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Preventive, Abortive, and Rescue Medications - What's the Difference?

by Teri Robert, Lead Health Guide

Discussing Migraine medications can get confusing, partly because there are so many, partly because they're used for different purposes. Migraine medications fall into three categories -- preventive medications, abortive medications, and rescue medications.

Preventive Medications

Preventive medications are taken daily to reduce the frequency and severity of Migraine attacks. Most doctors recommend preventive medications if you average three Migraines a month or more, or if your Migraines are especially debilitating. Some people are naturally reluctant to start taking a daily medication that may need to be taken indefinitely. Here's where we need to stop and think a bit. Migraine is a genetic neurological disease, not just having bad headaches. Most people aren't so reluctant to take daily medications for diseases such as diabetes or thyroid disease. Once we get our heads around the fact that Migraine is a disease, resistance to taking daily medications seems to lessen.

There are only four medications that have been officially approved by the FDA for Migraine prevention:

  • Inderal (propranolol), a beta blocker originally developed for heart disease and high blood pressure
  • Blocadren (timolol), another beta blocker
  • Depakote and Depakote ER (divalproex sodium), a neuronal stabilizing agent, also known as an anticonvulsant, originally developed for seizure disorders
  • Topamax (topiramate), another neuronal stabilizing agent

In addition to those approved for Migraine prevention, the FDA has also approved onabotulinumtoxin A (Botox) for the treatment (prevention) of chronic Migraine.

There are many other medications (more than 100 total) that are being used effectively for Migraine prevention. It's quite common for medications to be prescribed for conditions other than those for which they were first developed. This is called off-label prescribing. Medications prescribed off-label for Migraine prevention include:

  • Antihypertensives (blood pressure medications)
    • Alpha-2 Agonists such as clonidine (Catapres)
    • ACE Inhibitors such as Lotensin and Monopril
    • Beta Blockers such as Lopressor and Corgard
    • Calcium Channel blockers such verapamil, Cardizem, and Plendil
  • Antihistamines such as cyproheptadine (Periactin)
  • Antidepressants
    • Tricyclic antidepressants such as amitriptyline
    • SSRI antidepressants such as Lexapro
    • SNRI antidepressants such as Effexor
    • MAOI antidepressants such as Nardil
  • Cox-2 Enzyme Inhibitors such as Celebrex
  • Muscle relaxants such as Soma and Zanaflex
  • Neuronal stabilizing agents (anticonvulsants) such as Keppra and Zonegran
  • Leukotriene Blockers such as Singulair and Accolate
  • Medications generally used for ADD such as Adderall and Strattera
  • Medications developed for dementia or Alzheimer's disease such as Namenda
  • Dietary supplements such as Coenzyme Q10, vitamin B2 and magnesium
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