Anticonvulsants. These are medicines that prevent or reduce seizures. Your doctor may recommend topiramate (Qudexy XR, Topamax) or valproic acid (Depakene, Depakote) to prevent headaches. Anti-seizure drugs could make you sleepy. You may also find it harder to focus.
Beta-blockers. These relax your blood vessels. They’re often prescribed to control blood pressure. For migraines, your doctor may suggest atenolol (Tenormin), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), propranolol (Inderal, Inderal LA, Inderal XL, InnoPran), or timolol. Side effects include feeling depressed and having problems during sex.
Botulinum toxin (Botox). A doctor can inject small amounts around your face and scalp every 3 months to keep migraines from happening. This treatment is approved only for people who have headaches at least 15 days a month. The more often you have migraines, the better Botox seems to help.
Calcium-channel blockers. These include diltiazem (Cardizem, Cartia, Tiazac) and verapamil (Calan, Covera HS, Verelan). They ease the narrowing of your blood vessels and are also given to treat heart disease. Side effects can include constipation and low blood pressure.
Antidepressants. Your doctor may prescribe tricyclic antidepressants (TCAs) like amitriptyline (Elavil) or nortriptyline (Aventyl, Pamelor). Some people gain weight and feel very tired when they take these. TCAs can also cause severe problems if you have heart disease or are pregnant. Research suggests that selective serotonin and norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta) and venlafaxine (Effexor XR) may also help prevent 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. Atogepant (Qulipta), eptinezumab (Vyepti), erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality) are approved to prevent migraine attacks. You give yourself a shot once a month with a pen-like device. Mild pain and redness at the injection site are the most common side effects. The long-term safety of CGRPs is unknown.
NSAIDs and triptans. If you're prone to migraines around your period, your doctor may have you take nonsteroidal anti-inflammatory drugs (NSAIDs), like naproxen (Anaprox, Naprosyn) or certain triptans, typically used to stop migraines once they've started, each month. You may be able to stave off an attack if you start a few days before your menstrual cycle starts and then stop a few days after your flow begins.
Do You Need It?
You may want to consider medicine to prevent migraines if you:
- Have pain that hampers your life, despite treatment
- Get 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:
- You don’t get headaches often and they’re controlled by anti-inflammatories like ibuprofen and naproxen.
- You have other health conditions such as asthma, diabetes, pancreatitis, or a liver problem like hepatitis.
- The 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, you and your doctor could consider devices like:
- 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, a hand-held device placed over the vagus nerve in the neck. It releases mild electrical stimulation to the nerve's fibers to relieve pain.
- Nerivio, a wireless remote electrical device, for use at home, that changes nerve activity. You put it on your upper arm when a migraine headache starts.
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. They 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.
Give It Time
Doctors will often start migraine treatment with the beta-blocker propranolol, the antidepressant amitriptyline, or the anti-seizure medication topiramate. About half of people will have half as many migraines once they're taking the right dose.
For any of these drugs to work, you'll need to follow your doctor's instructions. In most cases, that will mean taking medicine regularly. It could be up to 3 months before you start to notice a difference.
If you feel like a drug isn't working or has side effects that make you want to stop taking it, talk to your doctor. You may be able to get a different treatment that would be a better fit.