100 Migraine Drugs, A to Z: clonazepam

Clonazepam (Klonopin) is a drug approved for the treatment of panic attacks and certain types of seizures. It is also used “off label” to treat anxiety, insomnia, and muscle spasm. Clonazepam belongs to the family of benzodiazepines, which includes diazepam (Valium), alprazolam (Xanax), and lorazepam (Ativan). Clonazepam tends to have a longer lasting effect and it is thought to be less likely to cause physical and psychological dependence and tolerance, i.e. the need to keep increasing the dose to achieve the same effect.

Clonazepam is not the first or even the tenth choice when treating migraine headaches. However, adding clonazepam to other medications can provide significant relief. This could be in part due to the fact that patients with migraines are 2-3 times more likely to have anxiety and panic attacks. They are also often anxious about getting their next migraine and this anxiety and tension becomes a self-fulfilling prophesy. Anecdotal reports, including one from a fellow headache expert and friend, Dr. Morris Meizels, suggest that in some patients who do not respond to a variety of other treatments, clonazepam can be very effective.

I use it in a very small number of patients whose anxiety, neck pain, and/or insomnia are major contributors to their migraine headaches and whose migraines do not respond to several standard preventive therapies. Before prescribing clonazepam, among the medications we try first are antidepressants, such as nortriptyline or duloxetine. These have no risk of addiction, but sometimes can be difficult to stop due to physical dependence and they can have other unpleasant side effects. I also always suggest aerobic exercise, meditation and cognitive behavioral therapy (CBT). ThisWayUp.org.au offers a very affordable and scientifically proven way to do CBT on your own.