If at least two severe, long-lasting migraines occur each month, preventive medication may be considered.
A daily preventive medication does not eliminate migraines altogether. Instead, it keeps migraine headaches from occurring as frequently, shortens their duration, and moderates the symptoms. Reducing the frequency of migraines by half is considered a success.
For most people, migraines result from inflammation caused by a chemical in the brain called calcitonin gene-related peptide (CGRP). CGRP is a neurotransmitter—a molecule that enables communication between the brain’s neurons. When released in the body, CGRP triggers inflammation in the meninges, membranes that surround the brain and spinal cord.
How anti-CGRP medication works
Anti-CGRP medications prevent migraines by blocking the receptor that releases the CGRP in the brain. While new to the market, anti-CGRP’s have proven to reduce the frequency and severity of migraines.
How are anti-CGRP medication is administered
Most anti-CGRP medication are administered by patient self-injection via an auto-injector. (An autoinjector is a spring-loaded syringe containing the exact correct dose of medicine, making self-injection relatively easy.) A person will use the injection monthly or quarterly, depending on the type of medication. Another form of the medication will be administered via intravenous infusion, which will require a person go to a doctor’s office on a quarterly basis.
Examples of anti-CGRP medication
Anti-CGRP medication that may be prescribed for migraines include, erenumab (Aimovig), fremanezumab-vfrm (Ajovy), and galcanezumab-gnlm (Emgality).
Typically used to treat epilepsy, these medications, also called neuromodulators, can be effective in relieving migraine symptoms even when the individual does not have epilepsy.
How anticonvulsant medications work
Anticonvulsant medications are believed to prevent migraines by interfering with brain and nerve cell communication.
Examples of anticonvulsant medications
Valproic acid (Valproic, Depakote) and topiramate (Topamax) are both FDA-approved for migraine treatment.
Medications originally designed to treat depression may be helpful in easing migraine headaches.
How antidepressant medications work
It is thought that the group of medications called tricyclic antidepressants affect brain chemicals involved in migraines.
Example of an antidepressant medication
While the antidepressant amitriptyline (Elavil) is not specifically approved by the FDA to treat migraines, it may be prescribed for this purpose. Medications considered helpful for a patient's condition can legally be prescribed without being on the approved FDA list for that condition. This practice is called off-label prescribing.
Beta blockers block the effects of epinephrine, commonly known as adrenaline. They are often prescribed to treat high blood pressure and are sometimes used to treat migraine headaches.
How beta blocker medications work
It is not known exactly why beta blockers help prevent migraines. Beta blockers do relax blood vessels, leading to improved blood flow. This relaxation effect could be helpful in reducing the nervous system excitability that may be a factor in causing migraines.
Examples of beta blockers used to treat migraines
Originally developed for heart-related problems, a beta blocker called propranolol (Inderal) was the first FDA-approved migraine medication. The second, timolol (Blocadren), was first developed for treating glaucoma, and is sold as an eye drop.
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Calcium Channel Blockers
Initially developed to treat high blood pressure, calcium channel blockers are usually not the first choice for treating migraines. Calcium channel blockers may be advised if other medications have been unsuccessful.
How calcium channel blockers work
These medications widen blood vessels and keep calcium from reaching the blood vessels. This action prevents migraine-related blood vessel changes.
Example of a calcium channel blocker used to treat migraines
The channel blocker verapamil (Calen) is one that may be prescribed off-label for migraines.
Onabotulinum Toxin A (Botox)
This medication is administered in a series of injections in various parts of the head and neck, and is approved by the Food and Drug Administration to treat chronic migraines.
How onabotulinum toxin A works
It is thought that onabotulinum toxin A (Botox) relieves pain by blocking pain signals. The injections are typically recommended when migraines occur more than 15 days a month. To be most effective, it is generally advised that a series of injections be given every 12 weeks.
While other types of botulinum toxin preparations exist, only Onabotulinum toxin A. (Botox) is licensed for use to treat migraines.
Also called narcotics or painkillers, opioids are sometimes prescribed for migraines. They are not approved to treat migraines and are generally not the first or even second choice for treatment. Frequent use of opioid painkillers can lead to more migraine headaches. Opioids also may cause nausea, which is already common with migraines.
How opioids work
Opioids weaken pain signals to the brain, and can treat migraine pain without treating the neurological symptoms.
Examples of opioids used to treat migraines
Opioids that may be prescribed for migraine headaches include hydromorphone (Dilaudid, Exalgo) and tramadol (Ultram).
See Types of Opioids
Risks and Potential Side Effects of Migraine Medications
Medications that ease migraine symptoms are generally powerful types of pain relief, with potentially life-threatening risks and side effects in some cases. These medications may not be recommended for:
- Those with certain medical conditions other than migraines
- Women who are pregnant or planning to become pregnant
To avoid dangerous interactions, it is important that the patient’s health care provider and pharmacist know about all medications being taken. Checking to see whether alcohol use is safe while using these medications is also advised.
While migraine medications must be taken with care, these medications can make a significant difference in easing the pain and other symptoms associated with migraines, enhancing quality of life.