Preventive Migraine Treatments

Preventative migraine treatments are meant to reduce the number, severity, and duration of migraine attacks. Preventative methods may also be used during a migraine attack to help your acute treatment work more effectively.¹

Compared to preventative migraine treatments, acute treatments are used to help treat the migraine and its symptoms in that moment.¹

Who is a good candidate for preventive treatments?

Preventive treatments can be effective for many people with migraine. The American Headache Society recommends using these criteria when considering prevention:^1,2

• Migraine attacks that interfere with daily routines regardless of acute treatment
• Frequent attacks
  • 4 or more headache days per month with some migraine-related disability
  • 2 headache days per month with severe disability
• Acute treatments have not worked
• Acute treatments have resulted in unwanted side effects

Preventive treatments are often used along with acute treatments. Preventive treatments may also be used to slow or stop the progression from episodic to chronic migraine. But they do not stop a migraine that has already started. Acute treatments provide relief from symptoms during migraine attacks.²

About 38 percent of people with episodic migraine would benefit from preventive treatment. But only around 13 percent take preventive medicines.^1,2

The National Headache Foundation’s guidelines recommend considering preventive treatment based on attack frequency (at least 4 or more migraines per month). You and your doctor should work together to choose a preventative treatment based on your specific needs.³

Even if you do not have many attacks, you may want to consider preventive treatment if:^1,2

• You have hemiplegic migraine
• Your migraine attacks come with brainstem aura or prolonged (over an hour) aura
• You have experienced a migrainous stroke

Can preventive treatments help menstrual migraine?

People who have menstrual migraine attacks may benefit from preventive treatments. These are attacks that are associated with a person's period (menstruation). Experts are not sure what causes menstrual migraine. But it is thought to be related to hormonal fluctuations, especially declines in estrogen levels.⁴

Hormonal treatments that contain estradiol in the form of oral birth control, vaginal rings, or patches are sometimes used as a preventive treatment for menstrual migraine. Small studies have found that using an estradiol patch in the days leading up to menstruation reduced menstrual migraine frequency. But the results of hormonal treatments have been mixed.^2,4

Examples of preventive migraine treatments

There are several types of preventative migraine treatments.

Migraine-specific preventative medicines

Migraine-specific preventative medicines include 4 types of calcitonin gene-related peptide (CGRP) antibodies:^1,2,5

• Vyepti™ (eptinezumab-jjmr)
• Aimovig™ (erenumab-aooe)
• Ajovy™ (fremanezumab-vfrm)
• Emgality™ (galcanezumab-gnlm)
• Gepants

Nonspecific preventative medicines

Many preventive treatments for migraine are nonspecific. This means they were first used to treat another health condition. People then noticed the treatment helped prevent migraine attacks. Nonspecific preventive treatments for migraine include:^1,2

• Beta-blockers and other blood pressure-lowering medicines
• Anticonvulsants
• Some antidepressants
• Botox^®

Non-medicinal options

There are also non-medicinal options to help prevent migraine attacks. These include:^1,2

• Relaxation training
• Biofeedback
• Cognitive behavioral therapy
• Physical therapy
• Acupuncture
• Vitamins like magnesium
• Migraine devices
• Diet/lifestyle measures, like managing triggers, staying hydrated, using caffeine

You and your healthcare provider will examine several factors when deciding which treatment is the best fit for you. These factors include:^1,2

• Migraine frequency, severity, and duration
• Treatment history
• Cost
• Any other medical conditions you have
• Your potential for pregnancy
• Personal preference

What to expect with preventive treatment

Overall, a preventive treatment is successful if it improves your quality of life. Examples of treatment success include:¹

• Fewer, shorter, or less severe migraine attacks
• A better response to acute treatment and using these treatments less often
• Less interference from migraine in your daily life
• Less time missing work or social events

If you take preventive medicines by mouth, your doctor may start you at a low dose to minimize side effects. Other medicines (like injectable treatments) can be given at a higher dose if your healthcare provider agrees.^1,2

Before beginning treatment for migraine, tell your healthcare provider about all your health conditions and any other medicines, vitamins, or supplements you take. This includes over-the-counter medicines.