Medicines That Can Prevent Migraine Headaches

It's the best situation: Stop a migraine before it starts. To do that, your doctor may consider these types of prescription drugs.

Anticonvulsants. These are medicines that prevent or reduce seizures. Your doctor may recommend topiramate (Qudexy XR, Topamax) or valproic acid (Depakene, Depakote) to prevent your headaches.

Beta-blockers. These relax your blood vessels. Your doctor may suggest metoprolol (Lopressor, Toprol XL) or propranolol (Inderal, Innopran XL).

Botulinum toxin (Botox). A doctor can inject small amounts around your face and scalp every 3 months to stop migraines from happening.

Calcium-channel blockers. These include diltiazem (Cardizem, Cartia, Covera HS,Tiazac) and verapamil (Calan, Verelan). They ease the narrowing of your blood vessels.

Antidepressants . Your doctor may prescribe amitriptyline (Aventyl) or nortriptyline (Pamelor). Research suggests duloxetine (Cymbalta) and venlafaxine (Effexor XR) may be helpful in preventing migraines.

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. Eptinezumab (Vyepti), erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality) are specifically approved to prevent migraine attacks. You give yourself an injection once a month with a pen-like device.

Do You Need It?

You may want to consider medicine to prevent migraines if you:

  • Have pain that hampers your life despite treatment
  • Get at more than three moderate to severe headaches per month
  • Take a lot of painkillers
  • Don't get enough relief from meds you now take
  • Have side effects from your headache drugs
  • Have uncommon migraine conditions like continuing aura (blurred vision or seeing spots or wavy lines)

Preventive medicine might not be right for you if:

  • Your headaches are infrequent and controlled by anti-inflammatories like ibuprofen and naproxen.
  • Other health conditions keep you from taking preventive drugs.
  • Those drugs could mix badly with other medicines you take.
  • You prefer treatments that don't involve meds.

If you can't take medication or prefer not to, there are also devices you and your doctor could consider:

  • Cefaly, a small headband device that sends electrical pulses through the forehead to stimulate a nerve linked with migraines
  • Spring TMS or eNeura sTM, a device for people who have an aura before migraine headaches. You hold it at the back of your head at the first sign of a headache, and it gives off a magnetic pulse that stimulates part of the brain. 
  • Noninvasive vagus nerve stimulator (nVS) gammaCore is a hand-held portable device placed over the vagus nerve in the neck. It releases a mild electrical stimulation to the nerve's fibers to relieve pain.
  • Nerivio, a wireless remote electrical neuromodulation device that is self-applied to the upper-arm and should be used in the home environment at the onset of migraine headache

Continued

If You’re Pregnant

Your headaches may ease up during your second and third trimesters.

If you have severe migraines, your doctor may suggest that you first try a treatment that's not a drug -- such as biofeedback, relaxation therapy, or stress management training. He may also recommend a preventive drug that has the lowest risk possible.

Talk to your doctor about the pros and cons of taking preventive medications for migraine. Together, you can decide the best approach for you.

WebMD Medical Reference Reviewed by Arefa Cassoobhoy, MD, MPH on March 12, 2020

Sources

SOURCES:

American Academy of Neurology: "Evidence-Based Guidelines for Migraine Headache."

George R. Nissan, DO, director of research, Diamond Headache Clinic, Chicago.

FDA.

MedlinePlus: "Propranolol (Cardiovascular)," "Metoprolol."

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