Migraine medication options in New Zealand
Medications are an important treatment option for many people with migraine
There are two types of migraine medications. Acute medications can be taken at the start of a migraine attack and can help to minimise the symptoms of migraine, such as head pain and nausea. Preventive medications can help to minimise the frequency and severity of migraine attacks and can be helpful if you experience migraine symptoms frequently or your migraine attacks are debilitating.
Some migraine medications can be purchased over-the-counter from a pharmacy without a prescription, some medications require a prescription from a health professional. Over the counter medications are usually cheaper on prescription but you may have to pay for a consultation with a health professional or pay a prescription fee. Some health insurance policies cover the cost of prescriptions for funded medications.
Please note: Medications and dosage recommendations on international websites may differ from New Zealand guidelines. Please talk with your health professional for specific migraine medication treatment advice.
Simple pain relief medications
Funded and available without a prescription
- Paracetamol
- Paracetamol plus caffeine
- Soluble aspirin
Short-acting non-steroidal anti-inflammatory drugs (NSAIDs)
Funded and available without a prescription
- Ibuprofen
- Diclofenac
- Naproxen (higher dose needs a prescription)
Medications that help with migraine-related nausea and vomiting (antiemetics)
Funded, prescription-only medicine
- Metoclopramide
- Ondansetron
- Prochlorperazine (buccal form is only partially funded)
Medications that help during a migraine attack (abortive medications)
Triptans are the only funded medications in New Zealand specifically developed for migraine disease.
Funded, prescription-only medicine
- Sumatriptan, though you can buy sumatriptan 50mg without a prescription
- Rizatriptan
Both these triptans are short-acting. There are five other triptans available globally - almotriptan, eletriptan, zolmitriptan, naratriptan and frovatriptan. Almotriptan, eletriptan and zolmitriptan are short-acting, naratriptan is medium acting and frovatriptan is long-acting.
Sumatriptan is available in oral form and as the injection Imigran.
Migraine can cause your digestion to slow down and impact how your medications are absorbed during a migraine attack.
Sometimes taking an antiemetic such as metoclopramide can help. Your GP can prescribe you an antiemetic. (1)
Medication-overuse (rebound) headache can occur if you take too many pain relief medicines to treat headaches and migraine. It may feel like a tension-type headache or migraine-like attack. Headaches often improve within two months of withdrawal of the overused medicine, but can feel worse before improvement is seen.
To minimise your risk of medication-overuse headache, limit your use of acute medications.
- Paracetamol and NSAIDs: don’t take for headache more than 15 days per month
- Triptans: don’t take more than 10 days per month. (2)
Avoid opioids such as codeine and tramadol for treating migraine headache. They can make headaches and migraine worse, they’re not as effective as other migraine medications and can lead to dependence and addiction. (2)
Medications to prevent migraine (preventives)
Preventive migraine medications used in New Zealand were developed to manage other conditions such as high blood pressure and depression but were found to be effective for migraine prevention.
Funded, prescription-only medicine
Blood pressure medications/antihypertensives
Beta blockers
- Propranolol
- Nadolol
- Metoprolol
- Atenolol
Angiotensin receptor blockers (ARBs)
- Candesartan
Calcium channel blockers
- Verapamil
Antidepressants
- Amitriptyline
- Nortriptyline
- Venlafaxine
Anti-epileptics
- Topiramate
- Sodium valproate
- Gabapentin
- Lamotrigine
Antihistamine
- Pizotifen
Pain medication, used to treat some kinds of nerve pain and epilepsy
- Pregabalin
A preventive medication doesn’t prevent migraine attacks from ever happening again. Migraine is a lifelong, genetic, neurological condition.
To be considered effective, a preventive should be reducing the impact of your attacks by about 50%. Remember to record your attacks using a migraine diary.
You don’t need to be on a preventive for the rest of your life. After 6–12 months of taking an effective dose of a preventer, you can often successfully reduce and stop taking it. If migraine attacks recur, you can restart a preventive medication. (1)
In-hospital infusions for migraine
- Chlorpromazine infusion
- Prochlorperazine infusion – intramuscular or intravenous
- Dihydroergotamine (DHE) infusion
Botox for use in chronic migraine
Botox (onabotulinum toxinA) is approved by Pharmac for preventative migraine treatment for people with migraine attacks on 15 or more days per month. Most public hospitals have chosen not to fund Botox for people with chronic migraine, or have restricted access.
Medications to help manage menstrual migraine
A combination of the above medications is used for menstrual migraine, particularly naproxen. Oral contraception to prevent ovulation and oestrogen, such as estradiol may also be used. All are funded and prescription-only medicine.
Calcitonin Gene-Related Peptide (CGRP) monoclonal antibodies
Calcitonin gene-related peptide (CGRP) monoclonal antibodies are the first medications developed specifically to prevent migraine.
CGRP is a small protein involved in the cascade of events that lead to a migraine attack. CGRP helps transmit pain signals in the brain, ramp up inflammation and dilate blood vessels. The CGRP monoclonal antibodies block this protein, by either binding to CGRP itself or binding to the receptor sites found in some parts of the nervous system such as the trigeminal nerve, effectively turning off its ability to stimulate the neurological dysfunction that is a migraine attack.
The Food and Drug Administration (FDA) has approved 4 CGRP medications:
Aimovig (erenumab)
Emgality (galcanezumab)
Ajovy (fremanezumab)
Vyepti (eptinezumab)
Aimovig, Emgality and Ajovy are a once a month self-injection. Ajovy also has the option to use quarterly, with three injections four times a year. Vyepti is a one-hour intravenous infusion every 3 months.
Aimovig
Medsafe has approved Aimovig and it is available as a 70mg and 140mg dose. It’s available on prescription, but it’s not funded. A 70mg injection costs $678 and 140mg costs $1,356.
Your GP can prescribe Aimovig but some GPs aren’t aware of the CGRP monoclonal antibodies and it is only available through Grafton pharmacy in Auckland.
Emgality
Medsafe has approved Emgality and it is available as a 120mg injection. Two injections (240mg) are given as a first, loading dose, and then one injection every 4 weeks. Each injection costs from $325.
Your GP can prescribe Emgality for you – it doesn't require a neurologist prescription. Your GP may want to find out more information about it if they're not familiar with prescribing it, because it only became available in New Zealand in September 2022.
Emgality should be available through any chemist in New Zealand. The wholesaler is CDC Pharmaceuticals, but even pharmacies that don't usually purchase medicine from CDC can still get Emgality through them.
Ajovy
Ajovy has been approved by Medsafe but is not available in New Zealand.
Vyepti
Vyepti has yet to be approved by Medsafe.
Please note: Medications and dosage recommendations on international websites may differ from New Zealand guidelines. Please talk with your health professional for specific migraine medication treatment advice.
References
- Managing Your Migraine, Dr Katy Munro, UK migraine specialist, National Migraine Centre.
- Health Navigator, Migraine medicines