Preventive Migraine Medicines: All You Need to Know

Dr. Risa Ravitz | May 6, 2019

A solution that stops the onset of migraine before it has even started is undoubtedly the treatment that migraine sufferers are looking for. There are a number of preventive medicines out there that aim to do just this: decrease the frequency, severity and duration of migraine attacks.

In addition, preventive therapy also aims to allow abortive medicines to work more effectively, thus reducing the overuse of these medications, as well as helping patients manage the cost of their care. I usually refrain from prescribing these medicines for long periods of time, with many of my patients experiencing a continued reduction in migraines once they come off the medication after a period of anything from three months to two years.

What are the preventive medicines that are available?

Many preventive medications were initially developed for other conditions, and it was discovered later that these are helpful in treating migraines. The few main medicines that are prescribed as a preventive treatment for migraine sufferers include:

Cardiovascular drugs

Beta-blockers are commonly used to treat high blood pressure, but are also prescribed to prevent or reduce the severity of migraine symptoms. They include Atenolol, Metoprolol, and Nadolol, and shouldn’t be prescribed for people with breathing problems or slow heartbeats, as they work by blocking the effects of adrenaline and slowing down the patient’s heart rate.

Calcium channel blockers are also used to treat high blood pressure, and can be used in patients who are not good candidates for beta-blockers. They work by preventing muscles in blood vessel walls from contracting and tightening. Some calcium channel blockers include Nicardipine, Nimodipine, Verapamil and Nifedipine.

Anti-seizure drugs

Anticonvulsant drugs that usually treat seizure disorders have also proven to be helpful in limiting the frequency of migraines. They include topiramate and valproate. It’s important to note that in high doses, they can cause side effects such as nausea, weight gain or loss, and in the case of topiramate, there is a chance of memory difficulties or concentration problems.


Tricyclic antidepressants (TCAs) change neurotransmitter levels in the brain but work on pain receptors in both the brain and spinal cord. They have an indication for the prevention and treatment of chronic migraine, even in patients that do not suffer from depression. Frequently used TCAs include Amitriptyline, Doxepin, and Nortriptyline.

Which drug is right for me?

I always stress to my patients that it may take a while to see the full effects or to find the right combination for them, so it’s important to stick with a new treatment until they can be sure of its effects. I also tend to tailor the preventive medication choice to also help with other symptom relief. For example, TCAs are good for migraine, concurrent neck pain and sleep disturbances. All of the above medications require a prescription and monitoring by a physician for efficacy and safety.

If you want to find out more about what the best preventive medicine option is for you, you can schedule an online consultation with Modern Migraine MD here.

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