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.
Find evidence-based tips for treating a migraine attack here.
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.
Medications that help during a migraine attack (abortive medications)
Simple pain relief (analgesia)
Paracetamol
Paracetamol plus caffeine
Funded and available without a prescription.
Non-steroidal anti-inflammatory drugs (NSAIDs)
Ibuprofen
Diclofenac
Naproxen (higher dose needs a prescription)
Aspirin
Funded and available without a prescription.
Triptans
Triptans are the only funded medications in New Zealand specifically developed for migraine disease.
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. Zolmitriptan is available as a nasal spray which is useful in people with severe nausea or vomiting.
Sumatriptan is available in oral form and by injection into the skin (Clustran).
Both triptans are funded and available on prescription.
In-hospital injections for migraine
For treatment of migraine attacks in the emergency department, as well as treatments listed above, injections may be used to manage symptoms or prevent recurrence.
Chlorpromazine
Prochlorperazine
Metoclopramide
Dexamethasone
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.
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 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. These are not intended to be used long-term and should be reviewed every 6-12 months.
All of these medications are funded and available on prescription.
Blood pressure medications/antihypertensives
Beta blockers
Propranolol
Nadolol
Metoprolol
Atenolol
Angiotensin receptor blocker
Candesartan
Angiotensin-converting enzyme (ACE) inhibitor
Lisinopril
Calcium channel blocker
Verapamil (for hemiplegic migraine or migraine with brainstem aura)
Antidepressants
- Amitriptyline
- Nortriptyline
- Venlafaxine
Anti-epileptics
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.
Topiramate
Sodium valproate
Gabapentin
Lamotrigine
Antihistamine
- Pizotifen
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.
Occipital nerve block
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.
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)
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 US 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.
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.
Ajovy
Ajovy has been approved by Medsafe but is not available in New Zealand.
Vyepti
Vyepti has yet to be approved by Medsafe.
Gepants
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 is pending Medsafe approval and an application to fund atogepant has been submitted to Pharmac.
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