Migraine medication options
Medications for migraine
Acute medications are 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 are taken 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 but others 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 unfunded 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. Healthify is a trusted New Zealand source of information about health and medications.
Medications to use during a migraine attack (acute medications)
All acute medications are funded in New Zealand. Find evidence-based tips for treating a migraine attack here. Opioids such as codeine or tramadol are not recommended to treat migraine attacks. They can make headaches and migraine worse, they’re not as effective as other migraine medications and can lead to dependence and addiction.
Available without a prescription
- Paracetamol
- Paracetamol plus caffeine
NSAIDs are available without a prescription
- Ibuprofen
- Diclofenac
- Naproxen (higher dose needs a prescription)
- Soluble aspirin
Prescription-only medicine
- Metoclopramide
- Domperidone
- Ondansetron
- Prochlorperazine (buccal form that dissolves in your mouth is only partially funded)
Triptans are the only funded medications in New Zealand specifically developed to treat migraine attacks.
Prescription-only medicine
- Sumatriptan tablets, though you can buy sumatriptan 50mg without a prescription
- Sumatriptan injection
- Rizatriptan (tablets)
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.
Injections or infusions may be used to treat migraine attacks in the emergency department, as well as treatments listed above.
- Chlorpromazine infusion
- Prochlorperazine infusion – intramuscular or intravenous
- Metoclopramide
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 (prescription-only medicine).
Top tip from a migraine specialist
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.
Dr Katy Munro is a UK headache specialist GP who works at the National Migraine Centre. Her book, Managing Your Migraine, published by Penguin Life in 2021, contains lots of useful advice about living with migraine.
Medication-overuse headache
Medication-overuse headache can occur if you take too many medicines to treat headache and migraine attacks over a period of several months. It may feel like a tension-type headache or migraine-like attack. Headache often improves 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 and avoid opioids such as codeine and tramadol.
Paracetamol and NSAIDs: don’t take for headaches more than 15 days per month.
Triptans: don’t take more than 10 days per month.
Medications to prevent migraine (preventives)
All preventive medications are prescription-only (must be prescribed by a doctor or other health professional).
Funded preventive medication
Oral 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. These are not intended to be used long-term and should be reviewed every 6-12 months. Oral medications with the strongest recommendation and best evidence for effectiveness include propranolol (and other beta blockers), amitriptyline and topiramate.
Beta blockers
Angiotensin receptor blockers
Calcium channel blockers
- Verapamil (for hemiplegic migraine or migraine with brainstem aura)
These should not be used during pregnancy or in people planning to become pregnant. People of child-bearing potential are advised to try an alternative option or use two forms of contraception.
An occipital nerve block involves injecting local anaesthetic into the nerves at the back of the head, the occipital nerves. The aim of this treatment is to block the nerves from transmitting pain signals. They can reduce the severity and frequency of migraine attacks in some people.
Occipital nerve blocks have to be given by a health professional and have to be repeated when the numbing effect of the anaesthetic on the nerves wears off. Not all health professionals are trained and able to carry out the treatment.
Non-funded preventive medication
New preventive migraine medications have been developed specifically to treat migraine. Only two of these are available in New Zealand and none are currently funded. Pharmac’s Neurological Advisory Committee recommended that Pharmac fund three of the new medications at a high priority in December 2023. These were galcanezumab (Emgality), erenumab (Aimovig) and atogepant (Qulipta).
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 anti-CGRP monoclonal antibodies:
- Galcanezumab (Emgality)
- Erenumab (Aimovig)
- Fremanezumab (Ajovy)
- Eptinezumab (Vyepti)
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.
Galcanezumab (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 on average $325 but costs vary depending on the pharmacy.
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.
Find out more about Emgality in our Frequently Asked Questions, and visit our Emgality Advocacy Toolkit to support our work to get Emgality funded in New Zealand.
Erenumab (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 it is only available through Grafton pharmacy in Auckland.
Fremanezumab (Ajovy)
Ajovy has been approved by Medsafe but is not available in New Zealand.
Eptinezumab (Vyepti)
Vyepti has yet to be approved by Medsafe.
Gepants are another class of medication that targets calcitonin gene-related peptide (CGRP). Although initially developed as acute medication, to treat migraine attacks, some gepants have been found to be effective in prevention of migraine. Gepants that are used to treat migraine attacks can be a good option for people who can’t take or tolerate triptans, or for whom triptans don’t work. In addition, gepants are not associated with medication overuse headache so are useful for people with chronic migraine.
The US Food and Drug Administration has approved four gepants:
- Atogepant (Qulipta), for prevention of episodic or chronic migraine (taken daily)
- Ubrogepant (Ubrelvy), for treatment of migraine attacks
- Rimegepant (Nurtec ODT), for prevention of episodic migraine (taken every other day) and also for treatment of migraine attacks
- Zavegepant (Zavzpret), for treatment of migraine attacks.
Zavegepant comes as a nasal spray; the others as oral tablets.
None of the gepants are available in New Zealand at present. However, atogepant has been classified by Medsafe as a prescription medicine.
Preventive medication for chronic migraine only
Botox (onabotulinum toxinA) is approved by Pharmac for preventive migraine treatment for people with headache 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.
Top tips from a migraine specialist
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.
The exception to this may be the new CGRP medications. These may need to be used long-term, as many people find that migraine attacks recur once they stop these.
Dr Katy Munro is a UK headache specialist GP who works at the National Migraine Centre. Her book, Managing Your Migraine, published by Penguin Life in 2021, contains lots of useful advice about living with migraine.
