Migraines: Preventive and Abortive Medications for Chronic Headaches

Chronic migraines aren’t just bad headaches. They’re neurological events that can knock you out for hours or days-often with nausea, sensitivity to light, and a pounding pain that feels like a drill behind your eye. If you’ve been there, you know no amount of rest or ibuprofen always fixes it. The good news? We now have more targeted, effective ways to stop attacks before they wreck your life-and to keep them from coming back in the first place.

How Abortive Medications Work (and When to Take Them)

Abortive meds are your first line of defense during a migraine attack. They don’t prevent migraines-they stop them in their tracks. But timing matters. If you wait until the pain is at its worst, these drugs lose a lot of their power. Studies show taking them within an hour of the first sign of pain cuts recurrence rates nearly in half. That’s why experts say: act fast.

For mild to moderate attacks, over-the-counter NSAIDs like ibuprofen (400mg) or naproxen sodium (550mg) work for many people. They block the inflammatory chemicals that make your head throb. A combination of aspirin, acetaminophen, and caffeine (like Excedrin Migraine) has solid evidence behind it too. But if you’ve got nausea or vomiting, swallowing a pill might not help. Migraines slow down your stomach. That’s called gastric stasis. If your meds sit there undigested, they won’t work. That’s when nasal sprays, injections, or suppositories become better choices.

For moderate to severe migraines, triptans are the gold standard. Sumatriptan, rizatriptan, zolmitriptan-they all target serotonin receptors to narrow inflamed blood vessels and quiet nerve signals. About 42% to 76% of people get pain-free results within two hours, depending on the drug and dose. But triptans aren’t for everyone. If you have heart disease, high blood pressure, or a history of stroke, they’re off-limits. That’s where newer options come in.

The Rise of CGRP Medications for Acute Attacks

In the last few years, a new class of drugs has changed the game: CGRP inhibitors. These block a molecule called calcitonin gene-related peptide, which plays a key role in triggering migraine pain. Unlike triptans, they don’t affect blood vessels, so they’re safer for people with cardiovascular risks.

Ubrogepant (Ubrelvy) and rimegepant (Nurtec ODT) are oral pills taken at the first sign of a migraine. Clinical trials show about 20% to 30% of users are pain-free within two hours. Rimegepant has an added perk-it’s also approved for preventive use, meaning one pill can do double duty. Lasmiditan (Reyvow) is another option for triptan-resistant cases. It works differently, targeting a serotonin receptor that doesn’t affect the heart. In studies, it was 1.56 times more likely to relieve pain than a placebo. But it can cause dizziness or fatigue, so don’t drive after taking it.

And now there’s zavegepant (Zavzpret), a nasal spray approved in late 2023. It’s the first CGRP blocker you can inhale. In trials, 24% of users were pain-free after two hours-better than placebo and faster than some pills. For people who can’t swallow or who need rapid relief, this is a game-changer.

Preventive Medications: Stopping Migraines Before They Start

If you get migraines 4 or more days a month, or if abortive meds aren’t enough, it’s time to think about prevention. These aren’t pills you take when you feel a headache coming. You take them every day, rain or shine, to reduce how often and how badly migraines hit.

Traditional options include beta-blockers like propranolol and metoprolol, antiseizure drugs like topiramate and valproate, and older antidepressants like amitriptyline. These have been around for decades. They work for many, but side effects can be tough-brain fog, weight gain, fatigue. Topiramate, for example, can cause tingling in fingers and trouble with memory. Not everyone can stick with it.

Then came the CGRP monoclonal antibodies. These are monthly or quarterly injections-erenumab (Aimovig), fremanezumab (Ajovy), galcanezumab (Emgality). They’re not pills. They’re lab-made antibodies that lock onto the CGRP molecule before it can trigger pain. In trials, people saw 50% fewer migraine days per month. Some even cut their attacks in half. And because they’re targeted, side effects are mild: injection site reactions, constipation, or occasional muscle cramps.

The American Academy of Neurology gave these drugs the highest level of evidence in 2020-meaning they’re proven to work. And they’re especially helpful for people who’ve tried everything else. But they’re expensive. Without insurance, a single injection can cost over $1,000. Most insurers require you to fail at least two older drugs first. That’s called step therapy. It’s frustrating, but common.

Combination Therapy: Why Mixing Treatments Works Better

Sometimes, one drug isn’t enough. That’s where combining treatments shines. For example, taking a triptan with naproxen boosts pain relief more than either drug alone. One study showed 32% of people were pain-free at two hours with the combo-compared to just 22% with triptan alone. The NSAID tackles inflammation, the triptan calms the nerves. Together, they cover more bases.

For menstrual migraines-those that hit around your period-long-acting triptans like frovatriptan taken every day for a few days before and during your period can cut attacks by up to 70%. That’s a game-changer for women who know exactly when their migraines are coming.

Even non-drug methods help. Ice packs on the neck, dark quiet rooms, and hydration make abortive meds work better. A 2021 survey found 63% of migraine sufferers who used these alongside meds reported better outcomes. It’s not magic-it’s physics. Cooling nerves, reducing light input, and keeping fluids balanced help your body recover faster.

What Doesn’t Work (and Why It’s Still Prescribed)

Here’s the uncomfortable truth: too many people still get opioids or barbiturates for migraines. Narcotics like oxycodone or hydrocodone are sometimes prescribed because they’re fast-acting and familiar. But they don’t treat the root cause. They just numb the pain-and they’re addictive. Worse, using them more than 10 times a month can cause medication-overuse headaches (MOH), turning episodic migraines into daily ones.

Studies show 15.2% of migraine visits still end with a narcotic prescription. That’s nearly one in six. Meanwhile, only about 18.9% of patients get evidence-based abortive meds like triptans or CGRP inhibitors. That’s a huge gap. Doctors aren’t always up to date. Patients don’t always know to ask. And insurance doesn’t always cover the best options.

MOH is real. If you’re taking triptans more than 10 days a month, or NSAIDs more than 15 days, you’re at risk. The fix? Stop the overuse. It’s hard. You’ll get worse before you get better. But with proper support-like a headache specialist and a written plan-you can break the cycle.

What’s Coming Next

The migraine treatment landscape is changing fast. Atogepant (Qulipta), an oral CGRP blocker already approved for prevention, is being studied for episodic migraine. Early data looks strong. A new 5-HT1F agonist called lorecivivint is in early trials. And researchers are exploring genetic markers to predict who will respond best to which drug. The goal? Personalized migraine care.

By 2028, CGRP-targeted drugs could make up 65% of the migraine market. That’s up from just 10% in 2022. The future isn’t just about more drugs-it’s about smarter, safer, more tailored options. And for the first time, we’re seeing real hope for people who’ve struggled for years.

Practical Tips for Managing Migraines

• Keep a headache diary for at least 8 weeks. Note timing, triggers, meds taken, and symptoms. It’s the most accurate way to track patterns.
• Take abortive meds early-don’t wait for the pain to peak.
• If you’re vomiting or nauseated, try nasal sprays, injections, or suppositories instead of pills.
• Hydrate. Dehydration worsens migraines. Water isn’t optional.
• Use non-drug tools: ice packs, dark rooms, relaxation techniques.
• Ask your doctor about CGRP inhibitors if triptans don’t work or aren’t safe for you.
• Never use opioids regularly. They make migraines worse over time.

Next Steps

If you’re still struggling with migraines, talk to a headache specialist-not just your GP. Neurologists who focus on headaches know the latest guidelines and can help you navigate insurance, side effects, and combo therapies. Most major cities have headache clinics. If you’re in Australia, the National Headache Foundation offers free nurse-led support lines. You don’t have to suffer in silence anymore.