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Understanding Migraine -- Prevention

For anyone who endures frequent or severe migraines, preventing these painful headaches is a top concern. Experts don't know exactly what causes migraines. But they have been able to identify medications to help prevent them. 

People with frequent or severe migraine attacks can sometimes help prevent migraines if they:

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  • Adopt lifestyle changes
  • Avoid migraine triggers
  • Use preventive medications or devices

Preventive Migraine Medications

Preventive migraine medications can:

  • Decrease the number of migraines
  • Reduce the severity of the headache
  • Shorten the duration of the headache

This treatment approach is helpful for people with frequent migraines. Medications can reduce how often migraines occur by half or more.

You may want to consider preventive medications if:

  • Acute treatment medications don't help or you have bothersome side effects from them.
  • You have frequent migraines (more than one a week).

 

The latest guidelines say these drugs are effective for preventing migraines:

Antiepileptic drugs. Certain antiseizure drugs are also effective for preventing migraines. These drugs may work by calming the neurons in the brain. Neuron "hyperexcitability" plays a role in migraine and epilepsy. Up to 20% of people with epilepsy also have migraine.

Antiepileptic drugs include:

Beta-blockers. These drugs are commonly used to treat high blood pressure and heart disease. It's not clear how they help prevent migraines. But improving blood flow may play a role. Some beta-blockers that are effective for migraine prevention include:

Antidepressants. These medications affect the level of the brain chemical serotonin. Moderate evidence shows Elavil and Effexor are effective for preventing migraines. Other antidepressants may help as well.

Triptans for menstrual-related migraines. Triptans are commonly used for acute migraine treatment. But one triptan -- Frova -- is also helpful for preventing menstrual-related migraines. It affects serotonin levels and may also relieve pain in other ways. Several other triptans are being studied and may possibly be effective in preventing menstrual-related migraines.

Botox. Botox is a type of toxin produced by the bacteria Clostridium botulinum. It weakens or paralyzes muscles. Botox is often used to treat wrinkles. But it was also found to help some people with chronic migraines. The FDA approved Botox for the preventive treatment of chronic migraines in 2010. It is used for people who have long-term migraine headaches at least 15 days per month, with the headache lasting four hours daily or longer. It is thought that Botox inhibits the release of certain chemicals involved in the transmission of pain signals.

When using medication to prevent migraines, keep these tips in mind:

  • Your doctor will likely start you on a low dose and gradually increase it over time. It may take several months to find the best dose with the fewest side effects.
  • Don't suddenly stop taking preventive medications. That could trigger a severe rebound headache. Preventive medications need to be gradually tapered off under your doctor's direction.
  • Preventive migraine medications probably won't completely rid you of the headaches. You may still need to take acute medications when you do have a migraine attack.

If you can't take medications or prefer not to, a device may be worth considering. Cefaly is the name of the first FDA-approved device for preventing migraines in people over age 18. The portable headband-like device uses transcutaneous electrical nerve stimulation (TENS) to stimulate the trigeminal nerve, which has been associated with migraine headaches. Cefaly should only be used once per day for 20 minutes, during which the user will feel a tingling or massaging sensation.

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