Reference — Neurology
Migraine & Headache Medications Reference
Two buckets: abortive (stop an attack — take early) and preventive (reduce frequency). The high-yield safety facts cluster around triptans (vasoconstriction, serotonin) and cluster-headache oxygen.
Educational use only. Medication selection, contraindications, and dosing are provider-directed and individualized. This reference is an educational aid. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Abortive (Acute) Therapy
| Drug class | Notes / cautions |
|---|---|
| NSAIDs / acetaminophen | First-line for mild-moderate attacks; GI/renal cautions |
| Triptans (sumatriptan) | Serotonin agonists for moderate-severe migraine; take EARLY. Cause vasoconstriction → contraindicated in CAD, uncontrolled HTN, hemiplegic/basilar migraine; serotonin-syndrome risk with SSRIs/SNRIs |
| Ergotamines (DHE) | Vasoconstrictors; don't combine with triptans; many contraindications |
| Antiemetics (metoclopramide, prochlorperazine) | Treat nausea and help abort the attack |
| Cluster headache: high-flow O₂ | 100% oxygen via non-rebreather is first-line; triptans also used |
Preventive (Prophylactic) Therapy
| Drug class | Notes / cautions |
|---|---|
| Beta-blockers (propranolol) | First-line prophylaxis; avoid in asthma/bradycardia |
| Topiramate | Anticonvulsant; watch paresthesias, weight loss, cognitive effects, kidney stones |
| Amitriptyline | TCA; helpful when headache + insomnia/depression coexist |
| Anti-CGRP agents (-gepants/-mab) | Newer targeted migraine prevention/acute therapy |
Using acute medications too often (generally > 2–3 days/week) causes medication-overuse (rebound) headache — a key teaching point.
NCLEX Pearls
- ✦Abortive (take EARLY) = NSAIDs, triptans, ergots, antiemetics; preventive = beta-blockers, topiramate, amitriptyline, anti-CGRP.
- ✦Triptans cause vasoconstriction → contraindicated in CAD/uncontrolled HTN; don't combine with ergots.
- ✦Triptans + SSRIs/SNRIs → serotonin syndrome risk.
- ✦Cluster headache: 100% high-flow oxygen is first-line.
- ✦Overusing acute analgesics → medication-overuse (rebound) headache.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Heart Association / American Stroke Association (AHA/ASA) · American Association of Neuroscience Nurses (AANN). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →