Recurring migraine attacks can be debilitating and affect your quality of life. One member of MyMigraineTeam said, “I suffered from chronic migraine for over 40 years. Needless to say, I have been on every med that came down the pike.”

If you or someone you love experiences frequent migraine episodes, you may want to learn more about preventive migraine treatments. These are medications that you take regularly, even when you’re not experiencing migraine episodes, to reduce the frequency and intensity of future attacks. Another MyMigraineTeam member said, “I am going to have to look into preventive medicine. Too many migraine attacks each month.”

Here are five key things to know about preventive migraine treatment, including the different types of migraine prevention options available, the effectiveness of each treatment option, and who might benefit from each one.

1. Preventive Treatment Is Different From Acute Treatment

Preventive medicine for migraine headaches is not meant to treat an acute (immediate) migraine attack. Rather, these treatments — also known as prophylactic migraine medications or therapies — are taken regularly over a long period of time to reduce the frequency and severity of migraine headaches.

“I suffered from chronic migraine for over 40 years. Needless to say, I have been on every med that came down the pike.”

— A MyMigraineTeam member

Acute treatments, on the other hand, are used during a migraine attack to stop the symptoms as quickly as possible. If you have recurring migraine headaches, you may benefit from both preventive and acute treatment options.

Acute Migraine Treatments

Acute migraine medications are also called abortive medications. These medications are designed to shorten or stop a migraine when it’s happening. Examples of acute migraine medications include analgesics, ergotamines, triptans, ditans, and calcitonin gene-related peptide (CGRP) receptor antagonists.

FDA-approved CGRP antagonists for acute migraine include:

• Ubrogepant (Ubrelvy) — An acute migraine treatment taken by tablet, typically given to people with migraine whose headache pain isn’t relieved by common over-the-counter drugs
• Zavegepant (Zavzpret) — A nasal spray used to treat acute migraine headaches after they’ve started. This medication may be an option for people who cannot use triptans due to cardiovascular risk factors or who find triptans ineffective or don’t tolerate them well.
• Rimegepant (Nurtec ODT) — An orally disintegrating tablet used for both acute treatment of attacks and preventive medication

Analgesics — such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) — work to reduce pain, but they aren’t designed specifically for migraine pain. Acetaminophen and the combination of acetaminophen, aspirin, and caffeine have been shown to effectively treat acute migraine.

Ergotamines and triptans are used to treat throbbing headache pain but can come with some negative side effects because they both constrict (narrow) blood vessels. Side effects might include sleepiness, chest tightness, and fatigue.

In 2019, the U.S. Food and Drug Administration (FDA) approved lasmiditan (Ryvow) for acute migraine headaches. This medication works very similarly to the triptans, but it reduces the pain from migraine headaches without constricting blood vessels.

Preventive Migraine Treatments

Examples of preventive migraine medications include:

• Blood pressure-lowering medications, such as candesartan (Atacand). Keep in mind that this is an off-label use, meaning it’s not officially approved for migraine prevention.
• Antidepressants, such as amitriptyline, which is also used off-label for migraine prevention.
• Anticonvulsants, such as topiramate (Topamax, Eprontia, Qudexy, Trokendi)
• Neurotoxins, such as onabotulinumtoxinA (Botox)
• Certain CGRP receptor antagonist therapies
• CGRP monoclonal antibodies

Later, we will dive deeper into each of these preventive migraine treatment options.

2. Preventive Treatment Won’t Eliminate Migraine Attacks

The main goal of preventive medication is to reduce the frequency and severity of migraine attacks. However, preventive treatments very rarely eliminate migraine attacks altogether.

Preventive therapy also aims to improve the effectiveness of acute migraine treatments and prevent people from relying too heavily on acute medications. Many acute treatment medications come with unwanted long-term effects and are less effective when they are overused.

3. There Are Many Different Options for Preventive Treatment

There are different options available for preventive migraine treatments. All of the options vary in their effectiveness, research support, and novelty.

Blood Pressure Medicines, Antidepressants, and Anticonvulsants

Blood pressure medications, antidepressants, and anticonvulsants are some of the older, original preventive medications prescribed for people with recurrent migraine. Blood pressure medications such as beta-blockers, angiotensin converting enzyme (ACE) inhibitors, and angiotensin-receptor blockers (ARBs) help lower blood pressure and heart rate. However, they can also cause side effects like tiredness and dizziness.

Preventive treatments will very rarely stop someone from having migraine attacks, but they aim to reduce their frequency and severity.

Some doctors prescribe certain antidepressants — tricyclic antidepressants and selective serotonin-norepinephrine reuptake inhibitors (SNRIs) — for people with episodic migraine. Episodic migraine describes migraine attacks that occur less than 15 days per month, whereas people with chronic migraine have migraine attacks over 15 days per month for at least three months. While these antidepressant medications can help with sleep, they can also cause dry mouth, weight gain, and other side effects.

Anticonvulsants have long been used as a treatment option to prevent migraine attacks. However, these medications shouldn’t be used by people with liver disease or by those who may become pregnant. Anticonvulsants can also cause side effects like tingling, memory issues, and reduced appetite.

Botulinum Toxin

Botulinum toxin, such as onabotulinumtoxinA, has been used to prevent migraine attacks for over 10 years. While Botox is often associated with cosmetic treatments for wrinkles, it’s actually a neurotoxin that works by reducing muscle contractions. Scientists believe that botulinum toxin prevents sensory and pain nerves from firing in the meninges — the tissues surrounding the brain. This treatment may also prevent the release of CGRPs in the brain that are known to increase inflammation and contribute to migraine.

CGRP-Targeted Therapies

In recent years, therapies that target CGRPs have revolutionized migraine treatment. One member of MyMigraineTeam said, referring to CGRP injections, “I would push your GP for the new preventive injections.”

Some of the preventive CGRP-targeted medications that bind to CGRP receptors (known as CGRP antagonists) include atogepant (Qulipta) and rimegepant.

CGRP monoclonal antibodies (mAbs) are another type of CGRP-targeted therapy. These antibodies are designed to target specific antigens — or any substance within the body that causes your immune system to produce antibodies, such as CGRP. Unlike other treatments, the monoclonal antibody treatment remains active in a person’s body for several weeks, providing longer-lasting protection against migraine attacks.

Some of the preventive CGRP-targeted medications are biologics, meaning they are produced using live systems, such as bacteria, plants, or animal cells. Examples of CGRP mAbs include:

• Eptinezumab-jjmr (Vyepti)
• Erenumab-aooe (Aimovig)
• Fremanezumab-vfrm (Ajovy)
• Galcanezumab-gnlm (Emgality)

Anti-CGRP medications are getting so much attention because they are the first migraine headache prevention medications that are specific to migraine. All other preventive treatments have primarily targeted other conditions. CGRP mAbs are given as an injection or infusion every few months. Compared to other preventive treatments, CGRP mAbs appear to have fewer side effects and may work for people who cannot tolerate other preventive therapies.

4. The Best Migraine Treatment Plan Depends on the Person

Not only are there different types of medications available, but they can also be combined in different doses. Using just one medication is called monotherapy. Using two or more migraine preventive medications at the same time is called polytherapy. If you decide to try polytherapy, it’s essential to work with a doctor, since some migraine medications can interact with each other.

Anti-CGRP medications are getting so much attention because they are the first migraine headache prevention medications that are specific to migraine.

Consider Coexisting Conditions

Many people with migraine also have comorbid conditions — two or more conditions that occur at the same time, with some type of link between them. Often, people with migraine have comorbidities such as:

• Stroke
• Angina (chest pain)
• Epilepsy (a brain condition that causes recurring seizures)
• Some psychiatric disorders (depression, anxiety, and panic disorder)

Some acute or preventive therapies may worsen a person’s comorbid conditions.

5. Your Doctor Is a Wealth of Knowledge

The treatment landscape for migraine is quickly changing. It’s important to stay in regular contact with your doctor to discuss the latest treatments available to you. Your doctor can also help determine what preventive treatment options may be safest and most effective for you.

Healthcare providers should consider preventive treatment in the following circumstances:

• Recurring migraine attacks disrupt your daily life, even though you’re taking acute medications.
• Your migraine attacks are recurring (four or more migraine attacks per month).
• Acute medications aren’t working or have too many unwanted side effects.
• Your migraine attacks come with uncomfortable sensory symptoms (auras), such as visual sparks, tingling, or numbness.

If any of these describe your situation, it may be a good idea to reach out to your doctor about preventive care.

Talk With Others Who Understand

MyMigraineTeam is the social network for people with migraine and their loved ones. On MyMigraineTeam, more than 84,000 members come together to ask questions, give advice, and share their stories with others who understand life with migraine.

Are you living with chronic migraine and want to know more about preventive migraine treatment? Share your experience in the comments below, or start a conversation by posting on your Activities page.