5 Outdated Migraine Medications You May Want to Upgrade

Migraine treatments have come a long way in recent years. While older medications may still offer some relief, many were developed before newer, more targeted options became available. Today, many migraine medications may work better for your symptoms — and cause fewer side effects — than those of the past.

If you’ve been using the same migraine medication for years, it might be time to revisit your treatment plan with your prescriber. Here, we’ll cover five migraine medications that may be considered outdated — and explore what other options you might want to consider instead.

5 outdated migraine medications to consider upgrading

The best treatment for migraines can vary for everyone. But in some cases, older migraine medications may not be the best choices. They can come with more side effects or offer less benefits compared to newer ones.

1. Ergotamine

Ergotamine (Ergomar) was once a go-to option for treating migraines. But it’s not prescribed as often today. It works by tightening blood vessels in the brain to ease migraine pain. Another related product is ergotamine / caffeine, which has also fallen out of favor.

The problem? Ergotamine can cause side effects such as nausea, muscle pain, and tingling. It also can be risky for people with heart problems and high blood pressure. It has a relatively long list of medication interactions, too. Other migraine medications are generally safer and more effective.

Ergotamine and its relatives are typically only recommended when other medications don’t work well for your symptoms. This is especially true for dihydroergotamine (Migranal, Trudhesa), which is still used for refractory migraines — mainly in hospitals.

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2. Fiorinal and other barbiturates

Another older option is Fiorinal. The brand-name version has been discontinued, but the generic is still available. It combines aspirin, caffeine, and a barbiturate called butalbital. Other versions, such as Fioricet, swap aspirin for acetaminophen, and some also include an opioid called codeine. 

Barbiturates are known for being habit-forming. They may also lead to rebound headaches if taken too often. They also cause drowsiness, slowed breathing, and can be dangerous when mixed with alcohol or other sedating medications. There’s also limited research supporting their long-term effectiveness for migraines.

Because of these risks, many healthcare professionals recommend switching to other treatments for pain associated with the onset of migraines that are better studied and come with fewer safety concerns.

3. Opioids

Opioids, such as hydrocodone / acetaminophen, oxycodone (Roxicodone), and tramadol (ConZip), are strong pain relievers. They may seem helpful to treat pain associated with the onset of severe migraines, but they don’t treat the root cause of them. They also come with risks. Opioids can lead to dependence, sedation, and more frequent headaches if taken too often.

In general, experts recommend avoiding opioids for migraines when possible.

4. Monoamine oxidase inhibitors

Some people with chronic migraines try older antidepressants called monoamine oxidase inhibitors (MAOIs), such as phenelzine (Nardil). These medications can help reduce the frequency of certain types of headache pain, but they’re generally avoided.

MAOIs come with many food and medication interactions that make them hard to take safely. These interactions can lead to hypertensive crises, which are episodes of very high blood pressure. Most people can benefit more from other preventative medications, including other newer antidepressants.

5. Gabapentin 

Gabapentin (Neurontin, Horizant, Gralise) is a medication that’s FDA approved to treat conditions such as nerve pain and seizures. It’s also sometimes prescribed off-label to prevent migraines.

Previous data indicated that gabapentin might reduce how often migraines happen. But some more recent research suggests gabapentin doesn’t work much better than a placebo (a pill with no medicine in it). It can also cause side effects such as dizziness, tiredness, and fluid buildup, which can lead people to stop taking it.

Gabapentin isn’t a preferred option for preventing migraines. Gabapentin may still be taken if other treatments aren’t a good fit, but it’s considered an older option in migraine care.

List of discontinued migraine medications

Several migraine medications are no longer available. These are some of the most notable examples.

Recommended medications for migraine treatment and prevention

If you’re having frequent migraines, dealing with tough side effects, or simply not getting the relief you need, you may want to discuss a different migraine medication with your healthcare professional.

Here’s a high-level summary of migraine medications that many people switch to. Some are designed to treat migraines, some prevent them, and a few do both. This isn’t a complete list.

Acetaminophen and NSAIDs

Acetaminophen (Tylenol) is a common pain reliever. It’s widely available over the counter (OTC), and it’s a first-choice option for treating mild-to-moderate migraines. The same goes for nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn). OTC combination products like Excedrin Migraine and Advil Dual Action are also available.

If you have relatively mild or infrequent migraines, an OTC pain reliever may do the trick. Ask your prescriber which one would be the safest and most effective option for you. They can also help ensure you’re not taking too much of any one medication — especially if you’re juggling multiple products.

Triptans

Triptans have been around for a while. But they’re still some of the most common treatments for moderate-to-severe migraines. They work by narrowing blood vessels in the brain and reducing inflammation. These prescription medications can be taken at the first sign of a migraine, and they come in multiple dosage forms — pills, injections, nasal sprays, and more.

Common triptans include:

• Sumatriptan (Imitrex, Tosymra, Onzetra Xsail, Zembrance SymTouch)

• Rizatriptan (Maxalt)

• Zolmitriptan (Zomig, Zomig-ZMT)

• Eletriptan (Relpax)

Combination products that pair a triptan with an NSAID are also approved. One example is sumatriptan / naproxen (Treximet), and another is meloxicam / rizatriptan (Symbravo).

If your migraines are intense or aren’t relieved by acetaminophen or NSAIDs, ask your prescriber about triptans. They can tell you if a triptan would be safe or unsafe for you to try — especially if you have a heart-related health condition.

CGRP antagonists

Calcitonin gene-related peptide (CGRP) antagonists are a newer group of migraine medications. They work by blocking a migraine-triggering protein called CGRP. They’re a preferred option for preventing migraines.

Injectable CGRP antagonists medications are usually injected on a monthly (or near-monthly) basis:

• Erenumab (Aimovig)

• Fremanezumab (Ajovy)

• Galcanezumab (Emgality) — can also treat cluster headaches

• Eptinezumab (Vyepti)

Gepants are a similar group of CGRP-blocking medications. They’re supplied as oral and nasal products, but they’re administered more frequently than the injectables. Ubrogepant (Ubrelvy) and zavegepant (Zavzpret) treat migraines, atogepant (Qulipta) prevents migraines, and rimegepant (Nurtec ODT) can do both.

CGRP antagonists are generally tolerated well. But they currently only come as brand-name products. None are available as lower-cost biosimilars or generics. Your prescriber can tell you if a CGRP antagonist would fit well into your migraine treatment regimen.

Lasmiditan

Lasmiditan (Reyvow) belongs to a newer class of migraine medications, known as ditans. Like triptans, lasmiditan treats acute migraine symptoms, but it works in a different way. Instead of constricting blood vessels, lasmiditan targets serotonin receptors in the brain that are involved in pain signaling.

Clinical studies indicate that lasmiditan effectively reduces migraine pain within 2 hours of taking it. It can also relieve other migraine symptoms, such as nausea and sensitivity to light or sound. It’s a medication to consider if medications like triptans or NSAIDs aren’t good options for your symptoms.

Miscellaneous oral medications

A number of other oral medications are prescribed for migraine prevention, typically in an off-label manner. Data supports their use, and migraine experts recommend them in several situations. Examples include:

• Antiseizure medications, such as valproate and topiramate (Topamax)

• Beta blockers, such as propranolol (Inderal LA, Innopran XL)

• Tricyclic antidepressants, such as amitriptyline

• Serotonin and norepinephrine reuptake inhibitors, such as venlafaxine (Effexor XR)

Most of these medications are widely available as generics. This helps lower their out-of-pocket costs. Your prescriber can tell you if any of these medications would be a good fit for your symptoms.

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Written by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Renad Abu-Sawwa, PharmD, BCPPS

Renad Abu-Sawwa, PharmD, BCPPS, is an associate professor and associate discipline director of clinical pharmacology at Rush Medical College with a practice site as a clinical pharmacy specialist practitioner at RUSH Children's Hospital in the Pediatric Epilepsy Clinic.

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