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Medications for Chronic Migraine

Other names: Migraine, Chronic

Migraine is a type of headache characterized by throbbing pain on one or both sides of the head, and usually accompanied by nausea, vomiting or loss of appetite. Some people may also experience an aura, which is the sudden onset of changes in vision before the migraine begins.

Chronic migraine is defined as having 15 or more headache days per month, with headaches lasting four hours a day or longer and at least half those headache days being associated with migraine.
People who have 14 or less headache days per month are defined as having episodic migraine.

Symptoms of chronic migraine include:

  • headache
  • visual disturbances
  • nausea and vomiting
  • sensitivity to light
  • sensitivity to noise

Treatment of chronic migraine includes preventive treatments such as Botox (onabotulinumtoxinA),  the calcitonin gene-related peptide (CGRP) antagonists, and medicines used for the acute treatment of migraine such as analgesics, triptans, and oral gepants.

Botox (onabotulinumtoxinA) is FDA approved for the preventative treatment of chronic migraine.

Botox works by inhibiting the release of the neurotransmitter acetylcholine from nerve cells, blocking the signals that induce muscle contractions. It is administered by injection into seven specific areas of the head and neck muscles, with results lasting up to 12 weeks depending on the individual patient.

Aimovig (erenumab-aooe), Ajovy (fremanezumab-vfrm), Emgality (galcanezumab-gnlm), and Vyepti (eptinezumab-jjmr) are all approved for the preventive treatment of migraine, including chronic migraine. These drugs belong to the class of drugs called calcitonin gene-related peptide (CGRP) antagonists which work by blocking the activity of the calcitonin gene-related peptide, a neuropeptide that has been implicated in the pain and vasodilation processes associated with migraine attacks.

Drugs used to treat Chronic Migraine

The following list of medications are in some way related to, or used in the treatment of this condition.

Drug name Rating Reviews Activity ? Rx/OTC Pregnancy CSA Alcohol
Botox Rate Add review
Rx C N

Generic name: onabotulinumtoxinA systemic

Drug class: skeletal muscle relaxants

For consumers: dosage, interactions, side effects

For professionals: Prescribing Information

onabotulinumtoxinA Rate Add review
Rx C N

Generic name: onabotulinumtoxinA systemic

Brand name:  Botox

Drug class: skeletal muscle relaxants

For consumers: dosage, interactions, side effects

For professionals: A-Z Drug Facts, AHFS DI Monograph

Legend

Rating For ratings, users were asked how effective they found the medicine while considering positive/adverse effects and ease of use (1 = not effective, 10 = most effective).
Activity Activity is based on recent site visitor activity relative to other medications in the list.
Rx Prescription Only.
OTC Over the Counter.
Rx/OTC Prescription or Over the Counter.
Off-label This medication may not be approved by the FDA for the treatment of this condition.
EUA An Emergency Use Authorization (EUA) allows the FDA to authorize unapproved medical products or unapproved uses of approved medical products to be used in a declared public health emergency when there are no adequate, approved, and available alternatives.
Pregnancy Category
A Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).
B Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women.
C Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use in pregnant women despite potential risks.
D There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use in pregnant women despite potential risks.
X Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use in pregnant women clearly outweigh potential benefits.
N FDA has not classified the drug.
Controlled Substances Act (CSA) Schedule
M The drug has multiple schedules. The schedule may depend on the exact dosage form or strength of the medication.
U CSA Schedule is unknown.
N Is not subject to the Controlled Substances Act.
1 Has a high potential for abuse. Has no currently accepted medical use in treatment in the United States. There is a lack of accepted safety for use under medical supervision.
2 Has a high potential for abuse. Has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions. Abuse may lead to severe psychological or physical dependence.
3 Has a potential for abuse less than those in schedules 1 and 2. Has a currently accepted medical use in treatment in the United States. Abuse may lead to moderate or low physical dependence or high psychological dependence.
4 Has a low potential for abuse relative to those in schedule 3. It has a currently accepted medical use in treatment in the United States. Abuse may lead to limited physical dependence or psychological dependence relative to those in schedule 3.
5 Has a low potential for abuse relative to those in schedule 4. Has a currently accepted medical use in treatment in the United States. Abuse may lead to limited physical dependence or psychological dependence relative to those in schedule 4.
Alcohol
X Interacts with Alcohol.

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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.