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Preventive Migraine Medicine

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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As headaches go, migraines are in a league of their own. Migraines typically produce pulsating pain on one side of the head. That can lay you low for up to 72 hours. About 20% of people with migraines have headaches preceded by aura, which can include: Blinking lights Blurred vision Blind spots or zigzags in your field of vision Aura may also include numbness or tingling on one side of the body. Aura without head pain is also a form of migraine. Migraines are often prompted by one...

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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.  

Migraine Drugs and Pregnancy

If you are pregnant or want to get pregnant, here's good news: Your migraines may 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.


WebMD Medical Reference

Reviewed by Richard Senelick, MD on October 01, 2014
 This tool provides general information and recommendations, and may not address specific individual circumstances. Do not rely on it exclusively to make decisions about your health. Always consult your doctor for personal medical advice.
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