Acute treatment Migraine drugs means the medication taken at the onset of a Migraine with the idea to decrease or eliminate the pain of a Migraine.  In general, these drugs are over the counter medications (OTC) like Tylenol or Advil, or prescription type drugs written by a doctor.

This is an article by Britt Talley Daniel MD, member of the American Academy of Neurology, Migraine textbook author, Podcaster, YouTube video producer, and Blogger.

Side effects of acute Migraine treatment drugs.  All drugs have possible side effects, and we all have to live with this fact.  Some persons are more sensitive to medications than others.  Hopefully, the Migraine acute treatment drug used will be better than the suffering of a Migraine, or to restate this:  That the treatment will not be worse than the disease.

A list of acute Migraine treatment drugs follows:

Read my mini Book on Migraine Here.

Associated questions.

What are the side effects of over-the-counter drugs?

All these drugs can cause frequent daily headaches or chronic migraine due to medication over use headache.  The International Classification of Headache Disorders version 3 states that simple analgesics like caffeine, Tylenol, or Advil taken as 1 pill 15 or more days a month may cause medication overuse headache.

Most of the over-the-counter group of drugs can aggravate GERD, gastroesophageal reflux disorder.  This is commonly called “heartburn” and treated with Tums or other antacids.

Specific side effects of the various drugs are:

Tylenol (acetaminophen) is listed as a centrally-acting non-opioid analgesic. Opioid drugs are narcotic analgesics such as morphine or hydrocodone which should never be used for headache because of addictive and headache causing qualities such drugs possess.  Other side effects of Tylenol are:

Hypersensitivity reaction

Anaphylaxis

Skin reaction, severe

Hepatoxicity

Nephropathy, from chronic use

Anemia

Thrombocytopenia

Common reactions-nausea, rash, headache.

Advil (ibuprofen) is an NSAID (nonsteroidal anti-inflammatory drug).

NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke, which can be fatal. This risk may be increased in patients with cardiovascular disease or risk factors for cardiovascular disease. Naproxen is contraindicated in the setting of CABG surgery. NSAIDs can also cause an increased risk of serious gastrointestinal (GI) adverse events, including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. Elderly patients and patients with a history of peptic ulcer disease and/or GI bleeding are at greater risk for serious GI events.

Side effects:

abdominal pain

acid or sour stomach

belching

bloating

cloudy urine

decrease in amount of urine.

decrease in urine output or decrease in urine-concentrating ability.

diarrhea

difficulty having a bowel movement (stool)

excess air or gas in stomach or intestines

full feeling

heartburn

indigestion

itching skin

pain or discomfort in chest, upper stomach, or throat

pale skin

passing gas

nausea

noisy, rattling breathing

rash with flat lesions or small raised lesions on the skin

shortness of breath

swelling of face, fingers, hands, feet, lower legs, or ankles

troubled breathing at rest

troubled breathing with exertion

unusual bleeding or bruising

unusual tiredness or weakness

vomiting

weight gain

Less common

Abdominal cramps

stomach soreness or discomfort

Caffeine is a common component of pain killers and of course is in coffee, tea, and chocolate.

Caffeine is found in Excedrin, Anacin, NoDoz, Vivarin, and Fioricet.

Side effects:

Feeding intolerance

Less common

Agitation

black, tarry stools

blood in the stools or urine

bruising

burning feeling or tenderness in the stomach

chills

coma

confusion

coughing or vomiting blood

decreased urine output.

depression

dizziness

fainting

fast heartbeat

fever

headache

hostility

indigestion

irritability

lethargy

lightheadedness

muscle twitching

nausea

persistent bleeding

rapid, shallow breathing

rapid weight gain

rash

seizures

severe stomach pain

stomach upset.

stupor

swelling of the face, ankles, or hands

trouble breathing

unusual tiredness or weakness

vomiting

vomiting of blood or material that looks like coffee grounds.

Aleve (naproxen) is an NSAID type pain killer.

NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke, which can be fatal. This risk may be increased in patients with cardiovascular disease or risk factors for cardiovascular disease. Naproxen is contraindicated in the setting of CABG surgery. NSAIDs can also cause an increased risk of serious gastrointestinal (GI) adverse events, including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. Elderly patients and patients with a history of peptic ulcer disease and/or GI bleeding are at greater risk for serious GI events.

Side effects:

belching

bruising

difficult or labored breathing

feeling of indigestion

headache

itching skin

large, flat, blue, or purplish patches in the skin

pain in the chest below the breastbone

skin eruptions

stomach pain

swelling

tightness in the chest

Less common

Bloating

bloody or black, tarry stools

blurred or loss of vision.

burning upper abdominal or stomach pain

cloudy urine

constipation

decrease in urine output or decrease in urine-concentrating ability.

disturbed color perception

double vision

fast, irregular, pounding, or racing heartbeat or pulse.

halos around lights

indigestion

loss of appetite

nausea or vomiting

night blindness

overbright appearance of lights

pale skin

pinpoint red or purple spots on the skin

severe and continuing nausea

severe stomach burning, cramping, or pain.

skin rash

swelling or inflammation of the mouth

troubled breathing with exertion

tunnel vision

unusual bleeding or bruising

unusual tiredness or weakness

vomiting of material that looks like coffee grounds.

weight loss

Triptans

There are 7 triptans now:

Imitrex (sumatriptan) 6 mg sc

Oral Imitrex (sumatriptan) 50,100 mg

Treximet (sumatriptan/naproxen) 1 tablet

Maxalt (rizatriptan), 5, 10 mg

Zomig (zolmitriptan) 2.5,5.0 mg

Axert (almotriptan) 12.5 mg

Relpax (eletriptan) 40 mg

Amerge (naratriptan) 2.5 mg

Frova (frovatriptan) 2.5 mg may be tried at onset of the headache.

Common triptan side effects are:

dizziness

injection site reaction

sedation

vertigo

nausea and vomiting

flushing sensation

tingling sensation

an unpleasant taste.

Other possible side effects include:

Asthenia

burning sensation

chest pain or discomfort

neck pain

neck stiffness

numbness

throat irritation

feeling of heaviness

flushing

sensation of pressure

sensation of tightness.

Less common side effects are: 

abdominal or stomach pain

anxiety blurred vision.

changes in patterns and rhythms of speech

chills

confusion

muscle cramps and stiffness.

Four of the triptans have problems when taken with other drugs.

These problems are:

Relpax (eletriptan)—is contraindicated with antifungals, macrolide antibiotics, or protease inhibitors.

Maxalt (rizatriptan)—requires a 50% decreased dose when taken with Inderal (propranolol).

Frova (frovatriptan)----should have a decreased dose when used with Birth Control Pills and Inderal (propranolol).

Zomig (zolmitriptan)---should have a decreased dose with Tagamet (cimetidine).

Dihydroergotamine (DHE) as Migranal nasal spray, Trudhesa nasal injection, IV or IM administration.

Common side effects:

nausea

rhinitis

application site reaction

vomiting

altered sense of smell.

Serious and/or life-threatening peripheral ischemia has been associated with the co-administration of dihydroergotamine with potent CYP3A4 inhibitors including protease inhibitors and macrolide antibiotics.

Because CYP3A4 inhibition elevates the serum levels of dihydroergotamine, the risk for vasospasm leading to cerebral ischemia and/or ischemia of the extremities is increased. Hence, concomitant use of these medications is contraindicated.

Side effects requiring immediate medical attention:

chest pain

cough, fever, sneezing, or sore throat

feeling of heaviness in chest

irregular heartbeat

itching of the skin

numbness and tingling of face, fingers, or toes

pain in arms, legs, or lower back

pain in back, chest or left arm

pale bluish-colored or cold hands or feet

shortness of breath or troubled breathing

weak or absent pulses in legs

Timolol a beta blocker eye drop.

Side effects:

hypersensitive to drug/class

asthma, bronchial, trouble breathing

COPD, severe

heart failure, uncompensated

2nd or 3rd degree AV block

sinus bradycardia

cardiogenic shock

caution if bronchospastic disease, major surgery, diabetes mellitus, hyperthyroidism, myasthenia gravis, glaucoma, angle-closure, anaphylactic reaction history

temporary blurred vision

temporary burning/stinging/itching/redness of the eye

watery eyes

dry eyes

feeling as if something is in the eye

headache

Report to doctor immediately for serious side effects:

dizziness

eye pain/swelling/discharge

slow/irregular heartbeat

muscle weakness

mental/mood changes

coldness/numbness/pain in the hands or feet.

vision changes

unusual tiredness/weakness

CGRP receptor antagonists:

Ubrelvy (Ubrogepant) is a calcitonin gene-related peptide, CGRP, receptor antagonist for the acute treatment of migraine.

Side effects

Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever

wheezing

tightness in the chest or throat

trouble breathing, swallowing, or talking

unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

nausea

dry mouth

somnolence.

Nurtec ODT 75 mg a is a calcitonin gene-related peptide, CGRP, receptor antagonist for the acute treatment of migraine.

Serious adverse reactions;

Allergic reactions with trouble breathing, rash, swelling of the face, mouth, tongue, or throat.

Common mild side effect is nausea, stomach pain, or indigestion, present in 2%/

Side effects may come days after Nurtec ODT is taken.

Reyvow (lasmiditan) is a serotonin (5-HT) 1F receptor agonist.  An agonist is a chemical that binds to a receptor and activates the receptor to produce a biological response.  Reyvow (lasmiditan) activates the release of serotonin, which helps migraine headache.

Geriatric use.  Dizziness occurred more commonly in persons over 65 years old and related to a dose effect.  The lowest effective dose of Reyvow (lasmiditan) should be used.

Other side effects

Dizziness

Paresthesia

Fatigue

Nausea

Vomiting

Muscle weakness

hypersensitivity reaction

decreased heart rate and increased blood pressure

Contraindications

Driving within 8 hours of dosing.

Caution if used with another CNS depressor.

Caution in elderly patients.

Caution with alcohol use.

Occipital Nerve Blocks using either steroids and/or local anesthetics injected near the greater and lesser occipital nerves in the back of the head.

The injection blocks pain signals and reduces swelling and inflammation in the back of the head and neck and is helpful for treating chronic headaches in this area.

The most common side effect is injection site pain which is short lived.  Other side effects include temporary 6-8-hour symptoms of bleeding, dizziness, weakness, and light headedness.  There is a slight risk of infection.

 Read my big book on Migraine above at Here.

This site is owned and operated by Internet School LLC, a limited liability company headquartered in Dallas, Texas, USA.  Internet School LLC is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.  Although this site provides information about various medical conditions, the reader is directed to his own treating physician for medical treatment.

Follow me at:  www.doctormigraine.com, Pinterest, Amazon books, Podcasts, and YouTube.

All the best.

Britt Talley Daniel MD