Skip to Accessibility Tools Skip to Content Skip to Footer

Treating Migraine without Triptans or Ergotamines

There is still hope for Migraine patients that can’t use targeted medicines like triptans and ergotamines. (See part 1)


Some drugs are used both to prevent Migraine as well as treat an attack. Examples include: intravenous magnesium and/or valproic acid which may be effective after a single dose, or may require up to 5 doses 24 hours apart. Intravenous levitiracetam has little written evidence for its use with oral gabapentin, but there has been some success with the combination and it may be an option for some patients. Intravenous Benadryl is sometimes used alone or in combination with other treatments and can be helpful in aborting a Migraine attack. Butterbur (petasides) is over the counter, and has also had some success when used as an abortive, although it is usually known for its effectiveness as a preventive. Feverfew also has some evidence that it is effective as an abortive as well as a preventive. Care should be taken as it can cause severe reactions when taken with other Migraine medicines. It should never be taken during pregnancy. Capsaicin nasal spray is initially painful for a few moments. Despite that, it is helpful for some patients and is a natural remedy that requires no prescription. Lidocaine nasal spray is sometimes helpful for certain patients, as are lidocaine patches. Midrin is a combination therapy that has been removed from use in the United States, however a Midrin equivalent is still available although it is unknown if it will remain so for very long. Midrin contains a drug that constricts blood vessels, and may remain contraindicated for some patients in which triptans or ergotamines are contraindicated. Caffeine alone or in combination with other treatments can trigger Migraine in some patients, but in others it can help to abort the attack. It’s easy to find and take, but it can sometimes lead to rebound and is often only effective in patients who do not consume daily caffeine. Peppermint oil can be soothing during an attack and act both as a cooling pain relieving agent to the skin, but also as aromatherapy. Periactin is sometimes helpful in children with Migraine as a preventive or an abortive. A TENS unit helps to lower the sensation of pain by overloading pain circuitry, and may be helpful for some patients.


Opioids are generally not considered a wise choice for most Migraineurs because of the risk of medication overuse headache (MOH) and the progression/chronification of Migraine to a more serious, difficult situation to treat, as well as the potential for abuse/misuse. Migraine isn’t a pain disorder but a neurological disorder of which pain is only a single component. Medicines that more specifically target the neurologic processes tend to be more effective. As a result, many physicians are beginning to refuse opioid treatment to their patients. If you ever have the need or desire for opioids to treat your Migraine attacks, this is a good topic of discussion for your next office visit. Opioids should not be a first choice treatment, but instead only used when other options are not available. Having an opioid treatment plan in place with your doctor before you need it is an option Migraineurs may want to take advantage of.

Surgical procedures for symptomatic relief include placement of peripheral stimulator devices in occipital and supraorbital regions of the head. These techniques are still investigational and have not yet been FDA approved for Migraine. Currently they are being used only in chronic Migraine patients.

Coming soon

— Developed by a United States company and already in use in Europe, the transcranial magnetic stimulator is enjoying success overseas, yet still awaits FDA approval for use here in America. Powerful magnetic pulses help to abort the Migraine process and may someday be an option for those who are unable to utilize other treatments.

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

Nahas, Stephanie J., MD, MSEd. “Symptomatic Treatment Options when Triptans and Ergots are Contraindicated.” American Headache Society’s Annual Scientific Meeting, 2012.