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Understanding Fast-Acting Migraine Medication: A Guide

Fast-acting migraine medication can wipe out a headache. But according to Christopher Gottschalk, MD, director of the Yale Headache & Facial Pain Center, this pain-free possibility often comes as a surprise to many who live with the neurological condition. The speed and success of each drug may vary with each attack.

“But one of the things I emphasize to people is I want to be sure that when you treat a migraine, you feel totally better in an hour or two,” he says. “And I say that to people every single day.” Total or partial relief may come well before the 2-hour mark for some. Ask your doctor to go over the pros and cons of all your treatment choices. They’ll help you find the most effective medicine for your symptoms.

What Medications Treat Migraine?

If you get only mild head pain every now and then, it’s worth asking your doctor if acetaminophen or high doses of nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, or naproxen might be right for you. But people with migraine who get good results from general painkillers are “few and far between,” says Anne Yacoub, MD, an assistant professor of neurology and co-director of the Johns Hopkins Headache Center.

The good news is there are a growing number of migraine-specific drugs used to ease headaches after they start. These medications target specific nerves and pathways that stop or reverse the migraine process. You may hear your doctor call this acute treatment.

Here’s a breakdown of drugs used to treat acute migraine headaches:

  • Triptans: These drugs act on a brain chemical called serotonin. Examples of triptans include: Almotriptan (Axert), Eletriptan (Relpax), Frovatriptan (Frova), Naratriptan (Amerge), Rizatriptan (Maxalt, Maxalt-MLT), Sumatriptan (Imitrex), Zolmitriptan (Zomig ZMT, Zomig)
  • Gepants: Also called CGRP antagonists, with examples including Rimegepant (Nurtec ODT), Ubrogepant (Ubrelvy), Zavegepant (Zavzpret)
  • Ditans: The only ditan approved for acute migraine treatment is Lasmiditan (Reyvow)
  • Dihydroergotamine: Known as DHE for short

These drugs target very specific serotonin receptors that play a role in migraine pain. But unlike triptans, they don’t narrow your blood vessels. Talk to your doctor about it if you have heart or blood vessel conditions, can’t handle side effects from other migraine meds, or don’t respond well to triptans.

When it comes to taking fast-acting migraine drugs, “Basically, the door is open for a couple of hours in the beginning of an attack,” Gottschalk says. “And then it pretty much closes.”

Which Migraine Medication Is Right for You?

There are some key questions to guide you and your doctor toward the right medication. Three things Yacoub likes to ask people with migraine are:

  1. Does your headache pain ramp up really quickly?
  2. Do you get nausea early during an attack?
  3. Do you often wake up with a headache?

If people answer yes to any of those things, Yacoub says shots and nasal sprays tend to be a good first choice. That’s because these non-oral forms get migraine medication into your bloodstream faster than a pill and bypass your gut. But the right migraine medication for you depends on several things.

When to Change Your Migraine Medication

In general, acute treatment shouldn’t be used more than two or three times a week. One worry is something called medication overuse headache. That’s the idea that symptom-relieving drugs may cause more headaches over time. There’s no strong evidence that all migraine-specific drugs lead to medication overuse headache. In fact, gepants are a type of acute treatment that can also be used as preventive therapy. But according to Gottschalk, the main concern isn’t that taking too much of these will bring on more migraine attacks down the road. “The conversation really should be that if you consistently have to treat your headaches more than three times a week, apparently we’ll need to do more,” he says.

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