Can Muscle Relaxers Help Treat Migraine?

Muscle relaxers aren’t a first-line treatment for migraine. Still, a doctor or healthcare professional may prescribe certain muscle relaxers, such as tizanidine, to treat migraine or other types of headaches. But in most cases, the risks may outweigh the benefits.

Migraine is a debilitating, intense form of headache that usually affects one side of your head. The pain can last from a few hours to a few days. People may also experience:

• nausea
• vomiting
• sensitivity to light and sound
• aura (flashing lights or spots in their line of vision)

About 75% of people in the United States with migraine identify as women. It typically affects people between the ages of 15 and 55 and gets less frequent and severe with age. Most people with migraine have a family history of the condition.

There are several treatment options for migraine. But when preferred treatments fail, a doctor may look for alternative ways to relieve symptoms or prevent headaches from occurring.

Muscle relaxers aren’t a first-line treatment for migraine. Still, a doctor may prescribe a muscle relaxer to help relieve certain migraine symptoms. Doctors sometimes prescribe them to treat other types of headaches as well.

A clinical trial is underway to determine if one muscle relaxer, tizanidine, could also help prevent migraine.

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Can muscle relaxers treat migraine?

Skeletal muscle relaxers are generally not FDA approved to treat migraine. If a doctor prescribes a muscle relaxer for migraine, it’s typically an off-label use.

Muscle relaxers come in two broad categories:

• Antispasmodics: These drugs treat muscle spasms and cramps. Doctors often use them to treat stomach cramps and fibromyalgia.
• Antispastics: These drugs reduce muscle tone and stiffness that may occur in conditions such as multiple sclerosis (MS), cerebral palsy, or spinal cord injuries.

It’s not clear why muscle relaxers may work for migraine. Antispasmodics don’t work directly on your muscles but have a sedating effect.

Each muscle relaxer works a bit differently and has a unique safety profile.

Tizanidine (Zanaflex)

Tizanidine is both an antispasmodic and antispastic. It’s FDA approved to manage spasticity in:

• MS
• stroke
• traumatic brain injury
• spinal cord injury
• amyotrophic lateral sclerosis (ALS)

Doctors also use tizanidine off label to treat chronic migraine. That’s when you experience migraine headaches at least 15 days each month. They may also use it to help with rebound headaches from medication withdrawal.

Other off-label uses of tizanidine include chronic neck and lower back pain, as well as some regional pain syndromes.

An ongoing clinical trial is testing whether tizanidine can prevent acute migraine attacks in people with a history of migraine.

Some common side effects of tizanidine include:

• drowsiness
• nervousness
• hallucinations
• involuntary muscle movement
• muscle weakness
• rhinitis
• constipation
• blurred vision

Most people don’t have serious side effects from taking tizanidine. Very rarely, adverse reactions, such as anaphylaxis and hypotension, may occur.

Cyclobenzaprine (Flexeril)

Cyclobenzaprine works on your central nervous system to relax your muscles. A doctor may prescribe it to help relieve pain from injuries such as strains and sprains. It’s FDA approved to use with rest and physical therapy for this purpose.

Off-label uses of cyclobenzaprine include treating fibromyalgia and myofascial pain from jaw joint disorders.

Cyclobenzaprine has a structure similar to a group of drugs that may be effective at preventing migraine headaches. But there’s little data to support the use of cyclobenzaprine to prevent migraine.

The most common side effects of cyclobenzaprine are:

• extreme fatigue
• nausea
• dizziness
• constipation
• dry mouth
• heartburn

Cyclobenzaprine may also cause more serious side effects such as:

• rapid heart rate (tachycardia)
• urinary retention
• loss of bowel muscle movement (ileus)
• confusion
• hallucinations

Methocarbamol (Robaxin)

Methocarbamol is an older medication first approved to treat muscle spasms in 1957. Like cyclobenzaprine, you use it with rest and physical therapy to treat acute musculoskeletal pain. There’s no specific data on whether it can effectively treat migraine.

Side effects of methocarbamol include:

• drowsiness
• dizziness
• fever
• blurry vision
• upset stomach
• metallic taste
• dark urine that’s often green, black, or blue

Other muscle relaxers

Researchers have looked into other muscle relaxers as migraine therapy. But there’s little data to support their safety or effectiveness for migraine. Examples include:

• carisoprodol (Soma)
• metaxalone (Skelaxin)
• baclofen (Lioresal)
• diazepam (Valium)

Natural muscle relaxers

Although they may not all function as muscle relaxers, several natural remedies and dietary supplements may help with headache or migraine. These include:

• coenzyme Q10
• feverfew
• magnesium
• riboflavin (vitamin B2)

Some people promote peppermint oil to relieve pain from headaches. While there’s not much evidence to support its use, it’s generally safe and well-tolerated.

Butterbur is another natural remedy with some potential to treat migraine. But it’s best to use it with caution.

In 2015, the American Academy of Neurology stopped recommending butterbur for migraine because of serious safety concerns. The National Institutes of Health suggests you only use butterbur products if the label states they’re free of pyrrolizidine alkaloids (PAs). PAs can damage your liver, lungs, and circulatory system.

Can muscle relaxers treat other types of headaches?

Some muscle relaxers may help treat other kinds of headaches besides migraine.

Tension headache

Tension headaches are very common and occur when muscles in your head and neck contract. Doctors sometimes prescribe tizanidine off label to prevent chronic tension headaches. But there’s not much evidence to support their use for this purpose.

Because muscle relaxers come with a risk of dependence, a doctor is likely to suggest other options to treat tension headaches.

Occipital neuralgia

Occipital neuralgia is a rare chronic headache disorder. These short, painful headaches start in your occipital nerves, which run through your neck and the back of your head.

Muscle relaxers may help treat occipital neuralgia. Other possible treatments include:

• nonsteroidal anti-inflammatory drugs (NSAIDs)
• anticonvulsants
• antidepressants
• local nerve blocks

Sinus headache

A sinus headache is actually pressure caused by sinusitis. Treatment for sinusitis typically does not involve muscle relaxers. If sinusitis is because of a bacterial infection, a doctor may prescribe antibiotics.

Options for managing sinusitis at home may include:

• nasal wash
• using a humidifier
• taking over-the-counter (OTC) decongestants

Cluster headache

Cluster headaches can be as painful as migraine, but they’re usually shorter. Some doctors may prescribe baclofen, an antispastic, off label to treat or prevent cluster headaches. But doctors don’t typically use muscle relaxers for this purpose.

The first-line treatments for cluster headaches are oxygen therapy and triptans. Triptans are prescription medications that are also common migraine treatments.

Doctors may also use verapamil, a blood pressure medication, to treat cluster headaches and migraine.

Rebound headache

Rebound headaches, also known as medication-overuse headaches, occur when you take too much of a drug to treat your headaches. They may result from withdrawal when you stop taking that drug.

A doctor may prescribe tizanidine off label to treat rebound headaches. You can use it as part of a program to help you stop using your original medication.

What are the approved treatments for migraine?

Treatment for migraine falls into two broad categories: abortive and preventive. Abortive medications help treat migraine headaches as they occur. Preventive medications help reduce the number and severity of your migraine attacks.

Abortive treatments

During a migraine attack, you may take a prescription or OTC pill to relieve symptoms. Options include:

• Pain relievers: OTC pain relievers, such as acetaminophen (Tylenol), and NSAIDs, such as ibuprofen, naproxen, and aspirin, can help with mild to moderate migraine headaches.
• Triptans: These prescription drugs cause blood vessels to contract. Doctors prescribe triptans if NSAIDs or acetaminophen are ineffective. Common triptans include:
  • sumatriptan (Imitrex)
  • rizatriptan (Maxalt)
  • zolmitriptan (Zomig)
• Gepants: These prescription drugs block calcitonin gene-related peptide (CGRP). They include ubrogepant (Ubrelvy) and rimegepant (Nurtec ODT).
• Ditans: Prescription medications, such as lasmiditan (Reyvow), work to counter specific serotonin receptors in the brain.

Preventive migraine treatments

To prevent the onset of migraine attacks, a doctor may recommend certain medications, electrical current stimulation, or alternative forms of therapy.

Medications include:

• Beta-blockers: Certain beta-blockers, such as propranolol, may be most effective at preventing migraine.
• Antiepileptics: Topiramate (Topamax) and valproate are antiepileptics that are often effective in migraine prevention.
• Antidepressants: Two antidepressants may be effective at treating migraine. Doctors often prescribe amitriptyline, a tricyclic antidepressant, and fluoxetine, a selective serotonin reuptake inhibitor.
• Calcium channel blockers: Verapamil, a blood pressure medication, may also help prevent migraine.
• CGRP inhibitors: Like gepants, monoclonal antibodies can also block CGRP. Popular prevention options include erenumab (Aimovig) and fremanezumab (Ajovy). Some gepants, such as atogepant and rimegepant, can also help prevent migraine.
• Botulinum toxin A (Botox): Widely known as a wrinkle reducer, botox injections can help prevent migraine. A clinician injects the toxin into specific points in your head and neck every 3 months.

Alternative therapy includes practices such as mindfulness and biofeedback. Some people may also find relief through cognitive behavioral therapy, also known as “talk therapy.”

Another option may be transcranial magnetic stimulation (TMS). TMS is a noninvasive procedure that involves magnetic pulses that stimulate nerve cells in your brain.

Takeaway

Migraine is a disabling disorder with many first-line treatment options. If OTC medications don’t work, a doctor might prescribe triptans, gepants, or ditans, among other options. Some muscle relaxers may also be effective in treating migraine or other headache types, but this is an off-label use.

Some muscle relaxers may have serious side effects. They may even carry a risk of overuse or dependency. Be sure to discuss these with a doctor before starting treatment.