Medicines to Prevent Migraine Attacks

Who should take a medicine to prevent migraine attacks?

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

• More than two migraine attacks per month that cause significant disruption to your life.
• Less frequent, but severe migraine attacks.
• You are using a lot of painkillers or triptan medicines to treat migraine attacks.
• Painkillers or triptans for migraine attacks do not work very well or you are unable to take them because of side effects or other problems.
• Migraine attacks are suspected of causing medication overuse headache - see below.

Before embarking on preventative treatment, it is probably best to keep a migraine diary for a few months to assess:

• How often and how bad your migraine attacks are.
• Your current use of medication to treat the migraine attacks.

This may help you to decide if preventative treatment is worth a try, and also to help assess if you may have medication overuse headache. See separate leaflet called 'Migraine - Triggers and Diary' which includes a migraine diary that you may like to print out and use.

What is medication overuse headache?

Medication overuse headache is caused by taking painkillers or triptan medicines too often for tension-type headaches or migraine attacks. It is a common cause of headaches that occur daily, or on most days. About 1 in 50 people develop this problem at some time in their life.

Which medicines are used to prevent migraine attacks?

Beta-blockers

These include propranolol, metoprolol, timolol 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 attacks lessened when on 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, chronic obstructive pulmonary diseases, peripheral vascular disease, or heart failure.

Amitriptyline

Amitriptyline is classed as an antidepressant. However, it has an antimigraine 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. Some people cannot take amitriptyline. For example, people who have had a myocardial infarction (heart attack), or have ischaemic heart disease, arrhythmia, or epilepsy.

Note: strictly speaking, amitriptyline is not licensed for preventing migraine. However, in practice, it is commonly used, and many doctors are happy to prescribe it for this purpose.

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 can also prevent migraine attacks.

Others

Various other medicines have been used for the prevention of migraine attacks. Most have limited evidence regarding their effectiveness or have potentially serious side effects. However, if all else has failed, a specialist may suggest that you try of one of these. They include: pizotifen, methysergide, gabapentin, calcium channel blockers, lisinopril, and selective serotonin re-uptake inhibitors (SSRIs).

Some points about medicines to prevent migraine attacks

• You need to take the medicine every day.
• It is unlikely to stop migraine attacks completely. However, the number and severity of attacks are often much reduced by a preventative medicine. It is 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, it is common to stop it to see if it is still needed. It can be restarted again if necessary.
• If a migraine attack occurs you can still take painkillers or a triptan in addition to the preventative medicine.
• 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, WC1BE 4HP
Tel: 020 7462 6601 Web: www.migrainetrust.org