How Migraine Prevention Treatments Work

Medically Reviewed by Murtaza Cassoobhoy, MD on February 13, 2023
3 min read

A migraine isn't only a headache. It's a complex web of symptoms that can affect your whole body.

Doctors used to think that a migraine attack happened only because blood vessels in your brain opened too wide. While that does happen, experts have discovered that other things, like brain chemicals and nerve pathways, are also involved.

While we don't know the root cause of migraine, today's treatments target what we know play a role to help stop an attack before one even starts.

Medicines that treat high blood pressure and heart problems may help you avoid migraines, too. We're not exactly sure why. While their effect on blood vessels may have something to do with it, they probably affect your brain and nerves as well to make it harder for the migraine process to start.

Beta-blockers such as metoprolol, propranolol, and timolol decrease your blood pressure and reduce the frequency of headaches. 

Calcium channel blockers such as verapamil can relax your blood vessels. Not all drugs of this kind help with migraines.

Drugs called tricyclic antidepressants (TCAs) can help prevent migraine attacks by increasing the amount of serotonin, a brain chemical known to play a part in migraine. Serotonin can lead to tightening blood vessels and a lower pain tolerance.

A new type of drug called CGRP blockers works to block a protein called calcitonin gene-related peptide that's believed to trigger and worsen a migraine attack. Some treatments are for acute migraine and others work to prevent migraine. They work by inactivating the CGRP ligand or blocking the CGRP receptor stopping the cascade that contributes to trigeminal neurovascular pain and inflammation.

Using birth control with hormones may help reduce or stop migraines that women get around the start of their periods. By basically blocking ovulation, the level of hormones in your body remains steady each month and you avoid the natural dip that can trigger headaches.

Two types of drugs typically used to stop migraines may also help prevent premenstrual migraines. NSAIDs, over-the-counter and prescription pain relievers including ibuprofen and naproxen, block a key chemical in the inflammation process. Certain triptans close off pain pathways in your brain and keep your blood vessels from widening.

Botox, a nerve toxin that comes from a type of bacteria, isn't just for "freezing" facial muscles that cause wrinkles and laugh lines. It can be used to stop chronic migraine headaches, too. During a treatment, your doctor will give you as many as 31 shallow shots in your head and neck. Once under your skin, the Botox travels to nearby nerve endings and blocks them from working. That prevents them from giving off signals to your brain that you're in pain.

Some experts believe that epilepsy and migraine are similar because they both cause your brain neurons to misfire. Anti-seizure drugs like divalproex (Depakote), topiramate (Qudexy XR, Topamax, Topamax Sprinkle, Trokendi XR), and valproate coax your nerve cells to send out normal signals again. They may also make it harder for nerve cells in your brain to send out messages of pain.

Nerve stimulation treatments gently jolt different nerves in your forehead, neck, and head with electrical or magnetic pulses. This may help interrupt the abnormal brain activity that triggers migraines. These treatments are devices worn like a headband for a few minutes each day.