Preventing Migraine Headaches
Estimates are that 18% of women and 6% of men suffer from migraine headaches. But fewer than half of people with migraines use preventive migraine treatments to reduce the frequency of headaches. Preventive therapy—also called migraine prophylaxis—can reduce the number of headaches by at least 50%, as well as reducing their severity.
You might want to consider migraine prophylaxis if you:
Have migraines that significantly interfere with your daily functioning, even after treatment
Have two or more migraines a month.
Experience little or no relief from migraine treatments
Have significant side effects from migraine treatments
Use triptan migraine medications (eletriptan [Relpax], sumatriptan [Imitrex], zolmitriptan [Zomig], and other drugs with a generic name ending in ‘-triptan') more than twice a week, and/or
Have unusual migraines, such as prolonged auras, weakness or paralysis just before or during headaches, or complete loss of blood flow to areas of the brain during migraine.
If you're considering preventive migraine treatment, it's important to understand that there are just a few medications for which the medical evidence is indisputable. The American Academy of Neurology, the professional organization of thousands of headache specialists in the United States, issues clinical guidelines rating treatments according to the strength of the medical evidence supporting them. Medical evidence comes from rigorous studies with large numbers of people, and it's the only way to know be certain how effective a medication is at preventing migraines.
The medications recommended by the American Academy of Neurology for first-line preventive migraine treatment fall into four categories.
The best-known migraine prophylaxis is a class of prescription drugs called beta-blockers. These were originally used to treat high blood pressure, but have been extensively studied and proven effective at preventing migraines. Excellent evidence supports the use of two particular beta-blockers:
Propranolol, long-acting (Inderal LA)
Propranolol has been used to treat high blood pressure for decades and has an excellent safety record. With either of these beta-blockers, side effects are infrequent and may include general fatigue and tiring quickly during exercise. Other drugs used to treat high blood pressure, like calcium-channel blockers, do not prevent migraines.
Another class of medications—tricyclic antidepressants—is used to prevent migraines. The only medication in this class recommended as first-line treatment by the American Academy of Neurologists is amitryptyline (Elavil). Although the US Food and Drug Administration hasn't approved its use in migraine headaches, several European countries have. “Off-label” use of drugs is not uncommon.
Amitryptyline has a long history of use in the treatment of depression. Side effects are relatively common and include dry mouth, weight gain, and sedation.
Many physicians and patients believe that other antidepressants, such as duloxetine (Cymbalta), sertraline (Zoloft), and trazodone (Desyrel), are effective migraine prophylaxis. As of early 2008, no studies confirm this impression, so they're rarely used as first-line preventive therapy.
Several medications that are used to prevent seizures are also first-line treatments for migraine prevention. Like amitryptiline, valproic acid is not approved by the FDA for use in preventing migraines, but it has a long history of use in treating depression.
Divalproex, extended release (Depakote ER)
Valproic acid (Depakene)
Side effects of anticonvulsants occur relatively frequently and include fatigue, nausea, tingling sensations, and weight gain. Anticonvulsants can cause birth defects and should not be used by pregnant or breastfeeding women.
Non-prescription drugs that can be effective at preventing migraines include non-steroidal anti-inflammatories (NSAIDs), especially naproxen. However, extended use of NSAIDs can cause both gastrointestinal distress and kidney damage, so they're not a good choice for long-term prevention of migraines. Aspirin does not prevent migraines.
Migraine prevention treatment tips
Be knowledgeable. Know which medications work—and which don't. If your doctor suggests a medication that isn't a first-line choice, find out why.
Be patient. It may take several weeks before you experience an improvement in your headaches.
Be consistent. Unlike treating migraines with medications, effective migraine prevention depends on having a consistent amount of medication in your system. Take your medication as scheduled. Check with your doctor about what to do if you accidentally miss a dose.
Be persistent. If the number and severity of your headaches don't decrease within several weeks, ask your doctor to try a different medication.