What are migraine treatment options if I can't take ergots and triptans?

For people who can't take ergots or triptans because of side effects or other potential problems, several other types of medications for migraine headaches may help.

Prescription analgesics. Prescription painkillers are more powerful than their over-the-counter (OTC) equivalents, yet they rarely relieve severe migraine pain. In many cases, prescription analgesics just provide higher doses of standard nonprescription products, such as ibuprofen or naproxen sodium. Some prescription analgesics contain barbiturates or opioids. Opioids, such as codeine and morphine, are sometimes indispensable medications, but they have a limited role in the treatment of headache. People who regularly use opioids run the risk of developing a tolerance to them, which means they need higher and higher doses to relieve the pain. They may also become dependent, meaning they develop withdrawal symptoms when they stop taking the medication.

Steroids. Occasionally, a migraine headache is exceptionally stubborn: despite treatment, it may persist for days or weeks. When this happens, a several-day course of a steroid, such as prednisone, may provide relief.

Antinausea medications. Migraine attacks often activate the sympathetic nervous system, which is probably best known for its role in the "fight or flight" response. Activating the sympathetic nervous system affects the stomach and intestines, as well as other parts of the body. As a result, nausea and vomiting often accompany migraine headaches, which prevent you from keeping down your medications. Even when vomiting does not occur, the stomach takes longer to empty into the intestines once the sympathetic nervous system is activated—which can impair the absorption of oral medications. A medication like metoclopramide relieves nausea and stimulates the activity of the stomach, allowing oral medications to be absorbed again.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.