What Does It Feel Like to Take Tizanidine for Migraines?
Key takeaways:
Tizanidine is a prescription-only muscle relaxer that’s sometimes used off-label to treat migraines. Its brand name is Zanaflex.
Tizanidine helps relax stiff muscles. For some people, it can prevent migraines and other chronic daily headaches.
Common side effects of tizanidine can include dizziness and drowsiness. Dry mouth is also a common complaint.
A migraine is much more than a bad headache. It’s a complex neurological disorder. And people who get migraines experience a range of disabling effects. Among them: nausea, temporary vision changes, and a throbbing pain that can send them to bed in a dark room for hours, even days.
For some people with recurrent (episodic) or even chronic migraines, typical migraine treatments don’t work to prevent or lower the number of migraine days. Tizanidine (Zanaflex) is one of many off-label treatments for migraines. Healthcare providers may prescribe an off-label treatment when other first or second-choice medications haven’t worked.
Below, three people who take tizanidine explain what it’s like.
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Navigating life with several medical conditions
In Tennessee, Mary Ellen Ciganovich lives with several serious medical issues, any one of which could make daily life difficult.
When she was in the first grade, she was diagnosed with epilepsy, a brain condition that caused her to have seizures. In 1989, she developed multiple sclerosis (MS), an autoimmune disease.
Mary Ellen, now 70, also lives with depression and gets migraines. Although she’s had migraines most of her adult life, they got much worse after her MS diagnosis.
As a life coach, author, and frequent speaker, Mary Ellen’s migraines can make it difficult to work. Managing her medical issues with the right combination of medications is something she continues to navigate.
For Mary Ellen, when the muscles in her neck begin to spasm, it is often the signal that she is developing a migraine. The migraine sometimes triggers an MS attack in which she has problems with balance and coordination.
“The whole room will start spinning, and I get so sick to my stomach,” she says. This can be accompanied by vision problems, trouble concentrating, fatigue, and weakness. Life comes to a halt.
About 10 years ago, her neurologist prescribed a daily dose of 4 to 6 mg of tizanidine to keep the muscles in her neck relaxed, helping prevent the start of a migraine.
Today, Mary Ellen takes a daily combination of medications to control her MS, epilepsy, depression, and migraines. She says it’s difficult to determine which medication is doing what, a common issue when a person is taking several medications for multiple medical problems.
Not long ago, she considered dropping the tizanidine because she wasn’t sure it was helping anymore. She is reconsidering.
“When I think about it, I still get headaches, but they aren’t nearly as bad as they used to be, so maybe it is still working.”
She says that’s a conversation she’ll have with the neurologist at her next appointment.
For a massage therapist who gets migraines, tizanidine works
Troy Patrick, a massage therapist who lives in Newport, Kentucky, is constantly bending over and putting a lot of stress on his upper body. He also gets migraines, which means that some days, it’s difficult, if not impossible, to function.
Troy, who is 58, was diagnosed with migraines when he was 18. But he can recall getting severe headaches as early as age 14.
“They would come out of nowhere, and I would feel this awful stabbing, like an ice pick to my head,” he says. As he got older, those headaches included flashing and even temporary vision loss.
Troy’s doctor prescribed different medications to take once a migraine developed. Troy also tried nerve blockers. Nothing was very effective at lessening the discomfort and pain he lived with, he says.
Five years ago after an MRI, Troy was diagnosed with Chiari malformation Type 1, a structural abnormality in the bottom of the brain where it meets the spine.
Although his neurologist has not been able to say for certain that the Chiari is responsible for his migraines, Troy says the migraines usually start at the back of his head at the base of his skull.
The Chiari diagnosis led Troy’s doctor to prescribe tizanidine to keep the muscles in his head and neck relaxed. For Troy, that has helped to prevent migraines from developing.
In the beginning, Troy was taking 4 mg a day but experienced two of the most common side effects: dizziness and extreme drowsiness.
“I couldn’t drive or do much of anything,” he says.
Today, his usual dosage is 2 mg, which allows him to function normally with the same results most days. If muscle stiffness is particularly bad after a long day of work, he will take 4 mg of tizanidine at bedtime.
Along with tizanidine, Troy gets Botox injections every 3 months to help block extra pain signals that add to migraines. He says the combination of these two, in addition to Aimovig (erenumab), another preventative prescription migraine medication, have greatly improved his quality of life.
“It’s not a perfect drug, but nothing I’ve taken has worked quite as well as the tizanidine when it's used in combination with the other therapies,” he says. “And it’s very affordable and usually covered by insurance.”
Teacher doesn’t have as many migraines anymore
As a fourth grade teacher and mother of two young children, Lindsey de los Santos often feels stressed.
For Lindsey, that can bring on a migraine, which can be a huge problem if she gets one in the middle of the school day. A sub will have to take over, and Lindsey will go home to lie down and rest.
“The hardest thing about having migraines is just missing out on life,” says Lindsey, who is 45 and lives in suburban Kansas City, Missouri.
Lindsey began having migraines in high school more than 30 years ago. She tried everything to treat them — ranging from over-the-counter pain relievers like Advil (ibuprofen) to yoga and massage.
Eventually, that included prescribed medications to treat the migraines, but she says nothing seemed to provide much relief.
“I was hitting a roadblock and continuing to get so many migraines.”
About 7 years ago, her neurologist suggested a different treatment. He prescribed tizanidine to help stop the muscle spasms and tightening in her neck, the first sign that she was going to get a migraine. It was a game changer.
“I could tell the difference pretty quickly,” she says.
In the beginning, the medication made Lindsey sleepy, but she saw that as an indirect blessing. It would force her to rest. Over time, her body began to adjust, and she seldom feels sleepy now.
Lindsey no longer takes tizanidine daily but takes 4 mg doses as needed. Sometimes, one dose isn’t enough. About 6 hours later, she’ll take a second dose. And the number of migraines, although not gone entirely, have dropped from three a week to usually one.
“It’s definitely better, but we’re still trying to manage it because some weeks it’s more than one.”
Still, Lindsey says the benefits of tizanidine have been huge and mentions a recent event when it saved the day. She was hosting a birthday party for her 7-year-old son when she began to feel the muscles tighten in the back of her neck.
“I took the tizanidine and did not get a migraine,” she says. “Tizanidine has been a life-changer.”
Lindsey also has a blog to connect others who have migraines. “I felt so compelled to start the blog because I feel like a lot of people with migraines feel really alone,” she says. “We talk and I share my journey.”
What does the pharmacist say?
Joshua Murdock, PharmD
Pharmacy Editor
Tizanidine (Zanaflex) is a prescription medication that helps relax stiff or rigid muscles. It’s FDA-approved to treat muscle spasticity in adults for a short period of time. It also has many off-label uses, including chronic migraines and chronic back pain.
It works by targeting nerves in your spinal cord, so many people use it to relieve muscle pain or tightness that stems from a brain- or spine-related health condition.
One of tizanidine’s main benefits is how quickly it starts working. This is important for many types of pain, especially migraine pain. Many people feel relief within 30 minutes to 3 hours of taking a dose.
Tizanidine tablets generally start working faster when taken with food, but food can delay the effects of tizanidine capsules. Try to be consistent about taking your tizanidine doses with or without food.
While tizanidine starts working relatively quickly, it's not without side effects. Some of tizanidine’s most commonly reported side effects are dry mouth, sleepiness, and dizziness.
You should avoid driving or performing other tasks that require mental alertness until you learn how tizanidine affects you.
Tizanidine’s dosage depends on your symptoms, medical history, and what you’re taking it for. At first, it’s recommended to take a 2 mg tablet or capsule up to 3 times per day as needed. This dosage can be slowly raised as needed, but you shouldn’t ever take more than 36 mg in a 24-hour period.
Note: If you’ve been taking tizanidine every day for 9 weeks or longer — especially at higher doses — you shouldn’t suddenly stop taking it. If you do, you may experience side effects like high blood pressure, a fast heart rate, and tight muscles. You should work with your healthcare provider to slowly lower your dose over time.
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