Preventive Treatments for Migraine

What are some common migraine prevention medications, and how do you know which one is right for you? Learn about the role of prevention in a migraine management plan.

Preventive migraine medications are taken on a regular basis to prevent the occurence of migraine attacks. Unlike acute migraine treatments, they are not intended to treat pain and other symptoms of an attack that has already started.

A complete migraine management plan will include both acute and preventive treatments. Remember, it may take some trial and error to find the right preventive medications and strategies for you. Below are answers to some common questions about migraine prevention and how to choose the right preventive treatments.

Do you need migraine prevention?

If you are living with migraine, the last thing you want is to have a migraine attack. Migraine prevention is a critical part of any migraine management plan, even if you only typically have one attack per year. People who have more frequent attacks will need more aggressive prevention strategies, which may include medication. Any decisions about migraine treatment and prevention should be made with your doctor. 

Additionally, preventive medications may help if you have:

• Disabling attacks despite using appropriate acute treatment
• Frequent attacks (more than one per week)
• Insufficient or no response to acute drug treatment
• Poor tolerance or contraindications for specific acute migraine medications
• History of long-term, excessive use of pain medications (analgesics) or other acute treatments that has made your headaches worse or led to decreased responsiveness to other drug therapies

Goals of Preventive Therapy for Migraine

Migraine prevention is intended to reduce the degree of disability associated with migraine attacks. Unfortunately, preventive treatment strategies rarely eliminate migraine attacks completely, but they can reduce the frequency and severity of attacks.

The ultimate goals of migraine prevention therapy are to:

• Reduce the frequency, severity and duration of attacks
• Improve responsiveness to acute treatment during attacks
• Reduce the level of disability experienced due to migraine attacks
• Reduce the need for emergency room visits
• Reduce excessive overuse of acute medications

Commonly Used Preventive Migraine Treatments

Many different preventive treatments are available. The type of migraine prevention that works for you will depend on many factors, including any co-existing conditions like high blood pressure, depression and/or anxiety, obesity, asthma, diabetes or pregnancy (among others). For this reason, choosing medications for migraine prevention is a complex process, and you should discuss your specific symptoms and needs with your doctor.

Some of the most common types of preventive treatments for migraine are listed below.

Types of Drug Treatment Options for Migraine Prevention

Your doctor will work with you to create a migraine prevention plan based on your specific needs. This means taking into account any other conditions for which you are currently taking medication and/or which may be impacted by certain preventive migraine treatments. 

In some cases, this may involve finding the right dose of a single medication to prevent your attacks (called monotherapy). However, if you are living with other health conditions commonly associated with migraine — such as depression, anxiety or obesity — your doctor may prefer to combine several different medications (called polytherapy).

Common scenarios for treating migraine prevention with medication include:

• One drug is calibrated to the ideal dose to prevent migraine attacks and limit side effects.
• One new drug is switched in for a medication you’re currently taking in order to improve tolerance or efficacy.
• Two drugs, typically from different drug classes, are used at less than maximal doses in order to complement each other and reduce the risk of side effects associated with each.
• Three or more drugs are used in either maximal or submaximal doses. This is often a trial-and-error process, and drugs are typically added and adjusted over time until a combination is reached that effectively reduces your number and severity of attacks.

Which preventive treatment is right for you?

When talking to your doctor about the preventive therapies that are right for you, there are several key things to keep in mind:

Setting Expectations

At the start of any conversation about preventive migraine treatments, ask your doctor what you can expect from the medication. This may include how the medicine works, what impact you can expect to see on the frequency and severity of your attacks, and any other benefits or drawbacks of a specific treatment.

Dosage and Administration

The frequency and dosage of medications vary. For many medications, doctors prescribe low doses at first and gradually increase the dosage as needed. Therefore, you may need to increase the dose of a new medication until the desired response is achieved.

Additionally, you should ask how often you need to take any potential medications and what the method of administration is (oral tablet, nasal spray, injections, etc.). If you are unlikely to regularly take the medication as prescribed, you should discuss alternative options with your doctor.

Duration of Treatment

It may take two to three months before you notice a decrease in the frequency or severity of attacks even after reaching the beneficial dose of a new medication. Once reaching the right dose and/or combination of preventive medications, treatment may be required for six to twelve months or longer. Make sure you understand what to expect when discussing any new medications with your doctor so you can give your treatment strategy enough time to work before making any changes. 

Side Effects

All medications have potential side effects, so any unusual symptoms should be reported to your doctor. It is important to discuss potential side effects and how you may be able to avoid or manage them if they occur. Different medications have different safety and cost factors, and these may play a role in deciding which preventive medication is right for you.

Often the severity of side effects can be limited by using low doses, increasing the dose slowly and allowing time for you to adjust to the new medication. If you are not tolerating the medication and start to experience side effects, contact your doctor to discuss changes to your treatment plan.

You should not suddenly stop taking preventive medications, as it may not be safe for some medications. Preventive medications need to be gradually tapered off after a period of sustained use.

Drug Interactions and Co-Existing Conditions

Discuss any other possible health conditions that may influence your headaches with your doctor, including depression, hypertension, seizures, diabetes, menopause, anxiety, asthma, constipation and pregnancy planning. These conditions may play an important role in choosing the right preventive treatment to manage your migraine attacks.

The American Migraine Foundation is committed to improving the lives of those living with this debilitating disease. To learn more about all of your migraine treatment options, visit the AMF Resource Library. For help finding a healthcare provider, check out our Find a Doctor tool. Together, we are as relentless as migraine.