Hello everyone! Welcome back to our migraine series. This article is going to touch on migraine medication: the good, the bad, and the ugly.

The Good

Many migraine sufferers use medication to help them manage their migraines. Typically patient will be on one or two different kinds: a prophylactic medication to stop the migraine before it happens, and/or an abortive medication to stop a migraine once it has already begun.

One of the most common preventative medications prescribed is called Topamax, which is actually an anti-seizure medication that has also been proven to help prevent and reduce migraine attacks. Aside from preventative medications, there is a class of abortive drugs called Triptans that have proven to be effective once a migraine has begun. Triptans act on the serotonin receptor, ultimately reducing inflammation and activation of the Trigeminovascular system. Other drugs that affect Calcitonin Gene Related Peptide have also become popular in recent years for their ability to reduce CGRP and dampen migraine pain. Maybe you have even seen commercials for them on TV (Aimovig is the most popular lately). All of these medications are GREAT for migraines….as long as they actually work for YOU!

The Bad


You’re in luck!

While there is no “bad” medication for migraine (even botox injections have been proven to reduce migraine days), sometimes certain medications just do not work for certain people. The reason why is many medications affect different parts of the brain and body. For example, botox injections help to “calm down” the nerves in the face that cause pain around the eye. If that is the source of your migraines, then great! You’re in luck. But if your migraines stem from something else, botox injections aren’t going to help you much. The great news is when medications work, it gives us great insight as to WHERE the migraine is originating from and helps us to better target that area.


Migraine medications can also be hit or miss in chronic migraine patients. This is because most migraine medications are not supposed to be used more than 15 days per month. Well, the definition of a chronic migraine is MORE than 15 headache days per month! This puts a damper on things. Also, a study in 2018 by Vikelis stated that, “Adherence to the initial oral migraine preventive medication prescribed was only 25% at 6 months and 14% at 12 months. Adherence failed over time and was poorer if the patient was switched to a second or third preventive.” Migraine medication adherence can be very poor for many reasons, but it is important to talk to your prescribing doctor if the medication that was prescribed isn’t working or you have issues taking it. They will probably find another medication that works for you!

The Ugly

Lastly, the ugly part about migraines is they CHANGE YOUR BRAIN. That’s right, every migraine you have is teaching your brain how to have another one. Studies have shown that areas in the brain that dampen pain actually shrink in migraineurs, while areas in the brain that perceive pain actually get bigger. In order to manage migraines properly, the brain must “un-learn” these pain responses. This is why migraines must be treated from a systemic and a neurologic stand point. Key parts of migraine treatment are reducing inflammation, improving neurological reactions, and decreasing the load in your “bucket” (see our blog called Trigger Happy – Why “Triggers” Are Not Causing Your Migraines).

Trigger Happy – Why “Triggers” Are Not Causing Your Migraines

For more information please check out the rest of our blog series on migraines or give us a call for a free 15 minute phone consultation with one of our clinicians to discuss how we can help manage your migraines.

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