Are Preventive Migraine Meds for You?

If you get severe migraine headaches so often that they interfere with your life, talk to your doctor about preventive medications. These preventative medicines aren’t the same ones you take to treat a migraine headache, but the kind you take so the headaches won't be so bad and you won’t have so many.

Preventive meds might help if you experience these things:

  • You have four or more migraine headaches a month.
  • You don’t get relief from your meds that you take for an attack (acute meds).
  • You use too much pain medicine.
  • You are sick from your headaches.
  • Your headaches last longer than 12 hours at a time

What Are the Benefits?

Preventive meds can improve your life by cutting down the number and severity of your migraine headaches, and also improve how well they respond to pain relievers.

There are a lot of drugs that prevent migraine headaches from occurring, so choosing the right one may be hard. Talk to your doctor about your medical history, other medicines you take, and how much you want to take each day.

It could take several months to find the drug combo that works best for you -- and a few more before you see the full effects -- but experts say you should stick with it until you do.

Even if you take preventives, you may still need to take acute medicines when you get a migraine to ease the pain and other symptoms. Many people do.

After a few months, or when your migraine symptoms are well-controlled, your doctor may recommend gradually stopping preventive meds. To avoid getting worse headaches that may occur from stopping abruptly, your doctor will usually have you taper off of them.

Cardiovascular Drugs

Beta-blockers, which are commonly used to treat high blood pressure, are often prescribed to prevent or reduce the intensity of migraine symptoms. Some beta-blockers often prescribed for prevention therapy include:

Beta-blockers aren’t recommended for certain people with breathing problems or slow heartbeats. Other side effects can include dizziness, cold fingers and feet, decreased sex drive, lethargy, and fatigue. They can cause gastrointestinal problems and depression.

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Antidepressants

Tricyclic antidepressants (TCAs) help ease depression by changing neurotransmitter levels in the brain. In a similar way, they also may help prevent migraines, even in people who aren’t depressed.

Amitriptyline is the only TCA actually proven to prevent migraines, but doctors also prescribe:

Side effects of TCAs are usually mild and include dry mouth or eyes, weight gain, and sleepiness.

Selective serotonin reuptake inhibitors (SSRIs) work as antidepressants and also pain relievers. They don’t seem to work as well as amitriptyline at preventing migraines. Some research shows they can even trigger migraines.

On the other hand, studies have shown that venlafaxine HCl is a very effective selective serotonin and norepinephrine reuptake inhibitors (SNRIs) for stopping migraine headaches, with few side effects.

Anti-seizure Drugs

Anticonvulsants are drugs that treat seizure disorders or epilepsy. They have been shown to work well in helping limit the number of migraines you get. Those used for treating migraines include topiramate (Qudexy XR, Topamax, Trokendi XR) and valproate (Depakote).

They do have side effects, though, when prescribed in high doses. Topiramate, for instance, can cause diarrhea, weight loss, and difficulty concentrating. Divalproex can cause drowsiness, nausea, abdominal pain, and vomiting.

CGRP Inhibitors

CGRP (calcitonin gene-related peptide) is a molecule involved in causing migraine pain. CGRP inhibitors are a new class of drugs that block the effects of CGRP. Erenumab (Aimovig), galcanezumab-gnlm (Emgality), and fremanezumab (Ajovy) are specifically approved to prevent migraine attacks. You give yourself an injection once a month with a pen-like device. In clinical trials, people consistently had one to two fewer migraine days a month than those who took placebo. Mild pain and redness at the injection site are the most common side effects.

Botox

Many people with very frequent migraine headaches (chronic migraine; that is headache more than 14 days/month) have had good results with Botox injections. And research has shown that getting Botox about every 12 weeks into your forehead and neck can prevent migraine headaches. Doctors often recommend Botox as an option when other treatments don’t work well.

Researchers think Botox injections block the pain-signaling transmissions between the head and neck and the central brain, where migraines start. The side effects are rare and limited to pain around the injection sites.

WebMD Medical Reference Reviewed by Jennifer Robinson, MD on February 14, 2019

Sources

SOURCES:

UpToDate: “Preventive treatment of migraines in adults.”

MedlinePlus: “Protriptyline,” “Imipramine,” “Gabapentin.”

Mayo Clinic: “Migraine Treatment.”

American Family Physician: “Medications for Migraine Prophylaxis”

FDA: “FDA approves Botox to treat chronic migraine.”

Association of Migraine Disorders: “Prescription Medications for Migraines.”

NPS MedicineWise: “Migraine preventive treatments.”

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