Medications can prevent and relieve migraine symptoms. Some preventive medications, which are also used to treat other conditions, include topiramate (Topamax), duloxetine (Cymbalta), and propranolol (Inderal).

There are several types of medications available to both treat and help prevent severe migraine symptoms.

Your treatment options may depend on whether 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.

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 preventive medications with other medications to enhance your treatment. Prevention medications may be taken orally (daily by mouth) or as 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 American Headache Society, several types of medications are effective for migraine prevention.

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 treat various types of seizures. The Food and Drug Administration (FDA) has approved a couple of these for migraine prevention (divalproex sodium, topiramate).

Some others may also be used off-label for migraine prevention. This is when a medication is used for a purpose other than its approved use.

Scientists aren’t sure exactly how anticonvulsants work for migraine prevention, but they’re thought to calm overactive nerve signals in the brain.

Anticonvulsant medications for migraine prevention are taken by mouth.

Pros of anticonvulsants for migraine

  • There’s some evidence that certain types of anticonvulsant medications are effective for preventing different symptoms of migraine (headache, pain, aura).

Cons of anticonvulsants for migraine

  • These medications have some serious side effects and may not be suitable for everyone.
  • You must 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.

Types of anticonvulsant medications

Anticonvulsant medications that are sometimes used to prevent migraine episodes include:

Some side effects may include:

These are not all types of anticonvulsants or all their side effects. To learn more about this class of medications, ask a doctor. They can also tell you about the benefits and harmful effects of anticonvulsants and whether one may be best for you.

Antidepressants

There are several types of antidepressant medications used to treat depression and other mood disorders. Several are also used off-label for migraine prevention.

When used for preventing migraine, antidepressants work by regulating neurotransmitters in the brain to prevent some symptoms. They’re taken by mouth.

Pros of antidepressants for migraine

  • Studies have 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.

Cons of antidepressants for migraine

  • 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:

Side effects can include:

These are not all the types of antidepressants or all of their side effects. To learn more about the effectiveness of these medications, talk with your doctor.

Beta-blockers

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 evidence that certain beta-blockers may be effective for migraine prevention. They are well-tolerated and inexpensive, and most people have mild side effects. They may also be helpful if you have a cardiovascular condition.

Cons of beta-blockers for migraine

  • This type of medication must be taken daily, and it may take some time for it to work. It 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:

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. Chronic migraine is classified by having migraine episodes at least 15 days per month.

Botox can help manage some migraine symptoms, such as:

  • migraine frequency
  • light and sound sensitivity
  • nausea

Botox is given as an injection. It works by blocking nerve endings that send pain signals.

Pros of Botox for migraine

  • Studies show it’s effective for managing chronic migraine symptoms.

Cons of Botox for migraine

  • The drug may have to be used for several 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:

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 two categories:

  • Monoclonal antibody medications: This class of medications is made from immune cells. It’s a type of biologic drug, meaning 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’re 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 for migraine

  • Studies show these drugs are effective for migraine prevention with minimal side effects.

Cons of CGRP inhibitors for migraine

  • 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, including their benefits, risks, and working times.

Examples of CGRP inhibitors

Types of monoclonal antibodies include:

Gepants can be in the form of a pill taken by mouth, like atogepant (Qulipta), or an oral tablet designed to dissolve quickly, such as rimegepant (Nurtec ODT).

Some potential side effects are:

  • flu-like symptoms
  • injection site reactions (discoloration or redness, itching, pain)
  • allergic reaction

The cost of your medication depends on:

  • if you have insurance and its coverage
  • 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 or drug search websites to learn more about the cost of your medication, with or without insurance.

There are other nonmedication options with evidence of some effectiveness. They include:

  • Vitamin B2: It’s not clear how vitamin B2 (riboflavin) prevents 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 headaches.
  • 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 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: Triggers can vary for everyone, but common ones may include stress, weather, and hormonal changes
  • Lifestyle changes: A good place to start when looking to control migraine symptoms is your lifestyle. Try exercise, good sleep habits, or dietary changes, as these may improve symptoms or the frequency of migraine episodes.

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. You can try migraine prevention medications, which come in many forms and have evidence supporting their efficacy.

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 attacks in the long term.