Medications Used for Prevention
Many drugs are being used or investigated for preventing migraines. To date, most standard drugs provide only modest protection.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) for Prevention
Standard NSAIDs. Nonsteroidal anti-inflammatory drugs (common pain relievers that are available over-the-counter or in prescription form). NSAIDs may be used for prevention of migraine under the following circumstances:
- Nonprescription NSAIDs. Regular, preventive use of low-dose aspirin (so-called baby aspirin), ibuprofen (Advil), and naproxen (Aleve) may reduce the occurrence of migraine headaches by about 20%. (Even with nonprescription NSAIDs, no one should take them regularly without consulting a doctor.)
- Prescription-strength NSAIDs. Prescription-strength NSAIDs can reduce the frequency of attacks in over half of migraine sufferers. There are many prescription brands available. Mefenamic acid (Ponstel) and naproxen (Anaprox) are particularly useful for preventing migraines associated with menstruation.
Long-term use of these drugs can lead to stomach ulcers and gastrointestinal bleeding.
Beta-Blockers
Beta-blockers are usually prescribed to reduce high blood pressure. Some, however, are also useful in reducing the frequency of migraine attacks and their severity when they occur. Propranolol (Inderal) and timolol (Blocadren) have been approved specifically for prevention of migraine. Others that may be effective include metoprolol (Lopressor, Toprol XL), and nadolol (Corgard).
Side Effects. Side effects may include:
- Fatigue and lethargy are common.
- Some people experience vivid dreams and nightmares, depression, and memory loss.
- Dizziness and lightheadedness may occur upon standing.
- Exercise capacity may be reduced.
- Other side effects may include cold extremities, asthma, decreased heart function, gastrointestinal problems, and sexual dysfunction.
If side effects occur, the patient should call a doctor, but it is extremely important not to stop the drug abruptly. There is some evidence that people with migraines who have had a stroke should avoid beta-blockers.
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