About 1 in 4 people get a clue (called a prodrome) that a migraine is imminent. Signs include:
Mood changes, excitability, irritability
Fatigue and yawning
Signs may occur as early as 1 or 2 days before the headache. Practice recognizing early signs. Your efforts may help you abort a headache.
Calcium channel blockers. These include dilatizem (Cardizem) and verapamil. They reduce the narrowing of your blood vessels.
Tricyclic antidepressants. Your doctor may prescribe amitriptyline (Elavil) and nortriptyline (Aventyl, Pamelor).
Anticonvulsants. These are drugs that prevent or reduce seizures. To prevent migraines, your doctor may recommend valproic acid (Depakote) or topiramate (Topamax).
Botulinum toxin (Botox). For migraine prevention, this can be injected in small quantities around your face and scalp every 3 months.
Making the Decision
You may want to consider medicine to prevent migraines if you:
Have pain that interferes with your life despite treatment.
Get at least three moderate-to-severe headaches per month.
Take a lot of painkillers.
Can't get enough relief from drugs you now take.
Have side effects from your headache drugs.
Have uncommon migraine conditions like continuing aura (blurred vision or seeing spots or wavy lines).
Preventive medicine might not be right for you if:
Your headaches are controlled by anti-inflammatories like naproxen and ibuprofen.
Other health conditions keep you from taking preventive drugs.
There could be bad interactions with other medicines you take.
You prefer treatments that don't involve drugs
If you can't take medication or prefer not to, there’s a device worth considering. Cefaly is the first FDA-approved machine that prevents migraines in people over 18. Worn around the forehead, this portable headband-like device gives out electrical impulses. These stimulate a nerve connected with migraines. You’ll feel a tingling sensation and should use it once a day for 20 minutes.
Migraine Drugs and Pregnancy
If you are pregnant, your migraines may ease up during your second and third trimester.
If you have severe migraines, though, your doctor may suggest first trying a non-drug treatment such as biofeedback, relaxation therapy, or stress-management training. He may also recommend a preventive drug that has the lowest risk possible.
Talk to your doctor about your thoughts on taking preventive medications for migraines. Together, you can decide the best approach for your headache problems.