Migraine management can feel like a constant chore, including avoiding triggers, monitoring migraine symptoms, and treating pain. Daily migraine treatments aim to prevent attacks before they start. If you’re having more frequent headaches or your acute (rescue) medications aren’t working well, a daily option may help.

In this article, we’ll review several daily medications for migraine and how they work. Some are approved by the U.S. Food and Drug Administration (FDA) specifically for migraine, while others are used off-label. We’ll also cover common side effects to watch for. These medications should be taken daily so they work as well as possible.

How Do Daily Treatments Differ From Acute Migraine Drugs?

Daily migraine medications help reduce how often you have migraine attacks. They can also make breakthrough migraine attacks less severe. Your doctor may recommend a daily medication if you have migraine at least four days a month or if the attacks interfere with daily life.

Daily treatments may also help if your acute medications aren’t working well or you’re taking them more than twice a week. Using acute treatment too often can lead to medication overuse headaches.

Even if you take a daily drug, you may still need acute medications. Examples include:

• Over-the-counter pain medications and nonsteroidal anti-inflammatory drugs (NSAIDs), such as acetaminophen, ibuprofen, and naproxen
• Triptans, such as sumatriptan (Imitrex, Onzetra Xsail, Tosymra) and zolmitriptan (Zomig)
• Anti-nausea medications, such as metoclopramide and prochlorperazine

Anti-Seizure Medications

Anti-seizure medications calm electrical signaling in the brain. This is how they treat seizures. These medications can also stop migraine before it starts. The FDA has approved topiramate (Eprontia, Qudexy XR, Topamax, Trokendi XR) for migraine prevention. It’s often one of the first choices for preventing migraine headaches.

Topiramate can help prevent both chronic and episodic migraine. It’s usually taken daily at first, and then the dose is increased and split into two doses a day. Some studies show it works better than other daily medications, such as propranolol.

However, topiramate can cause side effects, such as:

• Dizziness and drowsiness
• Fatigue and sleepiness
• Hair loss
• Changes in taste
• Stomach pain and cramping
• Loss of appetite
• Tingling (pins-and-needles sensations) in the hands and feet

Some daily migraine medications, including topiramate, shouldn’t be taken during pregnancy. If you’re planning a family, your doctor can help choose a treatment that fits your needs.

Divalproex sodium (Depakote) and valproic acid are other anti-seizure medications approved for migraine prevention. Both are taken twice daily. Potential side effects include:

• Nausea
• Abdominal (stomach) pain
• Pancreas inflammation
• Weight gain

Gepants

Gepants are a newer class of daily migraine medication. They block a protein called calcitonin gene-related peptide (CGRP). During a migraine attack, CGRP levels rise in the nervous system. High CGRP leads to inflammation that makes blood vessels swell. This protein also plays a role in migraine pain.

The FDA has approved several gepants. Some help prevent migraine, while others are taken as soon as an attack comes on. Gepants used as preventive treatments are oral medications.

Oral Gepants

Some gepants are pills or tablets taken by mouth. Rimegepant (Nurtec ODT) can be taken once a day to treat an acute migraine attack. It’s also approved for migraine prevention. In this case, it’s usually taken every other day.

Atogepant (Qulipta) is taken once daily to prevent episodic and chronic migraine. Be sure to follow your doctor’s prescribing instructions closely.

Most people taking oral gepants experience mild side effects, such as:

• Nausea
• Constipation
• Fatigue
• An allergic reaction, which may cause shortness of breath or a rash

Antidepressants

Despite the name, antidepressants can treat more than depression. Studies show they also work well for preventing migraine. Antidepressants work by balancing neurotransmitters (brain-signaling chemicals), such as serotonin and norepinephrine.

The FDA hasn’t approved antidepressants specifically for migraine. Instead, doctors prescribe them off-label (outside their approved use). Many antidepressants have been around for decades and are generally considered safe for daily use.

Tricyclic Antidepressants

Tricyclic antidepressants (TCAs) are the most commonly prescribed antidepressants for migraine prevention. Examples include amitriptyline and nortriptyline. These medications are usually taken at night. It may take up to four weeks for TCAs to reach their peak effectiveness.

Side effects of TCAs include:

• Weight gain
• Dry mouth
• Dizziness, drowsiness, or lightheadedness
• Nausea, vomiting, diarrhea, or constipation
• Irregular heartbeat
• Headaches

Selective Norepinephrine Reuptake Inhibitors

Selective norepinephrine reuptake inhibitors (SNRIs) raise levels of certain neurotransmitters in the brain. Venlafaxine is an SNRI taken daily to prevent migraine. Possible side effects include:

• Sexual dysfunction
• Headache
• Sweating
• Dry mouth

All antidepressants carry a warning about suicidal thoughts or thoughts of self-harm. If you notice these thoughts, speak with your doctor right away. You can also contact the 988 Suicide & Crisis Lifeline by calling or texting 988 or chatting online if you or someone you know needs help.

Blood Pressure Medications

Many medications are used to treat hypertension (high blood pressure) and can also help prevent migraine attacks. Some are FDA-approved for migraine prevention. Examples include beta-blockers, ACE inhibitors, and angiotensin-receptor blockers (ARBs).

Beta-Blockers

Beta-blockers relax blood vessels and slow the heart rate. Researchers aren’t sure just how these medications help prevent migraine, but they may work by calming overactive signals in the brain.

Propranolol (Inderal LA, InnoPran XL) is the only FDA-approved beta-blocker for migraine management. The American Academy of Neurology recommends propranolol as a first-line treatment for migraine prevention. It’s been used as a daily migraine medication for over 50 years.

Doctors may also prescribe other beta-blockers, like metoprolol or atenolol. Common side effects include:

• Hypotension (low blood pressure)
• Slow heart rate
• Fatigue (extreme tiredness)
• Depression
• Vivid dreams

People with a history of asthma or chronic obstructive pulmonary disease (COPD) shouldn’t take beta-blockers. These medications can narrow the airways and make breathing symptoms worse.

ACE Inhibitors and Angiotensin-Receptor Blockers

Some blood pressure medications may also help prevent migraine. ACE inhibitors and ARBs may work by relaxing blood vessels in the brain and reducing inflammation.

Your doctor may prescribe medications such as candesartan or lisinopril. Potential side effects include:

• Low blood pressure
• Headache
• Dizziness
• Nagging cough (with ACE inhibitors)
• Blurred vision
• Kidney problems

Talk With Your Doctor About Your Migraine Treatment Plan

Managing migraine is a team effort. It’s important to have open, honest conversations with your doctor about your symptoms. This helps them recommend a treatment plan that fits your needs. You may need to adjust your dose or switch medications to find what works best.

For example, rescue medications like triptans aren’t meant to be taken daily. If you’re taking a triptan more than a couple of times a week, it may be time to consider a preventive medication.

It can help to track how often you get migraine attacks and how they affect your daily life. Share details such as missed work, school, or social activities. Together, you and your doctor can find an approach that works for you.

Join the Conversation

On MyMigraineTeam, people share their experiences with migraine, get advice, and find support from others who understand.

Do you use daily medications to help prevent migraine? Let others know in the comments below.