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| Abortives | ||
| Class | Name | Mechanism |
| Analgesics | Acetaminophen (Tylenol), Metamizoleš, Acetaminophen/Aspirin/Caffeine (Excedrin Migraine) | Inhibit COX enzymes to reduce the production of pain-promoting prostaglandins. |
| Anesthetics | Lidocaine (intranasal) | Blocks sodium channels to numb nerve endings in the nasal passages, interrupting pain signals. |
| Anti-emetics | Metoclopramide (Reglan), Prochlorperazine (Compazine), Ondansetron (Zofran) | Block dopamine or serotonin receptors in the brain's nausea center to relieve nausea and vomiting; some also have pain-relieving effects. |
| Barbiturates* | Butalbital-containing compounds (Fioricet, Fiorinal) | Act as a central nervous system depressant to suppress neuronal activity and reduce pain perception. |
| Corticosteroids | Methylprednisolone, Prednisone, Dexamethasone | Powerful anti-inflammatory agents that reduce inflammation in the nervous system, used as rescue therapy for severe, prolonged attacks. |
| Ditans | Lasmiditan (Reyvow) | Selectively activates the 5-HT1F serotonin receptor on neurons, reducing the release of pro-inflammatory neuropeptides without causing vasoconstriction. |
| Ergots | Dihydroergotamine (Migranal, Trudhesa), Ergotamine/Caffeine (Cafergot) | Non-selectively activate multiple serotonin receptors, leading to vasoconstriction and reduced neuroinflammation. |
| Gepants (CGRP Antagonists) | Rimegepant (Nurtec ODT), Ubrogepant (Ubrelvy), Zavegepant (Zavzpret) | Block the CGRP (calcitonin gene-related peptide) receptor, preventing the peptide from transmitting pain signals. |
| Nerve Blocks | Auriculotemporal, Occipital, Supraorbital, Trigeminal, etc. | Involve injecting an anesthetic to temporarily block pain signals from specific nerves implicated in migraine. |
| Neuromodulation Devices | Cefaly (eTNS), Nerivio (REN), Savi (sTMS), gammaCore (VNS) | Use targeted electrical or magnetic pulses to disrupt pain signals and calm overactive nerve pathways during an attack. |
| NK1 Antagonists | Aprepitant (Emend), Fosaprepitant | Block the NK1 receptor for Substance P, a neurotransmitter involved in pain and inflammation. |
| NMDA Antagonists | Ketamine | Blocks NMDA receptors in the brain to interrupt central pain sensitization pathways, used as IV rescue therapy for refractory migraine. |
| NSAIDs | Aspirin, Diclofenac (Cambia), Ibuprofen (Advil), Ketorolac, Naproxen (Aleve), Celecoxib (Elyxyb), Indomethacin (Indocin), etc. | Block COX-1 and COX-2 enzymes to stop the production of prostaglandins, which are key drivers of pain and inflammation. |
| Opioids* | Butorphanol (Stadol), Tramadol (Ultram), Codeine/Hydrocodone | Bind to opioid receptors in the brain to alter the perception of pain. |
| Supplements | Mg, Caffeine, Ginger | Magnesium calms nerve excitability; caffeine enhances analgesic absorption and constricts blood vessels; ginger has natural anti-inflammatory properties. |
| Triptans | Almotriptan (Axert), Eletriptan (Relpax), Frovatriptan (Frova), Naratriptan (Amerge), Rizatriptan (Maxalt), Sumatriptan (Imitrex), Zolmitriptan (Zomig); Combos (rizatriptan/meloxicam) | Activate 5-HT1B/1D serotonin receptors, which constricts cranial blood vessels and reduces the release of inflammatory neuropeptides. |
| Prophylactics | ||
| Anticonvulsants | Divalproex (Depakote), Topiramate (Topamax), Zonisamide (Zonegran), Lamotrigine | Thought to prevent migraine by calming hyperexcitable brain networks, primarily by enhancing the inhibitory neurotransmitter GABA and blocking sodium channels. |
| Antidepressants | Amitriptyline, Nortriptyline (TCAs); Venlafaxine, Duloxetine (SNRIs) | Modulate levels of the neurotransmitters serotonin and norepinephrine, which play a key role in the brain's natural pain-control pathways. |
| Antihypertensives (ACE Inhibitors / ARBs) | Lisinopril, Candesartan (Atacand), Olmesartan (Benicar) | Mechanism not fully clear, but thought to prevent migraine by stabilizing blood vessels and reducing inflammation. |
| Antihypertensives (Beta-blockers) | Metoprolol (Lopressor), Propranolol (Inderal), Timolol (Blocadren) | Believed to calm overactive nerve cells and regulate the release of certain neurotransmitters to raise the threshold for migraine attacks. |
| Antihypertensives (Calcium Channel Blockers) | Verapamil, Flunarizine | Thought to work by preventing the constriction and spasm of blood vessels in the brain. |
| CGRP Antagonists (Gepants - Oral) | Atogepant (Qulipta), Rimegepant (Nurtec ODT) | Taken daily or every other day to consistently block the CGRP receptor, preventing migraine attacks from starting. |
| CGRP Antagonists (mAbs - Injectable) | Eptinezumab (Vyepti), Erenumab (Aimovig), Fremanezumab (Ajovy), Galcanezumab (Emgality) | Laboratory-made antibodies that bind to either the CGRP molecule or its receptor, providing a long-acting blockade to reduce migraine frequency. |
| Leukotriene Blockers | Montelukast (Singulair), Zafirlukast (Accolate) | Anti-inflammatory agents that block leukotrienes, which are inflammatory molecules that may have a role in triggering migraine. |
| Muscle Relaxers* | Carisoprodol, Tizanidine, Baclofen | Act as central nervous system depressants to reduce muscle tension, which can be a contributing factor or trigger for some individuals. |
| Neuromodulation Devices | Cefaly (eTNS), gammaCore (VNS) | When used regularly, they are thought to gradually desensitize pain pathways and raise the threshold for triggering a migraine attack. |
| OnabotulinumtoxinA (Botox) | (Brand name is also the class) | Administered via injections around the head and neck, it works by blocking the release of pain-transmitting chemicals from nerve endings. |
| Other Oral Meds | Clonidine*, Lithium | Clonidine reduces sympathetic outflow from the CNS; Lithium's mechanism is unclear but may influence neurotransmitter systems (used only in rare cases). |
| Supplements | Butterbur, Coenzyme Q10, Feverfew, Magnesium, Melatonin, Riboflavin (B2), Turmeric & Boswellia, etc. | Work through various pathways; Riboflavin and CoQ10 improve cell energy metabolism, while Magnesium calms nerve excitability, and Butterbur/Feverfew have anti-inflammatory effects. |