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Migraines & Headaches Health Center

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Preventives

If migraines are frequent or interfere with your life, it is time to discuss prevention with your doctor. Preventive medications can help stop migraines or reduce their intensity. See if they might help you.

Add Magnesium

People with migraines may sometimes have low levels of magnesium. Ask your doctor if getting more magnesium could help your migraines. Add magnesium by taking a dietary supplement or by eating more green vegetables, beans, peas, nuts, seeds, and whole grains. Magnesium supplements may cause side effects including diarrhea and upset stomach, so ask your doctor before taking them. Some people with health conditions such as kidney disease or who take certain other medicines should not take magnesium supplements. Note in your journal whether adding magnesium reduces your migraines.

Coenzyme Q10

With your doctor's approval, consider taking the supplement coenzyme Q10. Some small studies show it may decrease the frequency of headaches and the number of days with headache-related nausea. Coenzyme Q10 is likely safe for adults, but it can interact with some other drugs and may lower blood pressure in some people. Abnormal liver enzymes have been reported in some people. Just be sure to check with your doctor before taking this or any other supplements.

Menstrual Migraines

To prevent period-related migraines, doctors often recommend taking an NSAID (nonsteroidal anti-inflammatory drug) such as ibuprofen or naproxen. Treatment with an NSAID often begins 2 to 3 days before your period starts and continues until your period ends. Take the lowest effective dose. Don't take more than the amount listed on the drug label or recommended by your doctor. If you still have menstrual migraines, talk to your doctor about other preventive medications.

Who Preventives Help

You may benefit from a preventive plan if:

* You have 2 or more migraines a month.

* You don't get relief from pain medication.

* Your migraines include prolonged aura.

Preventive options include biofeedback, relaxation, acupuncture, a device that gives an electric impulse, as well as several types of prescription drugs.

Preventive Results

Despite their name, preventive migraine drugs may help with many aspects of migraine treatment. In fact, the goal for taking the drugs may vary, including:

* Prevention

* Fewer attacks

* Less severity and disability

* Shorter duration

* Decreased use of abortive medication

* Enhanced responsiveness of pain medication during attacks

Even if you take a preventive medication, you may still need to take abortive drugs at times to stop a migraine once it's started to ease pain and other symptoms. Many people do.

Preventives Prep

Ask your doctor what to expect from a drug:

* What will I gain?

* How long will it take to work? (You may need more than one drug. Finding the best dose for each may take a bit. After that, it may take 2-3 months before you see maximum improvement.)

* How can I avoid side effects? Can I just stop taking it? (You may need to taper off some preventives to avoid rebound headaches.)

Preventive Schedule

You may need more than one preventive medication, and you may need to take them a few times a day. Your doctor may have you take preventives every day. Or you may only need them a few days before a predictable trigger.

Typically, after a few months, or when migraines are well-controlled, your doctor may recommend gradually stopping preventive medication. To avoid rebound headaches that may occur from stopping abruptly, your doctor will usually have you taper off of them.

Beta-Blockers

Commonly used to treat high blood pressure, beta-blockers are also the most often prescribed type of medication to prevent or reduce the severity of migraines. Some migraine beta-blockers are timolol; Corgard (nadolol); Inderal LA or InnoPran XL (propranolol); Lopressor or Toprol XL (metoprolol); and Tenormin (atenolol). Beta-blockers are not recommended for certain people with breathing problems or slow heart beats. If your doctor suggests one, ask about side effects.

CCBs for Migraine

Calcium channel blockers (CCBs) are often used to treat high blood pressure. In some people, they also help prevent migraines and may help ease symptoms from aura. The CCBs most often used for migraines include Calan, Covera HS, Isoptin, or Verelan (verapamil) and Cardizem, Cartia XT, Dilacor XR, or Tiazac (diltiazem).

Other drugs used to lower blood pressure, Prinivil or Zestril (lisinopril), may reduce the length and severity of migraines.

TCAs for Migraines

Antidepressants help ease depression by changing neurotransmitter levels in the brain. In a similar way, they also may help prevent migraines and may have a painkilling effect. A type commonly used for migraines is tricyclic antidepressants (TCAs). They include Aventyl or Pamelor (nortriptyline); amitriptyline; Vivactil (protriptyline); Silenor (doxepin); and Tofranil (imipramine).

Antidepressants

TCAs are a common type of antidepressant used to help prevent migraines. But sometimes doctors prescribe:

* Selective serotonin reuptake inhibitors (SSRIs) such as Celexa (citalopram), Lexapro (escitalopram), Paxil (paroxetine), Prozac (fluoxetine), and Zoloft (sertraline)

* Serotonin norepinephrine reuptake inhibitors such as Cymbalta (duloxetine), Effexor (venlafaxine), and Pristiq (desvenlafaxine)

Antiserotonins

The serotonin blocker Sansert (methysergide) may help prevent migraines by constricting blood vessels and reducing inflammation. These medicationss are not used as often as other preventive meds because of their side effects, but they are an option for some people. The most serious side effect is the scarring of tissue around the kidneys that can lead to kidney failure. If your doctor prescribes this, consider asking if it's your only option.

Anticonvulsants

Anticonvulsants are drugs that treat seizure disorders or epilepsy. They have been shown to be effective in helping prevent migraines. Ones used to treat migraines include: Depakote (divalproex sodium); Depakene (valproic acid);  Horizant or Neurontin (gabapentin); and Topamax (topiramate).

Preventive Decision

Since several medications prevent migraines, choosing the right one can be a complex decision. Here are some things your doctor will consider:

* Other health problems you have that may influence your headaches, such as high blood pressure, asthma, depression or anxiety, seizures, obesity, or diabetes

* Whether you're pregnant or going through menopause

* Other drugs you take

* Each drug's side effects

* Your preferences about the number of times a day to take meds

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