Medicines to Prevent Migraine Attacks

Who should take a medicine to prevent migraine?

There is no definite rule. You may wish to consider this option if you have:

• more than two migraine attacks per month.
• less frequent, but severe migraine attacks.
• you are using a lot of painkillers or other tablets to treat migraine attacks.

Which medicines are used to prevent migraine?

Beta-blockers
These include propranolol, metoprolol, and atenolol. They are commonly used to treat conditions such as angina and high blood pressure. It was first noticed by chance that some people who were treated for angina, who also had migraine, found that their migraine improved with propranolol. It is not clear how they work to prevent migraine. However, beta-blockers are now a common treatment for migraine. A low dose may work, but the dose can be increased if necessary. Some people cannot take beta-blockers. For example, some people with asthma.

Amitriptyline
Amitriptyline is classed as an antidepressant. However, it has an anti-migraine action separate to its antidepressant effect. It is not clear how it works for migraine. A low dose is started at first, and can be increased if necessary.

Sometimes a beta-blocker and amitriptyline are used together.

Anticonvulsants
Medicines called sodium valproate and topiramate are sometimes used. These are classed as anticonvulsants, and are usually used to prevent seizures of epilepsy. However, it was found that they may also prevent migraine attacks.

Others
Various other medicines are sometimes tried when all else fails. These include: pizotifen, methysergide, gabapentin, calcium channel blockers, lisinopril, and selective serotonin re-uptake inhibitors (SSRIs).

Some points about medicines to prevent migraine

• You need to take the medicine every day.
• They are unlikely to stop migraine attacks completely. However, the number and severity of attacks are often much reduced by these medicines. It might be useful if you keep a migraine diary to monitor how well a medicine is working.
• It may take 1-3 months for maximum benefit. Therefore, if it does not seem to work at first, do persevere for a while before giving up.
• It is common practice to take one of these medicines for 4-6 months. After this you can stop it to see if it is still needed. It can be restarted again if necessary.
• You can still take painkillers or a 'triptan' for migraine attacks if they occur.
• It is worth trying a different medicine if the first one you try does not help.
• Read the leaflet in the medicine packet for a list of cautions and possible side-effects.

Further sources of help and information

Migraine Action
27 East Street, Leicester, LE1 6NB
Tel 0116 275 8317   Web: www.migraine.org.uk

Migraine Trust
2nd Floor, 55-56 Russell Square, London, WC1B 4HP
Tel: 020 7436 1336   Web: www.migrainetrust.org

© EMIS and PIP 2005   Updated: February 2005   Review Date: July 2006   CHIQ Accredited   PRODIGY Validated