Preventive medicines
Preventive medicines for migraine are medicines you take to prevent migraine attacks. There are several different types.
About preventive medicines for migraine
Preventive medicines are also known as prophylactics. You take them on a regular basis (sometimes every day) to help stop migraine attacks developing.
Preventive medicines aim to reduce how many migraine attacks you get and how severe they are. They are different from the medicines you may take during an attack to help reduce symptoms. These are called acute medicines, and include painkillers, anti-sickness medicines and triptans.
If you take a preventive you may still need to take acute medicines to treat migraine symptoms, such as head pain and sickness. But you may need fewer acute medicines and find that they work better.
When to take preventive medicines for migraine
Not everyone needs to take preventive migraine medicines. Many people can manage their symptoms through self-help measures or by taking acute medicines during an attack. But preventive medicines may help if:
- you are having frequent migraine attacks (often considered to be four or more days with migraine a month)
- migraine is having a big impact on your daily life (your migraine attacks might be very severe or last a long time)
- acute medicines are not helping, even at the maximum doses you can tolerate
- you are regularly taking acute medicines on more than two days a week – this increases the risk of medication overuse headache.
Talk to your GP to discuss whether preventive medicines would be a good option for you.
Types of preventive migraine medicine
There are several different types of medicine that can be used to prevent migraine. The most common ones are listed below.
Many preventive medicines were originally developed for other conditions, and then were later found to help with migraine. More recent medications have been designed specifically to prevent and treat migraine.
| Type | Other common uses | Example medicines used to prevent migraine | How to take | Other information |
|---|---|---|---|---|
| Angiotensin II blockers & ACE inhibitors | High blood pressure and heart failure | Candesartan, lisinopril | Daily tablets by mouth | Not recommended in pregnancy or when planning a pregnancy |
| Anticonvulsants/anti-epileptics | Epilepsy | Topiramate, sodium valproate | Daily tablets or liquids by mouth | Restrictions in women who are pregnant or of child-bearing age* |
| Beta blockers | High blood pressure and heart disease | Propranolol, metoprolol, atenolol, nadolol, timolol | Daily tablets by mouth | Should not take if you have asthma or chronic obstructive pulmonary disease (COPD). Not recommended during pregnancy |
| Botox injections | Overactive bladder, muscle spasms, excessive sweating and cosmetic treatment | – | Injections into muscles, every 3 months | |
| Calcitonin Gene-Related Peptide monoclonal antibodies (CGRP mAbs) | Specifically developed for migraine | Erenumab, fremanezumab, galcanezumab and eptinezumab | Injections under the skin every month; or infusion into a vein every 3 months | Not recommended during pregnancy due to lack of data |
| Calcium channel blockers | High blood pressure and heart disease | Flunarizine | Daily tablets by mouth | Not recommended during pregnancy |
| Gepants | Specifically developed for migraine | Atogepant, rimegepant | Tablets by mouth, daily or every other day | Not recommended during pregnancy due to lack of data |
| GON (greater occipital nerve) block injections | Other types of headache, including cluster headache | – | Injection around a nerve, every 3 months if needed | |
| Serotonin antagonists | Depression | Pizotifen | Daily tablets by mouth | |
| Tricyclic antidepressants | Depression | Amitryptiline, nortriptylline | Daily tablets by mouth |
* Both sodium valproate and topiramate can cause harm to a developing baby during pregnancy. This means there are strict rules around prescribing it if you are a woman or girl of childbearing age. It’s also recommended to prevent pregnancy in female partners of men taking sodium valproate. Ask your doctor if you need more information.
If you have menstrual migraine, your doctor may also recommend taking a short course of triptans every month to prevent migraine. You start this just before your periods begin.
We have more information on Botox injections, Greater Occipital Nerve (GON) blocks, Calcitonin Gene-Related Peptide monoclonal antibodies (CGRP mAbs) and gepants. These are usually only available via a headache specialist or consultant neurologist.
There are other, non-medical preventive treatments that some people find helps with their migraine. These include acupuncture, supplements and medical devices.
Choosing a preventive migraine medicine
Your doctor will assess several things when deciding which medicine to prescribe. The best migraine prevention medication for you will depend on several factors. These include:
- whether you have any other health conditions
- if you are taking any other medicines
- the side effects associated with the medicines
- other reasons that may prevent you from taking a medicine, such as pregnancy.
You should also have a say in which medicines you would prefer to take.
The beta blocker propranolol is often recommended first. If you are unable to take propranolol, your doctor may suggest another beta blocker or different type of preventive.
Certain medicines, including CGRP mAbs, gepants and Botox, usually need to be prescribed by a specialist for prevention of migraine. Your GP will need to refer you. A doctor will only prescribe these medicines if you have tried at least three other preventive medicines first, and they haven’t helped. You need to have tried them at the maximum doses you can tolerate for several months each.
If you can’t tolerate any medicine due to side effects, don’t carry on taking it. Make sure you let your doctor know so they can arrange an alternative for you.
Preventive medicines and pregnancy
There are certain preventive medicines that you cannot take if you are pregnant or it’s possible you could get pregnant. This is because they can cause harm to a developing baby. Other medicines may not be recommended in pregnancy, unless the benefits of taking them are thought to outweigh any risks. This will be individual to you. If you are pregnant or planning a pregnancy, talk to your GP about your migraine medicines.
We have more information about migraine in pregnancy.
Monitoring your preventive migraine medicine
Your doctor will want to monitor whether your medicine is helping to reduce the number of migraine attacks you get. Keeping a headache diary while you take your medicines can help with this. It’s also important to discuss any side effects you are getting with your doctor.
You will often start with a low dose of your medicine, with a plan to increase it if needed. This can help to minimise side effects.
It can take up to eight weeks to see any impact from the medication. Some medicines may work faster than this. Ideally, you should take a preventive for at least three months to assess if it has helped.
How long to take your preventive
If your medication is working well, you should be able to continue taking it for at least six months to a year. Your doctor may suggest having a break after this period of time to check whether you still need the medication. This isn’t always necessary. Some people find their migraines restart or become more frequent when they discontinue treatment. This isn’t the case for everyone. But it’s important to discuss this possibility with your doctor in advance and how to manage it. They can advise when you may be able to restart treatment.
If your preventive medicine doesn’t help
If your preventive migraine medication is not helping, talk to your doctor. They can review whether they may be able to increase your dose or try a different treatment. They may also suggest a combination of treatments. Some treatments are only available via a specialist.
Medicines and other treatments for migraine are changing all the time. If you are on long-term medication for migraine, it’s worth having regular reviews with your doctor. They can make sure you are on the best available treatment.
Last reviewed: January 2025
Next review due: January 2028
Reviewed by: The Migraine Trust Information and Support Services team and reviewer panel
If you have feedback on our information, please get in touch at: feedback@migrainetrust.org
References for our information are available on request.
