strongest over-the-counter and prescription drugs a physician may recommend for severe headaches, referred to as migraines.
In the realm of healthcare, migraines continue to pose a significant challenge for many individuals. However, advancements in medical research have led to the development of various treatments to alleviate the symptoms and improve the quality of life for migraine sufferers.
One of the latest classes of migraine treatments are gepants. These medications, such as Zavegepant, available as a fast-acting nasal spray since 2023, are designed to tackle migraines at their onset. Gepants do not constrict blood vessels like some other drugs, instead, they bind to blood vessels to reduce the effect of calcitonin gene-related peptides (CGRPs), which are released by the body during a migraine episode and cause the blood vessels to expand. Gepants may cause dizziness, dry mouth, nausea, and fatigue, but unlike some other drugs, they do not seem to cause headaches from overuse.
Triptans, another class of medications, are well-known for their ability to reduce pain once a migraine episode occurs. They work by binding to serotonin receptors and reducing the dilation of arteries around the brain during a migraine episode. Examples of triptans include sumatriptan, naratriptan, zolmitriptan, rizatriptan, almotriptan, and eletriptan. Triptans may cause side effects such as dizziness, nausea, vomiting, flushing, or neck pain. Around 1% of people who take the medication may experience cardiovascular events such as stroke, heart attack, and arrhythmia.
Ergotamines, a combination of ergotamine drugs and caffeine, can help treat migraine episodes and some other headaches that last longer than usual. However, ergotamines tend to cause more side effects than many other drugs, including nausea, vomiting, muscle cramps and pain, and decreased blood supply at high doses. They are not generally safe for people with a history of cardiovascular disease.
In addition to these treatments, over-the-counter medications such as nonsteroidal anti-inflammatory drugs and acetaminophen may help ease migraine pain. Metoclopramide, an effective antinausea or antiemetic drug, is also used to manage migraine episodes.
For those seeking preventive measures, antidepressants may help with the psychological challenges of living with migraine and reduce the frequency and severity of migraine symptoms by acting on the brain's serotonin system. Topiramate and valproate, originally developed to treat seizures, may also help ease migraine symptoms and prevent migraine episodes.
Beta-blockers, such as propranolol, timolol, metoprolol, atenolol, nadolol, and bisoprolol, are another option for migraine prevention. They may help with migraine episodes and some arrhythmias.
Lasmiditan, a ditan medication, disrupts serotonin receptors and is currently the only drug in its class. It produces fewer cardiovascular side effects than triptans and is safer and more tolerable, with dizziness, nausea, and fatigue being the most common side effects.
Verapamil, a calcium channel blocker, may work off-label to treat migraine episodes, although its mechanism is not fully understood.
The most frequently prescribed preventive migraine medications for adults currently include the oral CGRP receptor antagonists Atogepant and Rimegepant, as well as older options like beta-blockers (e.g., Metoprolol, Propranolol), Topiramate, and Flunarizin. Atogepant is notable as the first oral CGRP receptor antagonist widely used since 2025 for adults with at least 4 migraine days per month, significantly reducing migraine frequency and improving quality of life.
It's essential for individuals to discuss their treatment options with their healthcare provider to determine the best course of action for their specific circumstances. Each person's migraine experience is unique, and finding the right treatment can make a significant difference in managing symptoms and improving overall well-being.
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