Dr. Jessica Ailani outlines the key differences between the two forms of migraine medications
When treating migraine, there are two main forms of medication to manage symptoms: over-the-counter medications, such as ibuprofen, and prescription medications, such as triptans. Dr. Jessica Ailani, the director of the MedStar Georgetown Headache Center at MedStar Georgetown University Hospital in Washington, D.C., spoke with us about everything you should know about these therapies. Read on to learn more.
When patients are looking for relief for their migraine symptoms, over-the-counter medications are typically their first resource. “Over-the-counter medications work well if you have symptoms that are mild to moderate,” Dr. Ailani says.
These medications are also effective for individuals that experience symptoms with gradual onset (over hours). “Most over-the-counter medications are oral—something you swallow by mouth—so they take a little bit longer to work,” Dr. Ailani adds.
Common over-the-counter medications typically include analgesics such as acetaminophen (Tylenol®), ibuprofen (Advil®) and naproxen (Aleve®). In addition, they include combination analgesics, such as acetaminophen-aspirin-caffeine (Excedrin®) which are mixtures of one or two analgesics and caffeine.
If you are experiencing severe migraine attacks more than four or five days per month, or if your current over-the-counter medication regimen doesn’t provide sufficient relief, consult a health care professional right away. Your physician can help you identify which prescription medication is right for you and create a custom treatment plan to address your symptoms.
Prescription migraine medications for migraine include both preventive and acute treatments. These medications come in many forms, including tablets, nasal sprays, and injections, which can provide fast relief. “Prescription medication can be very beneficial if you have attacks that are moderate to severe at onset or if you have fast onset attacks,” Dr. Ailani says.
You do need a prescription from a health care provider, as they are not available over the counter.
Which is More Effective?
If cost or accessibility is a concern in identifying an effective treatment option, over-the-counter medications may be the best option for you, Dr. Ailani says. In addition, patients feel comfortable leaving their medications at work, in their purse or bedside table. “For migraine, having access to your medication when it’s occurring can be really important.”
The accessibility of over-the-counter medication is a double-edged sword. “If it’s easily accessible, it’s easy to overuse, and it’s easy to lose track of how often you’re taking these medications,” Dr. Ailani says.
Overuse of over-the-counter migraine medication can actually lead to medication-overuse headache, also known as rebound headache. “Medication-overuse headache happens when you are taking too much acute medication to treat migraine attacks or other headaches,” Dr. Ailani says. “And the medication itself starts to cause changes in the brain that lead to more frequent headaches.”
Rebound headache can also occur with overuse of prescription acute migraine medication. Triptans, for example, can lead to a medication-overuse headache when used more than 10 days per month. “We have to be very aware of what we’re prescribing, in combination with what someone might be using over-the-counter, to balance that risk of medication overuse with the frequency of migraine and the need for symptom relief,” Dr. Ailani says.
Doctors can identify medication-overuse headache by looking at a patient’s calendar of migraine attacks over time, and then making changes to their treatment regimen as necessary. “In some patients, medication-overuse headache can happen after the first few times they take their medicine,” Dr. Ailani says. “In others, it can take months or years. What we see is as the frequency of migraine goes up, the use of medication goes up, too.”
Consulting a Headache Specialist
Patients should consult a headache specialist to determine whether over-the-counter medication or prescription medication is better for treating their symptoms. A headache specialist can also create a formal treatment plan that outlines what to do upon the first signs of a migraine attack. This plan encompasses prescription medication options, over-the-counter medication options and non-medicine techniques for reducing migraine frequency.
To find a headache specialist in your area, consult our Find a Doctor tool.
Reviewed for accuracy by the American Migraine Foundation’s subject matter experts, headache specialists and medical advisers with deep knowledge and training in headache medicine. Click here to read about our editorial board members.