Migraine: medications and paying cash

Overview

Migraine is a neurological condition in which attacks of throbbing, often one-sided headache come with nausea and sensitivity to light and sound, lasting hours to days, sometimes preceded by a visual or sensory aura. Triggers include sleep changes, stress, hormones, alcohol and missed meals. A headache diary helps identify patterns and judge treatment.

For attacks, triptans such as sumatriptan and rizatriptan, taken early, are the standard prescription treatment, often combined with naproxen; anti-nausea medicines help when vomiting is part of the attack. The gepants and lasmiditan are newer options for people who cannot take triptans. Using any acute treatment on more than about ten days a month causes medication-overuse headache.

For people with frequent or disabling attacks, a daily preventive reduces how often they happen: propranolol or another beta blocker, topiramate, or low-dose amitriptyline are first-line and generic; monthly CGRP antibody injections and the gepants used daily are newer, effective and brand-only; and botulinum toxin injections treat chronic migraine. Propranolol and topiramate are FDA-approved for migraine prevention, but amitriptyline is not, and neither is every beta blocker, so using those for migraine is the prescriber’s decision.

Choosing between the options when you pay cash

Triptans are available as generics, and because monthly use is limited, prescriptions are small, so compare quotes for the same quantity. Dissolving tablets, nasal sprays and injections are separate products from the plain tablets, each with its own quote. The generic preventives can be prescribed as ninety-day supplies once the dose is settled.

The CGRP medicines and gepants are brand-only, so manufacturer programs and insurance with prior authorization are the usual routes; insurers may require a trial of generic preventives first.

Medicines at a glance

How the medicines in this group are supplied and usually taken. Each guide has the full details.

• Sumatriptan
  Tablets (Imitrex and generic), Nasal spray (generic; Tosymra), Nasal powder (Onzetra Xsail)
  Generic: Yes · See the guide
• Rizatriptan
  Tablets (Maxalt and generic), Orally disintegrating tablets (Maxalt-MLT and generic)
  Generic: Yes · See the guide
• Propranolol
  Tablets, Oral solution, Extended-release capsules (Inderal LA and generics, InnoPran XL, Inderal XL)
  Generic: Yes · Two to four times a day
• Topiramate
  Tablets (Topamax and generic), Sprinkle capsules (Topamax and generic), Extended-release capsules (Trokendi XR and generic)
  Generic: Yes · See the guide
• Amitriptyline
  Tablets (generic)
  Generic: Yes · Once a day
• Naproxen
  Tablets (Naprosyn, Anaprox DS and generic), Delayed-release tablets (EC-Naprosyn and generic), Controlled-release tablets (Naprelan and generic)
  Generic: Yes · Twice a day
• Eletriptan
  Film-coated tablets
  Generic: Yes · See the guide
• Dihydroergotamine
  Injection (vials or ampuls), Autoinjector (Brekiya), Nasal spray kit (Migranal and generics)
  Generic: Yes · See the guide
• Ubrogepant
  Tablets in single-tablet packets
  Generic: No · See the guide
• Rimegepant
  Orally disintegrating tablets
  Generic: No · See the guide
• Atogepant
  Tablets
  Generic: No · Once a day
• Naratriptan
  Film-coated tablets
  Generic: Yes · See the guide
• Zolmitriptan
  Tablets, Orally disintegrating tablets, Nasal spray (single-use devices)
  Generic: Yes · See the guide

Medications

Which of these is right for a given person is a decision for the prescriber. The guides explain what each drug is, how it is supplied, and why its cash price varies between pharmacies. No page on this site shows a price; prices come from pharmacies responding to your actual prescription.

Questions worth asking

• Which triptan and form suit my attacks, and how soon should I take it?
• How many days a month is it safe to use acute treatment?
• Should I be on a preventive, and which one first?
• Can the prescription allow a larger quantity per fill?
• Are any of my other medicines making headaches worse?

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