If you've ever struggled with chronic migraines, you've probably wondered if any treatments can help you break out of the cycle of headache pain. Thankfully, in the last 10 years, scientists have developed several new and highly effective migraine medications. Whether it's pills, injections or Botox, a neurologist can help you find the right medication to treat your chronic migraine.
George R. Nissan, DO, an internal medicine physician and headache medicine specialist co-directing the Diamond Headache & Migraine Center at Endeavor Health, answers some of the most common questions about migraines and the best medication to treat them.
Q: What exactly is a migraine — isn’t it just a bad headache?
Dr. Nissan: One of the biggest misconceptions is that a migraine is simply a bad headache, but it's actually a neurological disease that affects how the brain processes pain and sensory information.
During a migraine attack, the brain becomes hypersensitive, which can cause nausea, sensitivity to light and sound, or vision changes. This makes living everyday life very difficult. And because migraine attacks can last anywhere from a few hours to several days, they can significantly impact work and family life.
Q: What are the most common migraine triggers?
Dr. Nissan: Migraine triggers are different for everyone, but some of the biggest culprits include:
- Stress
- Poor or inconsistent sleep
- Hormonal fluctuations
- Skipping meals
- Dehydration
- Alcohol, especially red wine
- Certain foods
- Weather changes
Sometimes it can help to keep notes on each time you get a migraine to help you find out what your triggers are. If you notice you get a migraine after staying up late or skipping lunch, you can make lifestyle changes that may help to reduce how often you get migraines.
Q: What are the best medications for migraines?
Dr. Nissan: One of the most exciting developments in migraine care is that we now have medications that do different jobs and target different treatment pathways. Some are acute or rescue treatments designed to stop a migraine after it starts. Others are preventative treatments that help reduce how often migraines happen.
Acute medications come in three categories: triptans, CGRP receptor antagonists called gepants, or ditans.
Triptans work by narrowing blood vessels and blocking pain pathways involved in migraine attacks. They're often the first prescription choice for moderate to severe migraines. The most common brand names are:
- Imitrex
- Maxalt
- Zomig
- Relpax
- Amerge
- Frova
CGRP receptor blockers, or gepants, are a newer class of medications that block a protein known to play a major role in migraine attacks. Common gepants include:
- Ubrelvy, which treats migraine attacks after they begin.
- Nurtec ODT, which can treat an acute migraine and help prevent future attacks.
- Zavzpret, which is a nasal spray that may benefit migraine patients who experience nausea or vomiting as part of their acute migraine symptoms.
Ditans are selective serotonin receptor agonists, meaning they bind to specific receptors and block pain pathways. The only FDA-approved ditan is Reyvow, which can be taken by patients with cardiovascular conditions since it does not constrict blood vessels. However, Reyvow will no longer be manufactured as of early 2026.
Q: What helps reduce migraine frequency?
Dr. Nissan: If someone experiences frequent migraines — typically four or more migraine days per month — or chronic migraine, meaning they experience migraines 15 or more days each month, their neurologist may recommend preventive medications.
Some people benefit from monthly or quarterly injections of CGRP monoclonal antibodies, which block CGRP or its receptor to reduce migraine frequency. Common options include:
- Aimovig, which blocks the CGRP receptor to prevent migraines.
- Ajovy, which prevents episodic and chronic migraine and helps reduce monthly migraine days. It can be dosed as a once-a-month injection (225 mg) or every 3 months (675 mg) with equal efficacy.
- Emgality, which prevents episodic and chronic migraine and also has an indication for the treatment of episodic cluster headache.
- Vyepti, which is administered by IV infusion every three months for migraine prevention.
There are also oral preventive medications that were originally developed for other conditions, including:
- Topamax (topiramate), which is an anti-seizure medication that helps reduce migraine frequency.
- Indera (propranolol), Lopressor (metoprolol), or Toprol XL, which are beta blockers commonly used for blood pressure that also help prevent migraines.
- Elavil (amitriptyline), which is an antidepressant that can reduce migraine frequency.
- Qulipta, which is a daily oral CGRP medication specifically approved to prevent migraines and can be used for both episodic and chronic migraine patients.
Q: Can Botox help treat chronic migraine?
Dr. Nissan: Many people are surprised to learn that Botox isn't just for cosmetic treatments — it’s also FDA-approved for adults with chronic migraine because it blocks pain-signaling chemicals released by nerves around the head and neck.
Your headache specialist will administer a series of small injections approximately every 12 weeks. Many patients experience fewer headache days after several treatment cycles.
Q: How can someone figure out which migraine medication is best for them?
Dr. Nissan: Migraine treatment is highly individualized. When choosing a medication, we consider:
- How often migraines occur
- Severity
- Length
- Symptoms like nausea or aura
- Other medical conditions and current medications
- Whether you're pregnant or planning pregnancy
- Previous treatment experiences
If someone has one or two migraines a month, they may only need a rescue medication, but someone with chronic migraines may benefit from a preventive medication. If nausea makes it difficult to swallow pills during an attack, a nasal spray or injections may be a better fit.
When working with a neurologist, remember that the more you communicate about your symptoms, including what helps and what doesn't, the easier it becomes to create a treatment plan that's effective for you.
Q: What's your biggest piece of advice for people living with migraines?
Dr. Nissan: Don't accept migraines as something you have to live with. Migraine treatment has advanced tremendously over the last several years. The key is finding the treatment or combination of treatments that works best for you. Lifestyle changes such as improved sleep hygiene, maintaining adequate fluids, following a consistent meal schedule, and avoiding certain food or environmental triggers can also be helpful.
If migraines are interfering with your quality of life, get help. Your neurologist can help you find the right migraine medication for you and create a personalized treatment plan that can help you get back to living your life.
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