If you have more than four migraine days per month, you may want to consider a preventive medication.

However, preventive therapy may also be given for less frequent but very disabling symptoms.

It is reasonable to consider a preventive medicine when:

  • Symptoms are interfering significantly with work, school or social life

  • Symptoms are occurring at least once a week 

Although it is not officially endorsed, the use of a preventive medicine can be helpful to confirm a suspected diagnosis. 

Expect trying more than one agent. 

Since many migraine disorders are more chronic, treatment with preventive agents often offers the best relief to sufferers, but finding an agent that has tolerable side effects and is effective involves a trial and error process. It is usually most effective and safe to trial one medicine at a time, although some medications work well together in low doses. 

Don’t be afraid to try these medicines. 

These drugs were first used for many other medical purposes, such as prevention of high blood pressure, depression or epilepsy. These medicines act on the transmission of information in our nervous system and, at the low doses needed for preventing migraine, they usually have little or no other effects.

There are no firm rules on how any particular medication should be used. The Food and Drug Administration (FDA) has approved only four of these drugs for prevention of migraine: propanolol, timolol, divalproex sodium (Depakote) and topiramate (Topamax), but that does not mean that there has not been a great deal of research and success with a much larger number of migraine preventive drugs.

A beta blocker or calcium channel antagonist may be more appropriate for a patient with hypertension, while a tricyclic antidepressant may benefit a migraine patient who is depressed or having difficulty sleeping.

Preventive medicines need to be taken daily. 

These medicines should be started at a low dose to minimize side effects. The dose should be regularly increased in small amounts until an ideal dose is reached. 

Many medicines need be taken for 4-12 weeks to know if it works or not. Discuss with your physician the option to discontinue any medication that causes an unpleasant side effect.

Don’t expect too much. 

Migraine preventative treatments often do not completely prevent all migraine symptoms, but they aim to reduce the frequency and severity of symptoms.

Your best preventive medicine will depend on your medical condition.

You need to discuss with your health professional issues about pregnancy, weight, sleep disturbances, blood pressure and more. 

Preventive medicines are not forever. 

If a preventive treatment works well, that medication can then be continued for several months (usually 6-12 months). With better symptom control one may want to wean down the dose. When stopping a preventive medicine, there is a risk of the headaches returning. It is unusual for migraine frequency suddenly to bounce back again during weaning down. Migraine illness varies during a lifetime and the use of preventive medication may have to be adjusting for those variations. 

This information is NOT intended to endorse drugs or recommend therapy. While these reviews might be helpful, they are not a substitute for the expertise, skill, knowledge and judgment of healthcare practitioners in patient care. Only your doctor can decide which medications are right for you. Never stop, start or change the way you use a prescription medicine without first consulting your doctor.