasses of water a day).
• No potential trigger foods in diet.
• Plenty of sleep (at least seven hours a night).
• Relaxation therapy.

Is it possible to overmedicate?

It’s tempting — and easy — to rely too heavily on headache medications. Some people experience daily or almost-daily headaches. For those that get migraines, the headaches may seem to blend together, with no beginning or end. You may feel the need to reach for medications to relieve symptoms or stop headaches in their tracks.

But doing so can actually make headaches worse or more frequent. In particular:

• Daily or near-daily use of relief medications can interfere with certain parts of the brain. These parts control the flow of pain messages to the nervous system. Over-the-counter medications can pose a risk, including aspirin, acetaminophen, ibuprofen, and drugs with caffeine. So can prescription medications such as triptans, narcotics and barbiturates.
• Overmedicating with abortive therapies can lower the effectiveness of preventive drugs.

What’s a rebound headache?

Some headaches rebound (come back) because you use medications too much. Then you need to take even more medication, which makes the pain worse. This cycle can happen with:

• Taking pain relievers (either OTC or prescription) more than two days a week.
• Overusing abortive medications, with headaches returning after the last dose.

Talk to your healthcare provider about stopping medications. If you stop, the pain may improve over the next six to 12 weeks.

How can I manage headache pain?

These steps can help you or a loved one manage headache pain:

Medication tips

• Limit OTC and prescription medication use to two days per week. Too much medicine can increase headaches.
• Take medicine at the first sign of a headache.
• Take prescription medications as directed.
• Keep regular follow-up visits with a healthcare provider.

Headache education

• Educate yourself and your family about the type of headache you have and the treatment options.
• Maintain a headache diary to figure out headache patterns and triggers.
• Ask your provider for written instructions for what to do when a headache strikes.
• Call your provider when problems arise.

Lifestyle changes

• Don’t skip meals, especially breakfast.
• Get at least seven hours of sleep every night.
• Exercise for 30 minutes a day.
• Drink six to eight glasses of water a day.
• Identify and avoid headache triggers. These may include caffeinated foods and beverages, as well as many types of chips and other “junk” food. They may also include chemicals known as nitrates (found in deli meats, sausage, hot dogs and pepperoni) and tyramine (in aged cheeses and pizza).

Strategies at home

• Rest in a cool, dark, quiet room as needed.
• Use relaxation strategies to reduce stress.
• Apply a cold compress to your head.

What is an off-label drug?

Sometimes regulators approve a medicine for a specific use and researchers find it helps for another condition, too. Healthcare providers may then choose to prescribe the medicine for additional uses. That’s called “off-label” prescribing. It can also include healthcare providers giving children drugs approved for adults when there aren’t other good options.

Many of the medications used for headache pain weren’t approved specifically for that reason. Examples include medications designed for heart disease that also help with migraines.

Are off-label drugs safe?

Off-label prescribing is a common and legal practice in medicine. It’s also one of the ways researchers find new uses for existing, approved drugs. In many cases, it can lead to new clinical trials.

Always check with your healthcare provider before starting any medications.

How can I use headache medications safely?

Follow your provider’s instructions when it comes to taking any medication. Your provider will likely recommend that you:

• Start with pain medications least likely to form addictive habits.
• Avoid narcotic analgesics if possible.
• Begin with the lowest strength dose.
• Use caution with higher doses and stronger medications.
• Try to avoid frequent use. The more often you take medicine, the greater the chance it becomes harmful and less effective.

What should I know about OTC pain relievers?

Nonprescription medications, also called OTC drugs, are safe when used as directed. Keep these precautions in mind:

• Read the label: Know the active ingredient in the medicine.
• Watch the dose: Make sure you don’t take more than the recommended dosage for age.
• Avoid overmedicating: Consider how you use pain relievers and other medications.
• Talk with your healthcare provider: Discuss any medications with your provider, especially before taking products with aspirin, ibuprofen or naproxen sodium.
• Take care with medication for children: Don’t give children medication with aspirin or caffeine. Aspirin may lead to Reye’s syndrome.
• Avoid combinations: Don’t combine medications that contain caffeine, barbiturates and narcotics.

Is there a cure for migraines?

There is no cure for headaches, including migraines. Treatment can help relieve pain and other symptoms. If you get frequent headaches, including chronic migraines, talk to your healthcare provider about preventive medications.

What are the alternatives to medications for headaches?

There are several ways to manage headache pain without medication. Sticking to a healthy diet, drinking plenty of water and getting regular exercise can help you feel your best.

Many people who experience migraines also find relief through alternative medicine. Options may include:

• Acupuncture: A provider inserts thin needles into your body at specific points to relieve pain. The needles are not painful. You may need a few weeks of acupuncture to start feeling the effects.
• Biofeedback: During biofeedback, you learn to control certain nervous system functions. These include your heart rate, body temperature, muscle tension and blood pressure.
• Relaxation and mindfulness strategies: These techniques can also help improve headache symptoms.

Can I take headache medications if I’m pregnant or breastfeeding?

If you are pregnant or breastfeeding, talk to your healthcare provider before taking any pain relief medication. Your provider will help you find a treatment that relieves your pain and keeps you and your baby safe.

When should I call my healthcare provider about a headache?

If you have these symptoms, see your healthcare provider or go to the emergency room:

• Feeling that you’re having “the worst headache ever.”
• Headache that comes with vision loss, vomiting or loss of consciousness.
• Headache pain lasting more than 72 hours, with less than four pain-free hours in a row while awake.
• Feeling that something is “off” or not right.

Medications to relieve headache symptoms

How do symptomatic relief medications work?

These medicines help you find relief from the symptoms that may come with headaches, such as pain, nausea and vomiting. Some of these medicines are available over the counter. Others require a prescription.

Try to avoid:

• Foods, beverages and medications containing caffeine when taking these medications.
• Medications containing barbiturates (butalbital) or narcotics (codeine), if possible.
• Medications with aspirin, for young children.

Can a child take medications to relieve headache symptoms?

The U.S. Food and Drug Administration (FDA) has not approved many of these medications for children. Talk to your healthcare provider if your child has headaches or migraines.

What OTC medications can relieve headache symptoms?

These medications provide relief from headache symptoms, without a prescription:

Generic name: Aspirin

• Brand name: Bayer®, Bufferin®, Ecotrin®.
• Symptoms relieved: Fever and pain.
• Precautions and possible side effects: Heartburn, gastrointestinal (GI) bleeding, bronchospasm or constriction that causes narrowing of the airways, anaphylaxis and peptic ulcer. Don’t give aspirin to children under 14 years old. It can cause a rare but serious disease called Reye’s syndrome.

Generic name: Acetaminophen, paracetamol

• Brand name: Tylenol®.
• Symptoms relieved: Fever and pain.
• Precautions and possible side effects: Changes in blood counts and liver function, but side effects are rare if medication is taken as directed.

Generic name: Ibuprofen (NSAID, or nonsteroidal anti-inflammatory drug)

• Brand name: Advil®, Motrin IB®, Nuprin®.
• Symptoms relieved: Fever, pain and inflammation.
• Precautions and possible side effects: GI upset, GI bleeding, nausea, vomiting, rash and changes in liver function.

Generic Name: Naproxen sodium (NSAID)

• Brand name: Aleve®.
• Symptoms relieved: Pain.
• Precautions and possible side effects: GI upset, GI bleeding, nausea, vomiting, rash and changes in liver function.

What prescription medications can I take for headache symptom relief?

Talk to your healthcare provider to find out if any of these prescription medications may be right for you:

Generic name: Antiemetics promethazine HCI

• Form: Tablet, syrup, injection or suppository.
• Brand name: Phenergan®.
• Symptoms relieved: Nausea, vomiting.
• Precautions and possible side effects: Confusion, drowsiness, dizziness, GI upset, excitability, nightmares, uncontrollable muscle movements, and lip-smacking or chewing movements.

Generic name: Prochlorperazine

• Form: Suppository.
• Brand name: Compazine®.
• Symptoms relieved: Nausea, vomiting.
• Precautions and possible side effects: Confusion, drowsiness, dizziness, GI upset, excitability, nightmares, uncontrollable muscle movements, and lip-smacking or chewing.

Generic name: Trimethobenzamide HCI

• Form: Capsule injection, syrup or suppository.
• Brand name: Tigran®.
• Symptoms relieved: Nausea, vomiting.
• Precautions and possible side effects: Hypotension, blurred vision, drowsiness, dizziness, disorientation, uncontrollable muscle movements, and lip-smacking or chewing.

Generic name: Metoclopramide HCI

• Form: Syrup, tablet or injection.
• Brand name: Reglan®.
• Symptoms relieved: Nausea, vomiting.
• Precautions and possible side effects: Uncontrollable muscle movements, lip-smacking or chewing movements, sensitivity to sunlight, aching of lower legs, and diarrhea.

Generic name: Antihistamines cyproheptadine HCI

• Form: Syrup or tablet.
• Brand name: Periactin®.
• Symptoms relieved: Sleeplessness, length of migraine.
• Precautions and possible side effects: Weight gain, drowsiness.

Generic name: Diphenhydramine HCI

• Form: Tablet, liquid, liquid-gel.
• Brand name: Benadryl® (over-the-counter).
• Symptoms relieved: Nausea, vomiting
• Precautions and possible side effects: Sleepiness, dizziness, disturbed coordination, behavioral changes.

Abortive therapy for headaches

How does abortive therapy work?

You take abortive therapy medications early during a headache. They’re usually used for migraine headaches. These drugs stop the process causing headache pain. They help reduce headache symptoms, such as nausea, vomiting and sensitivity to light and sound.

For best results, take these medicines when you first notice the migraine. If you get a migraine aura (disturbance of senses), you may need to avoid some of these medications. Talk to your healthcare provider to figure out which medications are right for you.

Can IV drugs help stop a migraine?

Some headaches — especially migraines — last for more than 24 hours and don’t respond to other abortive medications. In these situations, your healthcare provider may recommend you get medication at an infusion site.

This site is usually a set of rooms at a hospital or clinic where people receive IV drugs. A nurse monitors the people receiving infusions. Generally, IV drugs can end the migraine attack, even when other abortive medicines were unsuccessful. You may be at the infusion site for a few hours or a full day, depending on your symptoms.

Can children take abortive therapies?

The FDA has approved some abortive therapies for teenagers but none for younger children. Talk to your child’s healthcare provider to figure out the best way to treat headaches.

What abortive therapy headache medicines are available?

Medications that can stop migraine headaches include:

Generic name: Ergot, dihydroergotamine, mesylate

• Brand name: DHE-45®, Injection Migranal® intranasal.
• Possible side effects: Nausea, numbness of fingers and toes. These medications cause narrowing of your blood vessels. If you have a history of coronary artery disease, myocardial infarction or stroke, you shouldn’t take these medications.

Generic Name: Triptans, sumatriptan succinate*, zolmitriptan*, rizatriptan*, naratriptan HCI†, almotriptan malate*$, frovatriptan succinate†, eletriptan hydrobromide*

• Brand name: Imitrex® injection, oral or intranasal; Zomig®, oral or Intranasal; Maxalt® oral; Amerge®oral; Axert® oral; Frova® oral; Relpax ®oral.
• Possible side effects: Nausea, headache, sleepiness, dry mouth, dizziness, fatigue, hot or cold sensations, chest pain, flushing, sense of tightness around chest or throat, numbness. (However, people generally tolerate these medicines well.) These medications cause narrowing of your blood vessels. If you have a history of coronary artery disease, myocardial infarction or stroke, you shouldn’t take these medications.

*short-acting
†= long-acting
$ = FDA approved for teens ages 12 to 18

Preventive therapy for headaches

How does preventive therapy work?

Some people take daily medications to prevent headaches. In many cases, researchers developed these medications for other medical conditions. But they discovered that the drugs also help headaches. These medications won’t cure headaches. However, they can reduce the frequency, duration and severity of headache attacks.

Preventive medications can be either OTC or prescription. While these drugs are not habit-forming, they may cause unpleasant side effects. Your healthcare provider will work with you to regulate the dosage. The goal is to maximize headache relief and minimize side effects.

Should I consider preventive therapy?

If you use symptomatic relief or abortive therapies more than twice a week, talk to your healthcare provider about daily preventive therapy. In addition, try other forms of headache treatment to decrease your headache attacks, such as:

• Adequate hydration (six to eight glasses of water per day).
• Biofeedback.
• Enough sleep (at least eight hours per night).
• Exercise.
• Dietary changes.

What should I expect when taking preventive headache medications?

You need to take preventive medicines one or more times a day. Stick to your medication regimen, and don’t skip a day. You may find that you need to switch medications and change dosages until you figure out the right solution for you.

While you’re taking the medication, record your headache frequency and severity each day. Doing so will help your provider figure out how the medicines are working. And remember, it may take some time to feel the full effects. Typically, you need about eight weeks before you and your provider can judge how it’s working.

Can I ever stop taking preventive medications?

Once you’ve achieved headache control and maintained it for six months to a year, you may be able to stop the medications. Don’t stop taking them all at once — your provider will help you slowly reduce the dosage. Some people may need to take the medication longer.

Can children take preventive therapies?

The FDA has not approved preventive therapies for use in children. Talk to your child’s healthcare provider to figure out the best treatment plan for any headaches.

What types of preventive therapy medications are available?

Medications to prevent headaches include:

Generic name: Amitriptyline HCI

• Brand name: Elavil®.
• Possible major side effects: Fatigue, dry mouth, weight gain and constipation.
• Instructions when used for headaches: Start at low dosages and slowly increase to a therapeutic level. Usually taken at night. You may need an EKG.

Generic name: Antihistaminescyproheptadine HCI (syrup or tablet)

• Brand name: Periactin®.
• Possible major side effects: May induce sleep. Can cause weight gain and drowsiness.
• Instructions when used for headaches: Start at low dosages and slowly increase. Usually taken at bedtime.

Generic name: Botulinum toxin injection

• Brand name: Botox®, Dysport®, Seomin® and Mybloc®.
• Possible side effects: Side effects from botulinum toxin injections vary depending on the area receiving treatment. Most problems improve in a day or two. They include: pain, swelling or discoloration at the injection site, flu-like symptoms, headache, neck pain, upset stomach, eyelid drooping and eye irritation or redness.

Generic name: Calcitonin gene receptor peptide (CGRP) antagonist, erenumab-aooe

• Brand name: Aimovig®.
• Possible side effects: Injection site reaction, constipation, cramps and muscle spasms.

Generic name: Gepants, rimegepant

• Brand name: NURTEC®.
• Possible side effects: Allergic reactions, including trouble breathing and rash, nausea, stomach pain/indigestion.

Generic name: Beta blockers atenolol, propranolol HCI

• Brand name: Tenormin®, Inderal®.
• Possible major side effects: Fatigue, depression, weight gain, faintness and diarrhea, memory disturbance, decreased performance among athletes.
• Instructions when used for headaches: One to three times a day, depending on the form.

Generic name: Calcium channel blockers, verapamil, flunarizine

• Brand name: Calan®, Isoptin®, Sibelium®.
• Possible major side effects: Constipation, dizziness, hair loss.
• Instructions when used for headaches: Start at low dosages and slowly increase. Taken twice a day. Usually, the first dose is in the morning.

Generic name: Anticonvulsants valproic acid

• Brand name: Depakote®.
• Possible major side effects: Nausea, drowsiness, weight gain, tremors, rare liver failure. May cause birth defects.
• Instructions when used for headaches: Start at low dosages and slowly increase. You may need periodic blood tests.

Generic name: Topiramate

• Brand name: Topamax®.
• Possible major side effects: Rare: glaucoma, kidney stones (when you take a higher dose, usually more than 150 milligrams), weight loss, word-finding difficulties.
• Instructions when used for headaches: Start at low dosages and slowly increase. May be taken two to three times per day.

Generic name: Gabapentin

• Brand name: Neurontin®.
• Possible major side effects: Generally well tolerated.
• Instructions when used for headaches: Start at low dosages and slowly increase. May be taken two to three times per day.

*Other SSRIs include citalopram (Celexa®), escitalopram (Lexapro®), fluvoxamine (Luvox®), paroxetine (Paxil®), sertraline (Zoloft®).