Chapter 6, Episode 4: Non-Migraine-Specific Preventive Medications
This content has been medically reviewed by Alicia Duyvejonck, DNP, AGNP, NP-C, AQH.
Before the FDA approved CGRP antagonists in 2018, preventive treatments for migraine primarily consisted of medications originally developed for other conditions, such as depression, epilepsy, and high blood pressure. Preventive treatments are typically considered for individuals experiencing four or more headache days per month or at least two severe headache days each month. They do not typically prevent all migraine attacks but can help reduce their frequency, severity, and disability.
The American Headache Society recommends several non-migraine-specific medications for prevention, including anti-hypertensive or high blood pressure medications, anti-seizure medications, antidepressants and others.1
Anti-hypertensives, such as propranolol, lisinopril or candesartan, may help by affecting the blood vessels in the brain. General side effects include dizziness, low blood pressure, exercise intolerance, fatigue and more. They are typically avoided in people with asthma, diabetes, low heart rate or other heart issues.
It is thought that Anti-seizure medications, such as topiramate, valproate sodium, and divalproex sodium, calm hyper-excitable nerve cells in the brain. General side effects include brain fog or difficulty thinking, dizziness, hair loss, sleepiness, changes in weight and more. These medications may reduce the effectiveness of oral contraception and should not be stopped abruptly. They also may carry a risk of birth defects, so reliable contraception is essential while taking them.
Antidepressants, such as amitriptyline and venlafaxine, may help stabilize the levels of neurotransmitters in the brain, which fluctuate during and between migraine attacks. General side effects include drowsiness, weight gain, dry mouth, dizziness, low sex drive and more. They are often used prior to sleep and should not be stopped abruptly.
Migraine treatments should be trialed for 8-12 weeks to determine effectiveness. Some treatments work better when combined with another type of preventive therapy like onabotulinumtoxinA, neuromodulation devices or cognitive behavioral therapy.
Preventive treatment is considered successful if it reduces the number of migraine or headache days by 50%, decreases the duration, severity, or disability of attacks, or improves the response to acute treatments. Finding an effective and tolerable treatment often involves trial and error.
Your healthcare provider will assess your health history, comorbid conditions, and other factors when selecting a preventive treatment. It is also important to let your provider know if you are pregnant or plan to become pregnant, are breastfeeding, or use hormonal contraception.
For more information, visit migrainedisorders.org
References
*The contents of this video are intended for general informational purposes only and does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. AMD does not recommend or endorse any treatment, products, or procedures mentioned. Reliance on any information provided by this content is solely at your own risk.