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Migraines & Headaches Health Center

Preventive Migraine Medicine

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Several types of migraine drugs 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 a decision.

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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).

If you can't take medication or prefer not to, a device may be worth considering. Cefaly is the first FDA-approved device for preventing migraines in people over age 18. The portable headband-like device gives electrical impulses on the skin at the forehead. This stimulates a nerve associated with migraine headaches. Cefaly is used once a day for 20 minutes, and when it's on you'll feel a tingling or massaging sensation.  

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