Migraines & Headaches Health Center

Preventive Migraine Medicine

Several types of migraine medicines can help prevent the piercing pain of migraines, including:

• Beta-blockers such as Inderal (propanalol) and Toprol (metoprolol), which relax blood vessels
• Calcium channel blockers such as Cardizem (dilatizem)  and verapamil, which reduce the amount of narrowing (constriction) of the blood vessels
• Antidepressants such as amitriptyline and nortriptyline --  tricyclic antidepressants which have been shown to be effective in preventing migraines.
• Anticonvulsants such as Depakote (valproic acid) and Topamax (topiramate) 
• Botox (botulinum toxin), which can be injected in small quantities around the face and scalp; when it works, it can be repeated in 3 months.

Should you take daily migraine medicine? Here are some points to consider in making your decision.

Consider Migraine Prevention Drugs If:

• You have moderate-to-severe headache pain that is disabling and interfering with your life despite treatment
• You have at least three moderate-to-severe headache days per month
• Your migraines are seriously affecting your quality of life
• You are taking migraine painkillers very frequently
• Your current migraine drugs are not providing sufficient relief
• You are having side effects from current headache drugs
• You prefer to take a preventive approach
• You don't mind taking a daily medication
• You have uncommon migraine conditions, like prolonged aura

Migraine Prevention Drugs Are Usually Not Used If:

• You have mild-to-moderate pain that is not disabling
• You have less than three moderate-to-severe headache days per month
• Your headaches are controlled by drugs like NSAIDS (anti-inflammatories like Aleve or Motrin) or triptans
• You don't have side effects from those drugs
• You don't take those drugs frequently
• You're not ready to take a daily migraine medication
• You have other health conditions that do not allow you to take preventive drugs
• You cannot tolerate side effects of preventive drugs
• There might be negative drug interactions with other medications you are taking
• You prefer a non-drug treatment (like biofeedback)

Migraine Drugs and Pregnancy

If you are pregnant or want to get pregnant, here's good news: Your migraines will likely ease up during the second and third trimester of pregnancy.

However, if you have severe migraines, doctors may advise first trying a non-drug approach such as biofeedback, relaxation therapy, or stress-management training . Or your doctor may suggest trying those approaches along with a preventive drug therapy 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.