Medications

Several different medications are used to treat NDPH

There are no NDPH-specific drugs, doctors rely on medications they have used to treat migraine and now there are new treatment options available that are specific to migraine, i.e. CGRP antagonists. Please go through the lists and classifications below to see potential options. We advise you to discuss any medications options with your doctor to determine the best care plan for you.

We did our best to be as accurate and inclusive as possible. If you see anything that needs to be corrected, please email us at info@ndphaware.org so we can make the necessary adjustments.

***It is important to note that just because one medication in a category doesn’t work for you, that does not mean that all medications in that category won’t work. Also, in many cases it can take high doses and up to several months to truly evaluate if a drug works or not, so don’t give up hope!

Abortives & Rescue Medications

Some medications, particularly for migraine-type headaches, are used to “abort” the headache after it has already started, and are designed to be taken as needed. If your NDPH has migraine-like symptoms, you may find these medications helpful:

Triptans/Ergots

Sumatriptan (Imitrex®)
Rizatriptan (Maxalt®)
Naratriptan (Amerge®)
Eletriptan (Relpax®)
Frovatriptan (Frova®)
Almotriptan (Axert®)
Treximet®
DHE (Dihydroergotamine®) nasal spray (Migranal®, Trudhesa™)
DHE (Dihydroergotamine®) injection (DHE-45®)

Anti-Inflammatories

Ibuprofen (Advil®)
Naproxen (Aleve®)
Celecoxib (Celebrex®)
Toradol (Ketorolac®)
Nabumetone (Relafen®)
Asprin®
Indomethacin (Indocin®)
Mobic (Meloxicam®)
Diclofenac (Voltaren®, Cambia®)

Preventives

Preventives, as the name suggests, are designed to be taken long-term to prevent headache from occurring.

Antidepressants

Elavil (Amitriptyline®)
Noritriptyline (Pamelor®)
Desipramine (Norpramin®)
Imipramine (Tofranil®)
Doxepin (Silenor®, Zonalon®, Prudoxin®)
Mirtazapine (Remeron®)
Desyrel (Trazodone®)
Fluoxetine (Prozac®)
Escitalopram (Lexapro®)
Citalopram (Celexa®)
Venlafaxine (Effexor®)
Duloxetine (Cymbalta®)
Wellbutrin (Bupropion®)
Zoloft (Sertraline®)
Paroxetine (Paxil®)
Desvenlafaxine (Pristiq®)

Anticonvulsants

Gabapentin (Neurontin®)
Pregabalin (Lyrica®)
Levitracetam (Keppra®)
Oxcarbazepine (Trileptal®)
Carbamazepine (Tegretol®)
Divalproex (Depakote®)
Zonisamide (Zonegran®)
Phenytoin Sodium (Dilantin®)
Phenobarbital®
Topiramate (Topamax®, Trokendi®)
Valproic Acid (Depakene®)

Antipsychotics & Stimulants

Lamotrigine (Lamictal®)
Lithium®
Quetiapine (Seroquel®)
Risperidone (Risperdal®)
Olanzapine (Zyprexa®)
Dextroamphetamine (Zenzedi®)
Methylphenidate (Daytrana®)

MAO inhibitors

Isocarboxazid (Marplan®)
Phenelizine (Nardil®)
Tranylcypromine (Parnate®)

ACE/ACE II inhibitors

Candesartan (Atacand®)
Captopril®
Enalapril (Vasotec®)
Losartan (Cozaar®)
Lisinopril (Qbrelis®, Zestril®, Prinivil®)

Alpha-adrenergic blockers

Clonidine (Catapres®)
Prazosin (Minipress®)
Doxazosin (Cardura®)

CGRP Monoclonal Antibodies

Recently, a new class of headache medications has been released that block the effect of calcitonin gene-related peptides (CGRP), which are small proteins that are highly prevalent in the sensory nerves that supply the head and the neck. These medications come as injections taken once a month or once every 3 months. New abortive CGRP blockers that can be taken at the first sign of a headache are also available. They have worked well for some NDPH patients with migraine-like symptoms.

Erenumab (Aimovig®)
Fremanezumab (Ajovy®)
Galcanezumab (Emgality®)
Eptinezumab-jjmr (Vyepti®)

Gepants

Gepants are a new class of migraine medication which are small molecule CGRP inhibitors/antagonists.

Ubrogepant (Ubrelvy®)
Rimegepant (Nurtec® ODT)
Atogepant (Qulipta®)
Zavegepant (Zavzpret®)

Ditans

Ditans are a new class of migraine medication which are 5-HT1F receptor agonists that act on the trigeminal system without causing vasoconstriction.

Lasmiditan (Reyvow®)

Muscle Relaxants

Since tension-type headache is potentially caused by tight head, neck, and scalp muscles, muscle relaxants are often used to treat tension-type NDPH. These include:

Baclofen (Lioresal®)
Tizanidine (Zanaflex®)
Carisoprodol (Soma®)
Metaxalone (Skelaxin®)
Cyclobenzaprine (Flexeril®)
Methocarbamol (Robaxin®)

Sleep Aids/Anxiety

Sleep difficulties commonly co-occur and contribute to headache. For that reason, sleep and anxiety medications are sometimes used to treat NDPH.

Alprazolam (Xanax®)
Lorazepam (Ativan®)
Diazepam (Valium®)
Chlordiazepoxide (Librium®)
Clonazepam (Klonopin®)
Buspirone (Buspar®)
Zaleplon (Sonata®)
Zolpidem (Ambien®)
Eszopiclone (Lunesta®)
Ramelteon (Rozerem®)
Zopiclone (Imovane®)
Cyproheptadine (Periactin®)

Anti-nausea

With migraine-type NDPH, nausea can be a bothersome symptom. The following anti-nausea medications are sometimes used for NDPH.

Diphenhydramine (Benadryl®)
Prochlorperazine (Compazine®)
Metoclopromide (Reglan®)
Promethazine (Phenergan®)
Chlorpromazine (Thorazine®)
Hydroxyzine (Vistaril®)
Ondansetron (Zofran®)

Opiates/narcotics

As a last resort, opioids can be used to treat pain from NDPH.

Hydrocodone (Vicodin®)
Fentanyl®
Tylenol #3®
Oxycodone (Percocet®)
Morphine®
Hydromorphone (Dilaudid®)
Suboxone®
Methadone®
Tramadol (Ultram®)
Codeine®

Miscellaneous

A variety of other drugs can be used for chronic pain or NDPH, including:

Ketamine®
Lidocaine®
Low dose naltrexone®
Mexiletine®
Memantine (Namenda®)
Fiorecet®
Steroids (methylprednisolone®, etc.)