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What Is Preventive Migraine Treatment? 5 Things To Know

Posted on February 20, 2024

Recurring, chronic 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 has chronic migraine, you may be interested in learning about preventive migraine treatments. Another MyMigraineTeam member said, “I am going to have to look into preventative medicine. Too many migraines each month.”

Continue reading for a list of five key things to know about preventive migraine treatment and a review of the different types of migraine prevention. This article will also discuss the effectiveness of treatment options and who may be a good candidate for each type.

1. Preventive Treatment Is Different From Acute Treatment

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

These acute treatments are to be used at the time you’re experiencing a migraine attack and want to stop it in its tracks. If you have chronic (recurring) migraine headaches, you may benefit from both preventive and acute treatment options.

Acute Migraine Treatments

Acute migraine medications are also called abortive medications since they aim to cut short, halt, or stop a migraine when it’s happening. Examples of acute migraine medications include analgesics, ergotamines, triptans, 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 is not relieved by common over-the-counter drugs
  • Zavegepant (Zavzpret) — A nasal spray taken to treat acute migraine headaches after they’ve started

Analgesics — such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) — work to reduce pain, but they are not specific for migraine pain. Headache pain can actually worsen if you take an analgesic too regularly.

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 nausea.

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 in such a way that it doesn’t narrow blood vessels.

Preventive Migraine Treatments

Examples of preventive migraine medications include:

  • Blood pressure-lowering medications, such as candesartan (Atacand)
  • Antidepressants, such as amitriptyline (Elavil)
  • Anticonvulsants, such as topiramate (Topamax)
  • Neurotoxins, such as onabotulinumtoxinA (Botox)
  • Certain CGRP receptor antagonist therapies
  • CGRP monoclonal antibodies

Later, we will discuss more of the details about each of the preventive migraine treatment options.

2. Preventive Treatment Will Not Eliminate Migraine Attacks

The main goal of preventive medication is to reduce migraine frequency and severity. However, preventive treatments will very rarely stop someone from having migraine attacks.

The main goal of preventive medication is to reduce migraine frequency and severity.

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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 behind them, and novelty.

Blood Pressure Medicines, Antidepressants, and Anticonvulsants

Blood pressure medication, antidepressants, and anticonvulsants are some of the older, original preventive medications prescribed for people with chronic migraine. Blood pressure medications like beta-blockers, angiotensin converting enzyme (ACE) inhibitors, and angiotensin-receptor blockers (ARBs) help lower blood pressure and heart rate. However, they can also make you feel tired and dizzy.

Some doctors prescribe 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. These antidepressant medications can help with sleep, but they can also cause dry mouth, weight gain, or other side effects.

Anticonvulsants have been a long-standing treatment option but should not be used by people with liver disease or by women who may become pregnant. Anticonvulsants can also cause tingling, memory issues, and reduced appetite.

Botulinum Toxin

Botulinum toxin, such as onabotulinumtoxinA (Botox), has been used to prevent migraine attacks for over 10 years. Botulinum toxin is a neurotoxin that reduces muscle contractions; often, people think of it solely as a cosmetic injection to get rid of wrinkles. Scientists believe that botulinum toxin prevents sensory and pain nerves from firing in the meninges — the tissues surrounding the brain. Botox 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 become very popular. One member of MyMigraineTeam expressed, “I would push your GP for the new preventative injections (referring to CGRP injections).”

Read more information about the two different CGRP targeted treatments.

Some of the preventive CGRP targeted medications that bind to CGRP receptors (i.e., CGRP antagonists) include atogepant (Qulipta) and rimegepant (Nurtec ODT).

CGRP monoclonal antibodies (mAbs) are another type of CGRP targeted therapy. The antibodies are designed to target specific antigens — or any substance within the body that causes your immune system to produce antibodies, such as CGRP. The monoclonal antibody treatment remains active in a person’s body for several weeks, making the drug especially effective for inhibiting migraine attacks for a longer period of time.

Some of the preventive CGRP targeted medications are biologics, meaning they are produced from a live system, such as a bacteria, plant, or animal cell. Examples of CGRP mAbs include:

Some preventive CGRP targeted medications are biologics, meaning they are produced from a live system, such as a bacteria, plant, or animal cell.

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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 had a different primary target. The 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 in people who cannot tolerate other preventive therapies.

4. The Best Migraine Treatment Plan Depends on the Person

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

It’s essential to work with a health care provider if you decide to use multiple migraine treatments since some medications interact with each other.

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Consider Coexisting Conditions

People with chronic migraine may have a comorbid condition. Comorbidity occurs when you have two conditions at the same time, and there is some type of association between them. Often, people with chronic 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 check in with your doctor about all of the options available to you. Your doctor can also help determine what preventive treatment options may be safest and most effective for you.

Health care providers should consider preventive treatment in the following circumstances:

  • Recurring migraine attacks affect your daily routine even though you’re taking acute medications.
  • Migraine attacks are recurring (four or more migraine attacks per month).
  • Acute medications are not working, or they have too many unwanted side effects.
  • Migraine attacks come with uncomfortable sensory symptoms (auras) which may be visual sparks, tingling, or numbness.

If any of these describe your current circumstance, 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 81,000 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.

Posted on February 20, 2024
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Marie Dorsey, Pharm.D., BCPS, AAHIVP is currently a clinical pharmacist at Bridgewell Medical, specializing in medication therapy management and holds a certification as an HIV pharmacist through the American Academy of HIV Medicine. Learn more about her here.
Amanda Studnicki, Ph.D. earned her Bachelor of Science in biomedical engineering from the University of Delaware in 2014 and a doctorate of philosophy from the University of Florida in 2023. Learn more about her here.

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