There are several types of medications available to both treat and help prevent severe migraine symptoms.
Your treatment options may depend on if you have episodic or chronic migraine, and on the severity and frequency of migraine episodes. Your doctor will discuss your migraine history and the right options for you.
In this article, we’ll discuss the different types of migraine prevention medications, pros and cons, and how they work.
Click on a class of medication to jump to its explanation:
If you experience frequent, severe migraine attacks that disrupt your life, your doctor may discuss preventive medications with you. These medications may prevent and treat migraine symptoms but don’t cure the condition.
Migraine medications are classified into two categories:
- Abortive medications. Also called acute treatments, abortive migraine medications help manage migraine symptoms as they occur.
- Preventive medications. These types of medications help lower your risk of having a migraine episode and the severity of symptoms.
You may be prescribed
- oral (taken daily by mouth)
- injectable medications you take less often (once every month to once every 3 months).
Your doctor or pharmacist can tell you more about the form and dosage of your migraine medication.
According to an updated 2021 consensus statement by the
The best preventive medication for you depends on several factors, including:
- the frequency and severity of migraine episodes
- your age
- other health conditions you may have
- other medications you may be taking
Anticonvulsant and antiepileptic drugs
Anticonvulsant medications are used to treat types of seizures. A few of these types of medications are approved by the Food and Drug Administration (FDA) for
Scientists aren’t sure exactly how anticonvulsants work for migraine prevention, but it’s thought that they calm overactive nerve signals in the brain. Anticonvulsant medications for migraine prevention are taken by mouth.
Pros of anticonvulsant drugs for migraine
Considerations for anticonvulsant medications
- These medications have some serious side effects and may not be suitable for everyone.
- You also need to take these medications daily, which may be inconvenient for some people.
Ask your doctor for more information about the benefits and risks of these medications and how long they take to start working.
Some types of anticonvulsant medications
Anticonvulsant medications that are sometimes used to prevent migraine episodes include:
- carbamazepine (Tegretol)
- divalproex sodium (Depakote and Depakote ER)
- topiramate (Topamax)
- valproate (Depakene)
Some side effects may include:
- vision problems
- allergic reaction
- suicidal thoughts or actions
- problems with coordination
These are not all types of anticonvulsants or all their side effects. To learn more about this class of medications, ask a doctor for more information. They can also tell you about the benefits and harmful effects of anticonvulsants and if one may be best for you.
There are several types of antidepressant medications used to treat depression and other mood disorders. Several are also used off-label for migraine prevention. They work by regulating neurotransmitters in the brain to prevent some migraine symptoms. They are taken orally by mouth.
Pros of antidepressants for migraine
Studieshave shown some types of antidepressant medications are helpful to prevent migraine symptoms in certain people. If you have mood disorders with migraine, antidepressants may help both conditions. Amitriptyline (Elavil, Endep) has the strongest evidence for effectiveness.
Considerations for antidepressants
- These types of medications can have serious side effects that some people cannot tolerate.
- They also need to be taken daily, which may be inconvenient.
Your doctor can tell you more about the pros and cons of these medications and what you can expect with treatment.
Examples of antidepressants
Some antidepressants used to prevent migraine episodes include:
- amitriptyline (Elavil, Endep)
- duloxetine (Cymbalta)
- nortriptyline (Aventyl, Pamelor)
- venlafaxine (Effexor)
Side effects can include:
- dry mouth
- weight loss
- weight gain
- suicidal thoughts
- vision changes
These are not all the types of antidepressants, or all their side effects. To learn more about the effectiveness of these medications, talk with your doctor.
This class of medications is used to treat cardiovascular conditions such as high blood pressure. Two of these types of medications are FDA approved for migraine prevention (propranolol and timolol). Other medications in this class may also be used off-label for migraine prevention.
It isn’t clear how beta-blockers work to prevent migraine attacks, but they may have different actions on the brain and reduce stress, which is a trigger for migraine.
Pros of beta-blockers for migraine
- There is
evidencethat certain beta-blockers may be effective for migraine prevention. They are well-tolerated, inexpensive, and most people have mild side effects. They may also be helpful if you have a cardiovascular condition.
Considerations for beta-blockers
- You have to take this type of medication daily, and it may take some time for it to work. They may not be suitable for everyone.
Ask your doctor if this class of medications is right to treat your migraine symptoms and what you can expect with treatment.
Examples of beta blockers
Certain beta-blockers may be prescribed to prevent migraine symptoms. These medications include:
Possible side effects include:
- trouble sleeping
- sexual side effects
Botulinum toxin (Botox)
Botulinum toxin (Botox) is made from the purified protein Clostridium botulinum. The onabotulinumtoxinA toxin is FDA approved to treat chronic migraine symptoms.
Botox can help manage some migraine symptoms, such as:
- migraine frequency
- light and sound sensitivity
Botox is given as an injection. It works by blocking nerve endings that send pain signals.
Pros of botulinum toxin for migraine
Studiesshow it’s effective for managing chronic migraine symptoms.
Considerations for botulinum toxin
- According to the American Migraine Foundation, the drug may have to be used for up to 6 months to see results. Each dosage involves a healthcare professional administering 31 injections in seven specific areas of the head and neck once every 3 months.
- Botulinum toxin is also more expensive than oral medications.
Your doctor can tell you more about the effectiveness of this medication and if it’s right for you.
Side effects can include:
- allergic reaction
- dry eyes
- vision problems
- muscle weakness
- neck pain
- swelling or drooping in the eyelid area
Calcitonin gene-related peptide (CGRP) inhibitors
CGRP is a type of protein that’s released in the brain and can affect migraine symptoms. CGRP inhibitors are a class of drugs that can be separated into:
- Monoclonal antibody medications. This class of medications is made from immune cells. It’s a type biologic drug, since it’s made from living cells.
- Gepants (CGRP receptor antagonists). Gepants are small molecules that block CGRP receptors from the peptides.
These newer medications are used for both episodic and chronic migraine prevention. They are thought to help prevent migraine episodes by binding or blocking CGRP proteins from activating in your body, which helps manage some migraine symptoms.
Pros of CGRP inhibitors
Cons of CGRP inhibitors
- They are more expensive than other migraine medications. Some have to be given as an injection by a healthcare professional.
Your doctor can tell you more about the specific medications in this class, as well as their benefits, risks, and how long they take to work.
Examples of CGRP inhibitors
- erenumab (Aimovig): prefilled injection for subcutaneous (under the skin) self-injection
- eptinezumab-jjmr (Vyepti): given intravenously (directly into a vein)
- fremanezumab-vfrm (Ajovy): prefilled pen for self-injection under the skin
- galcanezumab (Emgality): prefilled pen for self-injection under the skin
- atogepant (Qulipta): a pill taken by mouth
- rimegepant (Nurtec ODT): an oral tablet designed to dissolve quickly
Some potential side effects are:
- flu-like symptoms
- injection site reactions (redness, itching, pain)
- allergic reaction
The cost of your medication depends on:
- if you have insurance
- if it’s brand-name or generic
- the form of the medication (capsule, injection, etc.)
- the days’ supply (30-day versus 90-day)
- how often you take the medication
You can check with your doctor or pharmacist to learn more about the cost of your medication. You can also check GoodRx.com to find out the cost in your area without insurance.
There are other nonmedication options with
- Vitamin B2. It’s not clear how vitamin B2 (riboflavin) works to prevent migraine headaches, but it may help reduce the number of migraine episodes and headache pain. Ask your doctor if a vitamin B2 supplement could benefit you.
- Magnesium. Magnesium may prevent some specific symptoms of migraine, such as aura and migraine episodes related to your periods. Magnesium helps lower the number and severity of some types of migraine.
- Yoga. Practicing yoga can improve relaxation, which helps reduce stress and anxiety. Yoga also increases circulation, which can lower migraine severity and frequency over time.
- Neuromodulation. Neuromodulation devices are thought to reduce migraine by slowing down brain activity, which reduces pain from migraine headache.
- Cognitive behavioral therapy (CBT). CBT is a form of behavioral training that can help you relax and reduce stress, anxiety, and depression linked to migraine symptoms.
Do not take any over-the-counter products (vitamins, herbs, pain medications) without talking with your doctor first. They can tell you what’s safe for you to take.
Understanding more about your migraine symptoms can help you find effective relief. This includes:
- keeping a migraine diary (track your migraine attacks and symptoms)
- avoiding migraine triggers when possible (stress, weather, hormonal changes)
- lifestyle changes (exercise, good sleep habits, diet)
Migraine episodes can cause severe pain that disrupts your daily life, activities, and well-being.
If you experience frequent migraine headaches, there are steps you can take to reduce migraine-related symptoms and severity.
Speak with a doctor about the different types of medications available and if they could be effective for your symptoms.
There are also nonmedication options you can take to prevent migraine episodes.
Ask your doctor for more information about your type of migraine and how to prevent them in the long term.