Headache Medications
Prophylactic or Peventative Headache Medications are taken daily to prevent the onset of migraine. They are not intended for use during a migraine attack. Many different preventive medications are available, and the choice of medication depends on many factors such as co-existing conditions including high blood pressure, diabetes, or pregnancy (among others). Therefore, choosing medications for preventive therapy can be a complex process. Before starting to take medications, several basic principles need to be considered:
- The choice of a preventive medication needs to be tailored to meet each person’s individual needs.
- Co-existing medical conditions, drug side effects, other medications being taken, and individual patient needs will help determine which medication a physician chooses.
When deciding on preventive therapies, it is important to review with your doctor several important management principles:
- Low doses are used at first and gradually increased to higher doses as needed. Therefore, you may need to increase medication dose until the desired response is achieved.
- It may take 2 to 3 months before you notice a decrease in the frequency or severity of attacks.
- Treatment may be required for 6 to 12 months or longer.
- All medications have potential side effects so any unusual symptoms should be reported to your physician. It is important to discuss potential side effects, since some medications may be better tolerated than others.
- Side effects can often be limited by using low doses, increasing the dose slowly, or allowing time to adjust to the medication. If you are not tolerating the medication and if you start to have side effects, contact your doctor to discuss changes to the treatment plan.
- You should not suddenly stop taking preventive medications because of the risk of rebound headache or other side effects. Preventive medications need to be gradually tapered off after a period of sustained benefit.
Commonly used preventive medications:
| Type of medication | Medication class | Generic name | Side effects |
| Blood pressure medications | Beta-Blockers | Propranolol
Timolol Metoprolol |
Fatigue
Depression Nausea Insomnia Dizziness |
| Calcium channel blockers | Verapamil
Diltiazem Nimodipine |
Weight gain
Constipation Dizziness Low blood pressure |
|
| Antidepressants | Tricyclic antidepressants | Amitriptyline
Nortriptyline Imipramine |
Dry mouth
Sedation Decreased libido (sex drive) Low blood pressure |
| Selective Serotonin Reuptake Inhibitors (SSRIs) | Fluoxetine
Paroxetine Sertraline |
Weight gain or loss
Decreased libido |
|
| Anticonvulsants | Divalproex sodium
Gabapentin Topiramate |
Weight gain or loss
Sedation Skin rash |
|
| Serotonin antagonists | Methysergide
Methylergonovine |
Blood vessel spasm
Abdominal scarring (very rare) |
|
| Unconventional treatments | Magnesium salts | Magnesium oxide, magnesium diglycinate, magnesium chloride slow release | Diarrhea |
| Vitamins | Riboflavin | Urine discoloration | |
| Feverfew |
Acute headache medications are also a treatment option.