Preventive medicines
Taken to prevent migraine attacks
What they are used for
Preventive medicines (also known as prophylactics) for migraine are taken to prevent migraine attacks. They are taken every day and are aimed at preventing migraine attacks altogether or at least reducing their frequency and severity.
If you are having at least four migraine attacks per month you may wish to discuss preventive medication with your doctor. There are a range of different preventive migraine medicines that can be taken, including several that are just becoming available in the UK.
Types of preventive migraine medicine
The preventive medicine that are recommended to treat migraine fall into seven categories. Most preventive medications currently available are repurposed from other conditions. Here is an overview of each category, and tables of the different types of drugs in these categories and how they are taken can be downloaded here (tables from current page).
Angiotensin II blockers
Angiotensin II blockers are used in the treatment of hypertension and one type, candesartan, can help reduce migraine.
Anticonvulsants
Anticonvulsants are used in the treatment of conditions such as epilepsy. They are also known as anti-epileptics. Two different types of anticonvulsant can also be used to treat migraine. These are topiramate and sodium valproate.
Both sodium valproate and topiramate can cause harm to a developing baby during pregnancy. This means you cannot take these medications if you are pregnant. If you are a woman or girl of childbearing age, a doctor will only prescribe them if you have had a negative pregnancy test, you are using suitable contraception to prevent pregnancy, and you have signed a consent form to show that you have discussed the risks.
Anti-serotonergic drugs
Anti-serotonergic are used in the treatment of depression, and can help reduce migraine.
Beta-blockers
Beta-blockers are used in the treatment of high blood pressure, and can help reduce migraine. They should be avoided by people with asthma.
Calcitonin Gene-Related Peptide pathway monoclonal antibodies
Calcitonin gene-related antibodies (CGRP) monoclonal antibodies (MABs) is a new type of migraine medicine and was only developed a few years ago. CGRP MABs are the first preventive medicines specifically developed for the treatment of migraine.
Calcium channel blockers (calcium channel antagonists)
Calcium channel antagonists blocks dopamine receptors in the brain, and can help reduce migraine.
Tricyclic antidepressants
Tricyclic antidepressants are used in the treatment of depression, and can help reduce migraine. They can be helpful in people with migraine who also have difficulty sleeping.
There are other treatments that some people with migraine may be offered including Botox, Greater Occipital Nerve (GON) blocks and neuromodulation devices. These are usually only available via a headache specialist or consultant neurologist.
Chart with recommended doses for each medicine
Taking preventive migraine medicines
It is important to discuss the side effects of each preventive medicine with your doctor when deciding which medicine to take, and for these side effects to be monitored.
You will often start of a low dose and gradually increase. This can help to minimise side effects.
It can take six to eight weeks to see any impact from the medication. Ideally, you should take a preventive for three months to assess if it has had an effect on your migraine.
Drugs and new treatments for migraine are changing all the time. If you are on long term medication you should ensure that your treatment is regularly reviewed by your doctor.
