Pain Management Health Center

Consider Prevention

If migraines are frequent or interfere with your life, it may be time to discuss prevention with your doctor. Preventive meds can help stop migraines or reduce their intensity. Browse Tips to see if they might help you.

Who Preventives Help

You may benefit from a preventive plan if:

• You have 2 or more migraines a month.
• You don't get relief from pain meds.
• Your migraines include prolonged aura.

Preventive options include biofeedback, relaxation, and acupuncture as well as several types of prescription drugs.

Preventive Results

Despite their name, preventive migraine meds don't always prevent migraines. In fact, the goal for taking the meds may vary, including:

• Prevention
• Fewer attacks
• Less severity and disability
• Shorter duration
• Decreased use of abortive meds
• Enhanced responsiveness of pain meds during attacks

Even if you take a preventive med, you may still need to take meds called abortive meds that stop a migraine once it's started to ease pain and other symptoms. Many people do.

Preventives Prep

Ask your doctor what to expect from a med:

• What will I gain?
• How long will it take to work? (You may need more than one med. Finding the best dose for each may take a bit. After that, it may take 2-3 months before you see maximum improvement.)
• How can I avoid side effects? Can I just stop taking it? (You may need to taper off some preventives to avoid rebound headaches.)

Preventive Schedule

You may need to take more than one preventive med, and you may need to take them a few times a day. Your doctor may have you take preventives every day. Or, you may only need to take them a few days before a predictable migraine trigger -- like your period starting.

Typically, you take preventives for 6 - 12 months after you stop having migraines. To avoid rebound headaches that may occur from stopping preventives abruptly, your doctor will usually have you taper you off them.

Beta Blockers

Commonly used to treat high blood pressure, beta blockers are also the most often prescribed med to prevent or reduce the severity of migraines. Some migraine beta-blockers are: Blocadren (timolol); Corgard (nadolol); Inderal or InnoPran (propranolol); Lopressor, Lopressor LA, or Toprol XL (metoprolol); and Tenormin or Senormin (atenolol). Beta blockers are not recommended for certain people with breathing problems or slow heart beats. If your doctor suggests one, ask about side effects.

CCBs for Migraine

Calcium channel blockers (CCBs) are often used to treat high blood pressure. In some people, they also help prevent migraines and may help ease symptoms from aura. The CCBs most often used for migraines include Calan, Covera, Isoptin, or Verelan (verapamil) and Cardizem, Cartia, Dilacor, Matzim, or Tiazac (diltiazem).

Other meds used to lower blood pressure, Prinivil or Zestril (lisinopril), may reduce the length and severity of migraines.

TCAs for Migraines

Antidepressants help ease depression by changing neurotransmitter levels in the brain. In a similar way, they also may help prevent migraines and may have a pain-killing effect. A type commonly used for migraines is tricyclic antidepressants (TCAs). They include: Aventyl or Pamelor (nortriptyline); Elavil, Endep, or Vanatrip (amitriptyline); Vivactil (protriptyline); Adapin, Silenor, or Sinequan (doxepin); and Tofranil (imipramine).

Antidepressants

TCAs are a common type of antidepressant used to help prevent migraines. But if your doctor is concerned about a side effect, he or she may prescribe either of these classes of meds:

• Serotonin-norepinephrine reuptake inhibitors (SNRIs): Celexa (citalopram), Lexapro (escitalopram), Paxil (paroxetine), Prozac (fluoxetine), and Zoloft (sertraline)
• Selective serotonin reuptake inhibitors (SSRIs): Cymbalta (duloxetine), Effexor (venlafaxine), and Pristiq (desvenlafaxine)

Antiserotonins

The serotonin blocker Sansert (methysergide) may help prevent migraines by constricting blood vessels and reducing inflammation. These meds are not used as often as other preventive meds because of their side effects, but they are an option for some people. The most serious side effect is the scarring of tissue around the kidneys that can lead to kidney failure. If your doctor prescribes this, consider asking if it's your only option.

Anticonvulsants

Anticonvulsants are drugs that treat seizure disorders or epilepsy. They have been shown to be effective in helping prevent migraines. Ones used to treat migraines include: Depakote (divalproex sodium); Depakene (valproate); Fanatrex, Gabarone, Gralise, Horizant, or Neurontin (gabapentin); and Topamax or Topiragen (topiramate).

Preventive Decision

Since several meds prevent migraines, choosing the right one can be a complex decision. Here are some things your doctor will consider:

• Other health problems you have that may influence your headaches, such as high blood pressure, asthma, depression or anxiety, seizures, obesity, or diabetes
• Whether you're pregnant or going through menopause
• Meds you take
• Each drug's side effects
• Your preferences about the number of times a day to take meds