Migraine Preventive, Abortive, and Rescue Drugs

Reviewed by: HU Medical Review Board | Last reviewed: October 2020

Medicines to treat migraine can be confusing. It can be hard to learn which drug to take when, especially when you are newly diagnosed or in the middle of a migraine attack. Here are the basics of treating a migraine.

Three types of migraine drug treatments

Migraine drugs are broken into 3 types:1-3

  • Preventive
  • Abortive
  • Rescue

Preventive, abortive, and rescue medicines all have their uses, and a good migraine treatment plan includes all 3.

Preventive migraine drugs

Preventive migraine medicines are taken to reduce how often or how long someone has migraine attacks and how severe the symptoms are. Preventive migraine drugs are usually prescribed if someone has 4 to 5 migraine attacks each month.3

Most people take a preventive drug every day. Preventive migraine drugs also help a person respond better to abortive or rescue drugs when they do have a migraine. Some of these drugs cannot be taken while trying to get pregnant or during pregnancy.

There are hundreds of drugs and supplements used for migraine prevention. The ones most often prescribed include:1,3

Supplements like vitamin b2 (riboflavin), magnesium, and coenzyme Q10 are also used as preventives, especially in people who have fewer than 4 to 5 migraines a month.1

Abortive or acute migraine medicines

Abortive migraine drugs are also called “acute” drugs. These drugs should be taken during the early stages of a migraine. “Early” means within 15 minutes of when the pain starts and is mild. Using abortive drugs early greatly increases the chances of stopping a migraine before it gets worse.2

The goal of abortive migraine drugs is to reduce or stop the head pain, nausea, and vomiting that often comes with a migraine. These drugs tend to work best when given in 1 large dose rather than several small doses. Most abortive drugs should not be used more than 2 to 3 days per week.2,3

Different abortive drugs work for different people. Also, the type of abortive drugs that work at one time in a person’s life may change over the years. Abortive migraine medicines are also divided into whether they work best on mild, moderate, severe, or extreme symptoms.

Over-the-counter pain relievers may work alone as a mild migraine abortive treatment:2,3

  • Acetaminophen
  • Aspirin
  • Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen

Often, pain relievers must be combined with other abortive drugs in order to work. These drugs are thought to treat what is causing a migraine rather than masking the pain. Abortive drugs for mild to severe pain, nausea, and vomiting include:2,3

Depending on the person, some of these drugs may only be prescribed if other abortive medicines do not work or for chronic migraine.3

Rescue migraine medicines

Rescue migraine drugs are taken if abortive drugs did not work or the person cannot take those drugs for some reason. Rescue drugs do not stop a migraine in process or end one sooner, but do help the person with severe pain, nausea, and vomiting. These migraine drugs are usually given for short periods of 7 to 10 days to break a bad cycle.2,3

Common rescue drugs include:2,3

  • Prescription-strength pain relievers
  • Muscle relaxants
  • Steroids
  • Anti-seizure drugs
  • Anti-nausea drugs
  • DHE (dihydroergotamine)

If someone’s pain is extreme, they may need an IV (intravenous) of ergotamine, or opioids, barbiturates, or triptans taken by mouth to help control their severe pain. Severe pain that has not gotten better after 3 days is usually treated in an emergency room, infusion center, or hospital. Most doctors use opioids and barbiturates as a last resort. That is because the over-use of these drugs increases the chances that someone's migraines become chronic.2,3

Other migraine treatments

There are many other treatments for migraine other than drugs. This includes:3

  • Devices
  • Identifying and avoiding migraine triggers
  • Exercise
  • Regular sleep
  • Meditation, yoga, and biofeedback

It can be helpful to keep track of the migraine drugs you have tried. Use the Migraine Treatment Roadmap to record how well your prescriptions work and how often you use them.

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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