For those of us who have three or more Migraine attacks per month, and for those whose Migraines are especially severe, Migraine preventive treatments are essential to our Migraine arsenals.
When Migraine preventive treatments work well, they accomplish two main objectives:
They reduce the frequency of Migraine attacks.
They reduce the severity of Migraine attacks.
By accomplishing those two objectives, Migraine preventive treatments improve both our health and our quality of life.
At this time, all of the medications we use for Migraine prevention are hand-me-down medications – medications that were developed for other conditions, then found to also help with Migraine prevention. Four medications are approved by the Food and Drug Administration (FDA) for Migraine prevention:
- topiramate (Topamax)
- divalproex (Depakote)
- propranolol (Inderal)
- timolol (Blocadren)
OnabotulinumtoxinA (Botox) is approved by the FDA for chronic Migraine. Other medications are prescribed off-label for Migraine prevention, a common practice.
New medications for Migraine targeting calcitonin gene-related peptide (CGRP) are in phase III clinical trials and could reach the market in 2018. These medications would be the only ones on the market originally developed for Migraine prevention.
There are two devices being used for Migraine prevention:
The Cefaly device is approved by the FDA for Migraine prevention.
The Spring TMS device is approved by the FDA for the acute treatment of Migraine with aura and is in clinical trials in the U.S. for Migraine prevention. It is already approved for the prevention of Migraine with and without aura in Europe.
Some patients are trying implantable nerve stimulators for Migraine prevention. None of these stimulators is approved by the FDA for the treatment of Migraine. Some didn’t perform well enough in clinical trials to win approval, and the Autonomic Technologies stimulation system, which stimulates the sphenopalatine ganglion, is still in clinical trials.
There are some surgical procedures touted for Migraine prevention, but there have been insufficient double-blind, placebo-controlled trials to prove their effectiveness and safety.
It can take time and patience to find an effective preventive regimen, but the resulting improved health and quality of life make it worth the struggle. Above all,don’t lose hope. There are now so many preventive options that it’s virtually impossible to have tried them all. It would take more than 25 years of trying a new preventive every 90 days just to try all the preventive medications in use.
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Reviewed by David Watson, MD.
© Teri Robert, 2017.
Teri Robert is a leading patient educator and advocate in the area of migraine and other headache disorders, and has been writing for the HealthCentral migraine site since 2007. She is a co-founder of the Alliance for Headache Disorders Advocacy and the American Headache and Migraine Association. She received the National Headache Foundation’s Patient Partners Award for “ongoing patient education, support, and advocacy,” in 2004 and a Distinguished Service Award from the American Headache Society in 2013. You can find links to Teri’s work on her web site and blog and follow her on Facebook, Twitter, StumbleUpon, Pinterest, LinkedIn, and Google+.
Teri Robert is a leading patient educator and advocate and the author of Living Well with Migraine Disease and Headaches. A co-founder of the Alliance for Headache Disorders Advocacy and the American Headache and Migraine Association, she received the National Headache Foundation’s Patient Partners Award and a Distinguished Service Award from the American Headache Society. Teri can be found on her website, and blog, Facebook, Twitter, StumbleUpon, Pinterest, LinkedIn, and Google+.