What you should know about migraine

It’s very likely you or someone you know is living with migraine. In fact, 1 in 4 American households includes someone who has migraine. It is the third most common illness in the world. The American Migraine Foundation estimates that the annual cost of missed work and direct medical expenses related to migraine is as much as $20 million.

June is National Migraine and Headache Awareness Month, which is a time for healthcare providers and patients to speak out for migraine recognition and treatment. Here is what you should know about the differences between migraine and headaches, when to seek treatment, and what your prescription options are.

A migraine vs. a headache: What is the difference?

Types of headaches

A regular, or non-migraine, headache can have many origins. One of the most common types is a tension headache. Tension headaches are a dull, constant, non-throbbing pain that are typically associated with a tightness in the scalp. This type of headache is typically brought on by emotional stress or is sometimes depression-related. 

A sinus headache is associated with allergy and congestive symptoms typically leading to a pain behind the eyes and sinus cavity due to pressure build up. This type of headache may be more pronounced in the morning or when a patient bends over due to the pressure shift.

Cluster headaches can be very painful and are more common in males. The pain is in the area of the eye, and it can be very sharp, last for hours, and occur day after day. These headaches may be brought on by alcoholic beverages and smoking.

There are many other types of headaches. Some may be related to hormone changes or menstrual cycles. Others may be associated with caffeine or nicotine withdrawal. Hunger or fasting may cause headaches. Activities which cause eyestrain, like video gaming or computer use, may also lead to non-migraine headaches.

But none of these headaches are like a migraine. A migraine is unique. In fact, an ache in your head is only one symptom of a migraine. You can actually have a migraine without any pain in your head associated with it. So, how can you tell if you have a migraine? 

Migraine symptoms

The symptoms associated with a migraine attack are:

• Throbbing pain, typically on one side
• Light and/or sound sensitivity
• Nausea and/or vomiting
• Aura
• Vision changes, blurred vision, or blind spots

Most of these symptoms are self-explanatory, except for an aura. An aura associated with migraine episodes is a sensory change that occurs prior to a migraine’s onset. It can include seeing flashes of light or a tingling feeling in your extremities. It may last up to an hour. Not every migraine is associated with an aura. Patients who have experienced an aura will likely not experience one with every migraine. 

You don’t have to experience all of the above symptoms at once to be diagnosed with migraine. Every headache and every patient is different.

The frequency at which a patient experiences migraine attacks is very important to understand. Low-frequency episodic migraines are those occurring less than 10 times per month. High-frequency episodic migraines are those occurring 10-14 times per month. Chronic migraines are defined as occurring 15 times or more per month. 

If you are unsure about what type of headache you are experiencing, or if your headache has been persistent and difficult to relieve, your healthcare provider will be able to more accurately diagnose your headache or migraine, as well as make appropriate treatment recommendations. 

Migraine treatment options

There are both prescription and over-the-counter medications that you can take to treat migraine. Here is what your healthcare provider might recommend.

Over-the-counter migraine medications 

Acetaminophen and nonsteroidal anti-inflammatories (NSAIDs), such as aspirin, ibuprofen, or naproxen, may be taken on a short-term basis to provide migraine relief. These therapies are relatively inexpensive and may help in one or two doses. Caffeine, a vasoconstrictor, is also effective in relieving migraine pain. Excedrin Migraine, a popular OTC choice, is a combination product that contains acetaminophen, aspirin, and caffeine. Your pharmacist can point you in the right direction for pain relief if you’re unsure.

With all of these medications, it’s important to note that over-the-counter treatment is not meant for long-term use without direct guidance from your healthcare provider.

Over-the-counter migraine treatment
Drug name	Classification	Typical dose	Best SingleCare price
Aspirin	NSAID	325 mg to 1000 mg every 4 to 6 hours	$1.69
Ibuprofen	NSAID	200 mg to 400 mg every 4 to 6 hours	$6.06
Naproxen	NSAID	220 mg every 12 hours	$4.31
Excedrin Migraine	NSAID	(Acetaminophen 250 mg/ Aspirin 250 mg/ Caffeine 65 mg) 1 to 2 tablets every 6 hours	$2.40

Prescription migraine medications  

Unfortunately, OTC options do not provide adequate migraine relief for many. In those cases, prescription medication can make a difference. Prescriptions for migraine fall into two categories: those used for treatment and those used for prevention. 

Migraine treatment

Physician-developed treatment guidelines list NSAIDs (specifically, ibuprofen and naproxen) as first-line treatment for mild to moderate acute migraine. NSAIDs relieve pain by decreasing the release of inflammatory prostaglandins. They are a cost-effective treatment option for mild to moderate migraines. NSAIDs generally are covered with commercial or Medicare Part D insurance plans. Be sure to check out SingleCare for cost savings as well. For instance, a typical prescription for ibuprofen 800 mg may cost as much as $37 without insurance, but with a SingleCare coupon, this prescription is less than $6. NSAIDs should not be taken on an empty stomach, and even as a prescription, they may not be best for consistent, long-term use. 

For moderate to severe acute migraines, 5HT agonists, commonly known as “triptans,” are first-line treatment. Triptans stimulate serotonin in the brain, which decreases inflammation and causes vasoconstriction. Vasoconstriction plays an important role in migraine management as it controls the sensation of blood flow. This helps control the throbbing or pulsating feel that many experience during a migraine attack. 

There are several choices of triptan drugs available on the market, including: almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan. Your prescriber will decide which one may be best for you, but all have been proven effective at treating migraine. Triptans are also generally covered by insurance, though some plans may have limitations on which type of triptan they cover or what quantity. The out-of-pocket price for sumatriptan can approach $200 for just 9 tablets, but SingleCare brings that price down to less than $13.

Prescription migraine treatment
Drug name	Classification	Typical dose	Best SingleCare price
Ibuprofen	NSAID	600 mg every 6 hours	$6.06
Naproxen	NSAID	500 mg every 12 hours	$4.31
Almotriptan	5HT agonists (triptans)	6.25 mg – 12.5 mg at onset, may repeat once in 2 hours if no relief.	n/a
Eletriptan	5HT agonists (triptans)	20 mg to 40 mg at onset, may repeat once in 2 hours if no relief.	$161.04
Frovatriptan	5HT agonists (triptans)	2.5 mg at onset, may repeat once in 2 hours if no relief.	$112.56
Naratriptan	5HT agonists (triptans)	1 mg to 2.5 mg at onset, may repeat once in 2 hours if no relief.	$92.61
Rizatriptan	5HT agonists (triptans)	5 mg to 10 mg at onset, may repeat once in 2 hours if no relief.	$43.83
Sumatriptan	5HT agonists (triptans)	25 mg to 50 mg at onset, may repeat once in 2 hours if no relief.	$42.90
Zolmitriptan	5HT agonists (triptans)	2.5 mg to 5 mg at onset, may repeat once in 2 hours if no relief.	$37.97

Migraine prevention

Prevention options play an important role in the treatment of patients who have chronic migraine. These patients still need access to acute treatments when their migraines occur, but preventative medications can decrease how often these migraines occur. Until recently, Botox, or onabotulinumtoxin A, was the only FDA-approved preventative treatment. While very effective, Botox can be difficult to get approved under insurance and can be expensive. For years, several other medication classes have been used off-label for prevention of migraine with a great deal of success. These include seizure medications, antidepressants, and blood pressure medications. These medications generally have good insurance coverage and are cost-effective ways to help prevent chronic migraines. The following chart provides a summary of some options available in each class, though it is not intended to be all-inclusive. 

Medications frequently used for migraine prevention
Drug name	Classification	Typical dose	Best SingleCare price
Divalproex	Anticonvulsant	500 mg ER twice daily	$12.99
Topiramate	Anticonvulsant	25 mg twice daily	$8.53
Metoprolol	Beta-blocker	25 mg twice daily	$4
Propranolol	Beta-blocker	20 mg twice daily	$16.33
Amitriptyline	Tricyclic Antidepressant	25 mg at bedtime	$4
Venlafaxine	Selective Norepinephrine Reuptake Inhibitor (Antidepressant)	150 mg ER once daily	$15

Recently, a new class of drugs developed for migraine prevention came to market. These are a group of calcitonin gene-related peptide (CGRP) inhibitors. Patients who experience migraines are known to have higher levels of CGRP. When it binds to its receptor, it starts a cascade of events that lead to inflammation and migraine pain. People with chronic migraine may have their number of migraine days cut in half with CGRP inhibitors. 

These medications can be expensive and insurance coverage may vary a great deal. The manufacturers offer some savings programs, and SingleCare is always available to help you get the best price. The following chart provides a summary of what is currently available in this class.

Anti-CGRP migraine treatment
Brand name	Generic name	Classification
Aimovig	erenumab-aooe	CGRP Monoclonal Antibodies
Ajovy	fremanezumab
Emgality	galcanezumab-gnlm
Vyepti	eptinezumab-jjmr
Ubrelvy	ubrogepant	CGRP Molecule Receptor Antagonists
Nurtec ODT	rimegepant sulfate

These lists are not meant to be all-inclusive and treatments may not be appropriate for every person with migraine. It’s always best to speak with your healthcare provider to help decide your best course of treatment. You can compare more migraine treatments here.