Preventive Migraine Medicine: Making Your Decision

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

• Beta-blockers such as Inderol and Toprol, which relax blood vessels.
• Calcium channel blockers such as Cardizem and Procardia, which reduce the amount of narrowing (constriction) of the blood vessels.
• Antidepressants such as Amitriptyline -- a tricyclic antidepressant which has been shown to be effective in preventing migraines.
• Anticonvulsants such as Depakote and Topamax, which were recently approved by the FDA for preventing migraines.

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

You may need preventive 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 medications 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.

You probably don't need preventive drugs 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 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 nonmedication treatment (like biofeedback).

Migraine Medicines and Pregnancy Concerns

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.

However, if you have severe migraines, doctors may advise trying a nonmedication approach such as biofeedback, relaxation therapy, or stress-management training first. 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.

SOURCES: American Academy of Neurology: Evidence-Based Guidelines for Migraine Headache. George R. Nissan, DO, director of research, Diamond Headache Clinic, Chicago.