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3 Big Questions on Migraine Preventive Medications

3 Big Questions on Migraine Preventive Medications

We all have many questions about preventive medications for Migraine. The whole subject of Migraine preventive medications can be confusing for many reasons, including:

  1. There are no medications on the market that were originally developed for Migraine prevention. All the medications in use were originally developed for other conditions and have been handed down to us when it was noticed that they helped Migraines in the patients with those conditions.
  2. The medications that work for Migraine prevention belong to many different drug classes — beta blockers, calcium channel blockers, neuronal stabilizing agents (anti-seizure medications), various classes of antidepressants, and more.

Three of the most commonly asked questions about Migraine preventive medications are:

  1. If a preventive medication works, how long will it work?
  2. Will I be taking this type of medication forever?
  3. With chronic Migraine, we really won’t be able to tell if a preventive is helping any and won’t want to upset the apple cart by going off it and risking it not working if we want to try it again later?

Let’s take a look at these three questions:

If a preventive medication works, how long will it work?

We’d all love to have an answer to this question. Unfortunately, the answer is one that none of us like – We don’t know how long a medication will work. Just as Migraines differ from one person to the next, how well and how long preventive medications varies. For some people, once they find a medication that works, it works for years, possibly indefinitely. Other people have problems finding a medication that works longer than a few months. There are many variables that can impact the effectiveness of medications – other medications, other health conditions, our body chemistry, and more.

Before deciding that a Migraine preventive medication has stopped working, here are some other possibilities to consider:

  • Could you be having more frequent or more intense Migraines because you’re encountering a new trigger or have developed a new trigger?
  • Is it possible that when the medication started working you, that you stopped being as vigilant about managing your Migraine triggers and avoiding any that are avoidable?
  • If medications seem to “wear out” quickly, and you can’t identify your triggers, it’s worth asking your doctor about a lumbar puncture (spinal tap) to rule out idiopathic intracranial hypertension.

Will I be taking this kind of medication forever?

This is another question for which there is no “right” answer. Discontinuing preventives seems to go one of three ways:

  1. In some cases, the Migraineur finds their Migraines continue to be less frequent and severe.
  2. Some Migraineurs find their Migraines continue to be less frequent and severe for a period of time, then gradually increase in frequency and severity until they need preventives again.
  3. Other Migraineurs find their Migraines increasing in frequency and severity as soon as they discontinue their preventive medications.

Unfortunately, there’s no reliable way to predict what will happen if and when Migraine preventive medications are discontinued. Another unfortunate fact is that there’s a risk to discontinuing preventive medications that are working. Once discontinued, they may not work again if we discover that we need to continue with preventives, and there’s no predicting if they’ll work again.

Some doctors tell young patients that they’ll “probably outgrow” their Migraines. This isn’t a statement that comes true for many, if not most Migraineurs. It does occur more often in boys than girls.

Some women are told that their Migraines will stop once they go through menopause. This predictive statement can’t be counted on either.

Following spontaneous (natural) menopause:

  • 67% of women find that their Migraines get better;
  • 9% of women find that their Migraines get worse; and
  • 24% of women find that their Migraines don’t change at all.

However, when it comes to surgical menopause following a hysterectomy, it’s an entirely different matter. Following surgical menopause:

  • 33% of women find that their Migraines get better;
  • 67% of women find that their Migraines get worse;
  • and a statistically insignificant number of women find that their Migraines don’t change at all.

With chronic Migraine, we really won’t be able to tell if a preventive is helping any and won’t want to upset the apple cart by going off it and risking it not working if we want to try it again later?

Chronic Migraine (CM) can be extremely difficult to treat, but finding preventive medications that work is the goal. An important factor with CM is being sure that medication overuse headache (MOH) isn’t contributing to being chronic. By definition, CM is Migraine OR headache that occurs 15 or more days per month, with Migraines on at least eight of those days. It’s thought that the headaches (as opposed to Migraines) that occur with CM are actually Migraines that don’t fully develop the phases of Migraine and their associated symptoms. If the CM patient also has MOH, it may be more difficult to find effective preventives. It’s worth noting that the only medication with enough evidence behind it to be FDA approved for the treatment of CM is Botox, which has not been shown to be effective for episodic Migraine. That doesn’t mean that others can’t help; it simply means that Botox has the clinical trial evidence behind it to be approved by the FDA. Many of the medications we use have anecdotal evidence, but not enough evidence from clinical trials, partly because of the great expense involved in clinical trials. Related post: Will My Chronic Migraine Ever Be Episodic Again.

Wrapping it up

As with so many questions about Migraine, we simply don’t have easy answers to these questions. Instead, we have answers such as “Maybe,” “Sometimes,” and “It depends on the individual Migraineur.” The best “answer” is to partner with a doctor who truly understand Migraine disease and how to treat it and work with our doctor to make the best informed joint decisions possible.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

1. Marcus, Dawn A., MD; Bain, Philip A., MD. The Woman's Migraine Toolkit. New York, New York. DiaMedica Publishing. 2011.

Comments

  • 100dollarheadache
    6 years ago

    HI, MY NAME IS MICHAEL, (100 DOLLAR HEADACHE), I HAVE BEEN IN THE STAGE OF TRYING PREVENTATIVES BUT I HAVE HAD NO SUCCESS SO FAR. I AM STILL SUFFERING WITH MIGRAINE DESPITE TAKING THEM DAILY. IT HAS ONLY ADDED MORE SIDE AFFECTS, FATIGUE AND LACK OF ENERGY. I ALREADY SUFFER FROM SLEEP APNEA AND USE A C-PAP FOR NOT GETTING GOOD QUALITY SLEEP AND LACK OF OXYGEN. I THOUGHT USING C-PAP WOULD IMPROVE MIGRAINE ATTACKS BUT IT HAS NOT. IT SEEMS TO MAKE SENSE , NOT GETTING RESTFUL SLEEP, LOW OXYGEN LEVELS AND FEELING FATIGUED ALL DAY LONG. C PAP HAS IMPROVED MY SLEEP SOME WHAT BUT NOT MY SEVERE HEADACHES. MY PRIMARY DOCTOR SUGGESTED I TRY A BETA BLOCKER BLOOD PRESSURE MED TO PREVENT MIGRAINE AND HELP MY BORDER LINED HIGH BLOOD PRESSURE. I TRIED FOR 6 WEEKS AND STILL I HAD 7 MIGRAINES IN THAT TIME PERIOD. ON TOP OF THAT I WAS EXHAUSTED FOR MEDS.I ASKED MY DOCTOR TO STOP AND HE AGREED. I TOLD HIM I FELT EXHAUSTED ALL DAY, IT NEVER WENT AWAY. NEXT I TRIED A CALCIUM CHANNEL ER, VARAPOMIL.THIS ALSO HAS LEFT ME VERY FATIGUED. I FELT SEDATED. I RECENTLY HAD TO ABANDON THAT ALSO. I STILL GOT MIGRAINES WITH THESE 2 MEDS. YOU KNOW ALL THE TIME PEOPLE TELL ME REMEDIES FOR MIGRAINE AND YOU GET SO DESPERATE FOR RELIEF THAT YOU WILL TRY ANYTHING WITHIN REASON. MY NEIGHBOR ACROSS THE STREET, AN OLDER WOMAN TOLD ME SHE HAS NOT HAD A MIGRAINE IN 10 YEARS.SHE SWEARS THAT TAKING FISH OIL AND OMEGA 3 SUPPLEMENTS CURED HER.I WENT RIGHT OUT AND BUY IT THE NEXT DAY. I TOOK THEM FOR 2 MONTHS WITH NO RESULT . I STILL HAD MIGRAINES ALONG WITH FISH BURPS, HOW PLEASANT. IN RECENT MONTHS I HAVE ALSO LOSR WEIGHT, ABOUT 23 POUNDS. IT DEFINITELY HAS IMPROVED MY BLOOD PRESSURE BUT NOT HEADACHES. I AM LOOKING TO LOSE 15 MORE. I HAVE CHRONIC PAIN AND MIGRAINES AND I HOPE I PHYSICALLY FEEL A LOT BETTER.YOU KNOW MAYBE SOME PREVENTATIVES WORK FOR SOME AND NOT OTHERS. I HAVE RECOGNIZED MY TRIGGERS AND I AVOID THEM ALL, BUT STILL I SUFFER. THERE WAS A TIME I WOULD GET 12 A MONTH. TRIPTANS AND AVOIDING TRIGGERS HAS BROUGHT ME TO 5 OR 6 A MONTH. EVEN AT 6 A MONTH I LOSE 12 TO 15 DAYS OUT OF THE MONTH TO MIGRAINE. I ALSO MISS MANY FAMILY FUNCTIONS . MY CHILDREN SEEM TO UNDERSTAND BECAUSE THEY SEE ME THROWING UP AND SUFFERING. I AM A SINGLE FATHER OF 2 AND THEY KNOW WHAT TO DO IF I GET SICK. MY EXTENDED FAMILY JUST DOES NOT UNDERSTAND THE PAIN. ONLY ANOTHER PERSON WITH MIGRAINE WOULD UNDERSTAND HOW DEBILITATING IT IS. MY SISTER IN LAW HAS COMPARED IT TO HER ALLERGIES ?, WHAT ? I WOULD TRADE PLACES WITH HER ANY DAY. I AWAKE EVERYDAY AND I WONDER, AM I GOING TO BE SICK TODAY, IT IS ALWAYS ON MY MIND . IT COMES OUT OF NOWHERE AND I AM HIT WITH THE AURA, FLASHING, BLIND SPOTS AND DIZZINESS . I LITERALLY HAVE SECONDS TO GET MY MEDS IN MED TO BATTLE BACK. I SOMETIMES USE SUMERVAL, A NEEDLE. IT SEEMS TO WORK QUICKEST. EVEN THEN I CAN LOSE THE BATTLE. ON A FEW OCCASIONS I FACED 3 DAYS OF MIGRAINES. I DO NOT WISH THIS UPON ANYONE OUT THERE. I WOULD RATHER HAVE A ROOT CANAL AT THE DENTIST.

  • Laurie Vincent
    6 years ago

    Have you tried Lamotrigine/Lamactil as a preventative? I take 3 tablets, twice a day and I only get about one mild migraine a month. My Neurologist started me on it about five years ago when no other preventative medicine would work. I used to get 25 to 31 migraines every month. I also take Verapamil, too. Good luck.

  • Ellen Schnakenberg
    6 years ago

    Hi 100dollarheadache – There are enough single medicines out there that it would take over 25 years for a patient to try them all singly, let alone in combination etc. It’s unfortunate that we can’t use cookbook medicine on Migraine. Sometimes a drug works really well for one patient, but epic fails for another. It’s good to know your options, but it is also interesting to note that the AAN doesn’t even think there is much evidence for lamotrigine in Migraine patients, calling it ineffective. You can read more about their recommendations on preventive drugs here: https://migraine.com/blog/new-migraine-prevention-recommendations-from-the-american-academy-of-neurology/ It’s important to note that, just because a drug doesn’t work on a majority of patients, doesn’t mean that it’s not working for you. A good doctor will listen to the patient. If it’s working, then ignore what’s being said to the contrary 🙂

  • lara
    6 years ago

    I’ve found that anti-seizure meds are the only thing that work for me. I went on beta blockers, calcium channel blockers and anti-depressants and not only did these not work but they packed weight on me. Something I’d never had a problem with my entire life until I started taking these medications. Topamax hasn’t prevented my migraines completely but it has lessened the severity so that I’m not bed-ridden every single day which is the best I can hope for at this point. I am aware of my triggers but unfortunately two of my biggest triggers cannot be “managed” as they are weather and hormones. Cigarette smoke and perfume are also big ones and while I can somewhat manage them, there is always that one person who can’t abide by the “no smoking” signs and MUST smoke. UGH.

  • Jill M.
    6 years ago

    My response to these meds has been similar to yours, Larissa. The beta blockers/calcium channel blockers worsened my depression in addition to the weight gain. Played the “name game” with multiple anti-depressants trying to find one that worked well with my depression and helped with the migraines. Topamax worked great for a year at preventing migraines, until we figured out it was what was causing my sudden anxiety attacks. (went off the Topamax, no more chest pains, shortness of breath, etc. yay!!) Now I’m on Zonegran and lovin’ it! Doing as well preventing my migraines as the Topamax without the side effects. Totally agree with you about the smoking and loud perfume!

  • mrsbrimtown
    6 years ago

    Thank you! Especially for the statistics on migraines following natural menopause.

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