100 Migraine Drugs, A to Z: tizanidine

Tizanidine (Zanaflex) is a muscle relaxant that has been shown to relieve chronic migraines in a 200-patient double-blind study by Dr. Joel Saper and his colleagues. It may be particularly effective in people with neck and shoulder muscle spasm and pain. The majority of migraine sufferers have such muscle pains. It is also a good choice when you have insomnia along with migraines.

The main side effect of tizanidine is drowsiness and dizziness. This is why it is usually taken at night. The starting dose is 4 mg. It can be gradually increased to 8, and then 12 mg. In the double-blind study, the median dose was 18 mg. Some patients went up to 24 mg with 8 mg taken three times a day. Very few of my patients can take that much tizanidine during the day. At most, they will take 2-4 mg twice during the day and a higher dose at night.