Choosing Preventive Meds for Chronic Migraine

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BRITTANY MAYS
In thinking through when to start preventive treatment, really you're thinking of the whole person and how the headaches are impacting their quality of life and their functionality.

[MUSIC PLAYING] I like to use an analogy with my patients that preventive treatment is the first line or defensive line for prevention of your migraines. Your goal is to have an effective preventive treatment regimen that will ultimately reduce the frequency, so that you don't need to use your rescue treatment as much.

So there's many things that I take into account when working with my patients on deciding a correct or ideal preventive treatment strategy. So there's a couple of patients that will come in and they say, hey, Doc, I don't want to be on medication. And so in that aspect, we can begin to discuss a few options.

So there are some vitamins which I refer to as the nutraceuticals, like magnesium, riboflavin, which is vitamin B2, coenzyme Q10, which all can be protective against migraine specifically.

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Now, if there is somebody, for example, who has a history of mood disorders or anxiety, depression, in addition to having migraines, sometimes they'll start with an anxiety and depression medication that is used first line for migraine prevention. If someone has anxiety and maybe some blood pressure issues, I'll consider using a blood pressure medication first line for a headache prevention.

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And then there are some neuromodulatory devices that are out and FDA-approved for migraine prevention, which are nice externally applied devices and various mechanisms that you can use for migraine prevention, again, for those that may be their medical history is a bit too complex to really layer on another preventive. So maybe starting with the neuromodulatory device may be the way to go.

Migraine is a robust disease, very prevalent. And so kind of give patients some control that they can manage this, too. And then lastly, just to improve their overall health-related quality of life. That's what it comes down to is how can we allow patients to improve their function, allow them to participate in the activities that they want to remain, and engaged citizens in society, and productive citizens in society. So those are really the goals of preventive treatment.