Preventive Migraine Treatment

Preventive treatments reduce the number, severity, and duration of migraine attacks.

Who is a good candidate for preventive treatments?

Preventives are not just for chronic migraine. People who have frequent or severe migraine attacks may benefit from ongoing preventive treatment. National guidelines recommend considering preventive treatment if:¹

• Attacks significantly interfere with your daily routines, despite acute (or abortive) treatment
• You have 4 or more headache days per month
• Acute treatments are not working or side effects are intolerable
• You use triptans, ergots, or opioids on 10+ days per month
• You use acetaminophen, NSAIDs, or other non-opioid pain relievers on 15+ days per month
• You are unable to use acute treatments

Can preventives help with menstrual migraine?

For people who have menstrual migraine that occur before or at the very beginning of almost every menstrual cycle may benefit from short-term prophylactic, preventive medication. In this case, women may be prescribed medicine that is taken only for one or two days before the migraine symptoms typically appear and then during the period.²

How do preventive treatments work compared to abortives?

Preventive treatment may reduce your need for acute medications.³ This can help to prevent medication overuse headache. It may also slow or stop the progression from episodic to chronic migraine.⁴ By one estimate, 38% of people with episodic migraine would benefit from preventive drugs, but fewer than 13% use them.⁴

Preventive treatments do not stop a migraine that has started. Acute treatment is needed for relief from symptoms during a migraine attack.

What are the different types of treatments?

Preventive medications may be migraine-specific and non-specific. Non-specific drugs were first used to treat other conditions. Doctors and patients noticed that they had migraine prevention benefits. In some cases, the drugs were then studied and approved by the FDA for migraine prevention. Other drugs are used “off label” (unapproved) to prevent migraine. Off-label prescribing is common.

What are non-specific preventive migraine medications?

Non-specific drugs that help prevent migraine are:

• Beta-blockers and other blood pressure medications
• Anticonvulsants, such as topiramate and Depakote (divalproex sodium)
• Antidepressants, such as amitriptyline and venlafaxine
• Botox

What are migraine-specific preventive medications?

Migraine-specific preventive drugs are fairly new. They were developed based on understanding what causes migraine. Currently, the only migraine-specific preventive drugs are the CGRP antibodies. There are 4 medications in this drug family.

Dozens of other drugs have been used. Choosing a particular drug or combination will depend on several factors, including:

• Other medical conditions you have
• Your headache pattern and treatment history
• Cost
• How familiar your health care provider is with the options
• Your potential for pregnancy
• Your preferences

What are non-drug preventive option?

Non-drug options can be helpful in preventing migraine too. These include:

• Non-invasive devices
• Trigger recognition and complementary therapies

Keeping a migraine journal will help the doctor determine the severity of migraine attacks and give the migraine specialist a better understanding of which medications may work best.

How do I know if my treatments are working?

It may take up to 8 weeks to determine whether preventive treatment is working.⁴ Preventive treatments do not eliminate all migraines. Signs that your treatment is working are:

• You have half as many migraine attacks
• Your migraines do not last as long
• Your response to acute medications improves

Vitamins, minerals, and herbs may also be used in the prevention of migraine.⁵ People with migraine should make sure to tell their doctor about all medications and supplements they are taking, as some may interact badly with each other or cause serious side effects when taken together.