Migraine Prevention

There are many reasons to use medications or other strategies to try to reduce the frequency of migraine headaches. When an individual can identify a trigger for his or her migraines, such as certain foods or liquids, menstruation, or other exposures, these circumstances can possibly be avoided to reduce migraine events. If abortive medications are not tolerated, cause side effects, or are ineffective, migraine prevention medications should be used. Other reasons to use preventive medications include migraine headaches more than twice a month or migraine headaches that causes more than three days of disability a month, unusual migraine syndromes such as complicated migraines (migraines with prolonged aura), hemiplegic migraines, basilar migraines, or migrainous infarct, and also frequent use of abortive migraine medications. Last, but certainly not least, some of my patients prefer preventive therapy, even if they have infrequent migraine headaches.

There are many medications that are considered preventive agents for migraine headaches. Only four medications (propranolol - Inderal, timolol - Blocadren, topiramate - Topamax, divalproex - Depakote) are approved by the United States Food and Drug Administration for migraine prevention; however many medications are used "off label" for migraine prevention. Tricyclic antidepressants such as amitriptyline and nortriptyline as well as newer antidepressants (SSRIs and MAOIs) have been used for migraine prevention. Antihypertensives such as propranolol, timolol, and verapamil have also been used for migraine prevention. There are many antiseizure medications that have been used for migraine prevention with the most common agents being gabapentin, topiramate, divalproex, and others. Nonsteroidal anti-inflammatories have found some use as migraine preventive medications. An injectable medication, botulinum toxin (Botox), has been shown to have benefit in migraine prevention. And there are several emerging alternative therapies for migraine prevention that include butterbur (Petasites hybridus), feverfew, riboflavin (vitamin B2), magnesium, and coenzyme Q10.

As current research tries to understand of the cause of migraine headaches in each individual, more specific migraine treatments may become available for individual patients as well as the migraine population as a whole. By working with your doctor and keeping a detailed migraine diary, you will likely find a preventive medication that will reduce the frequency of your migraine headaches. It may take several months and multiple medication trials and dosage adjustments, but in the end most, patients find that preventive medication therapy, along with lifestyle changes, will improve the quality of their lives.

Be patient. It probably took years to get to this point in your headache pattern. It will likely take months to get you back to functioning without significant disability from your headaches.