According to the American Migraine Foundation, migraine affects 39 million adults and children in the United States.

Chronic migraine can be debilitating and often has a significant impact on quality of life. One of the best ways to manage this is with medications or therapies meant to prevent migraine episodes.

In medical terms, options that work to prevent migraine are also referred to as migraine prophylaxis. Some medications and treatments used as prophylactics can help reduce the frequency and severity of these headaches.

In this article, we explore the most common treatment options for migraine prevention, including what the research says about how effective these options are for preventing chronic migraine.

Angiotensin blockers are medications that prevent the production or uptake of angiotensin, a hormone that causes the blood vessels to narrow.

Angiotensin blockers may include angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs).


In one 2012 study, an ARB called candesartan was shown to reduce not only the number of headache days, but also headache hours, migraine days, and migraine hours, compared to placebo.

In another study from 2007, an ACE inhibitor called lisinopril showed significant reductions in migraine frequency and acute medications in study participants.

Side effects

Common side effects of angiotensin blockers may include:

  • cough
  • dizziness
  • fatigue
  • lightheadedness
  • gastrointestinal symptoms

As migraine prophylaxis, it can take weeks for ACE inhibitors and ARBs to show long-term benefits.

Anticonvulsant drugs, also known as antiepileptic drugs (AEDs), are medications that help treat and prevent epileptic seizures by slowing nerve signals in the brain.

Anticonvulsant drugs may include narrow-spectrum AEDs for specific types of seizures or broad-spectrum AEDs for multiple seizures.


According to a 2012 review, divalproex sodium and sodium valproate both showed effectiveness in reducing migraine attack rates in clinical studies. Topiramate was also found to significantly reduce migraine frequency in 11 different studies.

Gabapentin, lamotrigine, and oxcarbazepine have shown mixed results in their effectiveness for migraine prophylaxis.

Side effects

Common side effects of AEDs may include:

  • rash
  • fatigue
  • increased energy
  • gastrointestinal symptoms
  • paresthesia
  • weight gain
  • hair loss

Anticonvulsants typically begin working immediately, but for migraine prophylaxis, it can take 4 to 8 weeks to see results.

Antidepressants are medications that treat depression, anxiety, and other mental health conditions by altering the neurotransmitters in the brain.

Antidepressant medications commonly include selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), as well as other medications.


In an early study, an SSRI called fluoxetine was shown to significantly reduce the pain index after several months of treatment.

A more recent review from 2015 noted an SNRI called venlafaxine demonstrated a reduction in migraine intensity and duration over several studies.

Amitriptyline, a tricyclic antidepressant, was also found to be effective for migraine prophylaxis.

Side effects

Common side effects of antidepressants may include:

  • nausea
  • vomiting
  • drowsiness
  • dry mouth
  • difficulty concentrating
  • increased heart rate

As a preventive medication for migraine, antidepressants can take 4 to 6 weeks or more to show benefits.

Beta-blockers are medications that reduce heart rate and blood pressure by blocking the actions of the hormone adrenaline (epinephrine).

Beta-blockers, which can be nonselective, cardioselective, or third-generation, are the most commonly prescribed medication for migraine prophylaxis.


Multiple studies have found metoprolol to be effective for reducing migraine frequency by as much as 50 percent.

A 2019 study on propranolol also found this medication to be effective in reducing migraine frequency, duration, and severity.

Other potential beta-blockers for migraine prevention include timolol and atenolol.

Side effects

Common side effects of beta-blockers may include:

  • dry mouth
  • drowsiness
  • fatigue
  • weight gain
  • sleep disturbances

Beta-blockers can take months to show effectiveness as a preventive medication for chronic migraine.

Botox, or botulinum toxin type A, is an injectable drug produced by the bacterium Clostridium botulinum, which temporarily weakens or paralyzes the muscles.

While Botox is most commonly used for cosmetic purposes, it can also be used to treat certain medical conditions, such as chronic migraine.


In one systematic review, researchers analyzed the data from 28 trials on the effectiveness of Botox for migraine prevention. Studies included those comparing Botox to a placebo, as well as those comparing Botox to other prophylactic treatments.

Results of the analysis found that Botox was able to reduce headache frequency by roughly 2 headaches per month.

Side effects

Common side effects of Botox may include:

  • injection site pain
  • eyelid drooping
  • muscle weakness
  • neck pain

As a prophylactic agent for migraine, Botox is most effective after 4 weeks, with most trials recording results after as long as 12 weeks.

Calcitonin gene-related peptide (CGRP) therapy uses monoclonal antibodies to reduce the inflammation and pain associated with chronic migraine episodes.

Erenumab is the most common medication used for migraine prophylaxis, but other medication options are also available.


In one large trial, researchers assigned over 900 study participants with chronic migraine with either 70 milligrams (mg) erenumab, 140 mg erenumab, or a placebo.

Migraine symptoms were analyzed every 4 weeks for a period of 20 weeks to determine the effectiveness of erenumab in reducing migraine frequency.

Results showed that erenumab was able to reduce migraine days by 50 percent or more when compared with placebo.

Side effects

Common side effects of CGRP may include:

  • injection site pain
  • frequent upper respiratory infections
  • gastrointestinal issues
  • fatigue
  • nausea

CGRP generally shows results for migraine prevention within the first 2 months, with effectiveness becoming stronger over time.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are medications that help reduce inflammation and pain by blocking the production of prostaglandins.

NSAIDs are most commonly used for the prevention of menstrual migraine (migraine attacks that occur with menstruation).


According to evidence-based guidelines from the American Academy of Neurology and the American Headache Society, NSAIDs show modest benefits for the prevention of migraine attacks.

Naproxen sodium, flurbiprofen, ketoprofen, and mefenamic acid have all demonstrated benefits in clinical trials.

However, long-term, daily use of NSAIDs is not always recommended for migraine prophylaxis, as it can lead to medication overuse headaches.

Side effects

Common side effects of NSAIDs may include:

  • gastrointestinal symptoms
  • headaches
  • drowsiness
  • dizziness
  • organ damage (rare)

As a preventive option for menstrual migraine attacks, NSAIDs should be taken 2 to 3 days before menstruation and during the first 2 to 3 days.

Triptans, also known as serotonin-receptor agonists, are medications that help relieve inflammation by mimicking the actions of the neurotransmitter serotonin.

Like NSAIDs, triptans are more suitable for short-term applications, such as menstrual migraine prophylaxis.


In a 2008 study, frovatriptan was found to be effective at reducing migraine frequency in study participants.

Another study found that naratriptan was effective at reducing menstrual migraine attacks when taken 2 days before menstruation and 3 days during.

Zolmitriptan was also found to be effective at reducing the frequency of migraine attacks according to 2014 study.

Side effects

Common side effects of triptans may include:

  • headache
  • dizziness
  • nausea
  • fatigue

When used for migraine prophylaxis, triptans can show effectiveness for migraine symptoms and prevention in a matter of hours.

In addition to the medication options discussed above, certain vitamin and herbal supplements may also offer benefits for migraine prevention. These include:


According to the research, butterbur is the most effective herbal supplement for reducing frequency and severity of migraine attacks.

In addition, feverfew, magnesium, and riboflavin have shown effectiveness for migraine prophylaxis in research studies.

Other supplements, such as coQ10, may be effective, but more research is needed.

Side effects

Vitamin supplements don’t commonly cause side effects if they’re taken as directed and if they’re not interacting with another medication you may be taking or a health condition you may have.

That said, you should always talk with a doctor before taking any kind of supplements.

Vitamin supplementPossible side effects
coQ10mild insomnia or digestive upsets
butterburgas, headache, itchy eyes, diarrhea, breathing difficulties, fatigue, upset stomach, drowsiness
feverfewnausea, digestive problems, bloating; people sensitive to ragweed may experience allergic reactions
magnesiumloose stools, stomach upset, nausea (people with kidney issues are at a higher risk of experiencing side effects)
melatonindrowsiness, dizziness, headache and nausea
vitamin B2high doses may cause itchiness, numbness, burning/prickly sensations, orange urine, sensitivity to light
vitamin B12mild diarrhea, itching skin rash, headache, dizziness, nausea vomiting
vitamin Dexcessive amounts (over the daily recommended dose) may lead to hypercalcemia; symptoms include headaches, fatigue, excessive thirst, excessive urination, nausea, vomiting, decreased appetite.

Choosing the right treatment option for migraine prophylaxis is often a matter of trial and error, which can be difficult and frustrating, especially when your quality of life is negatively impacted by chronic migraine.

However, your doctor will work closely with you to help find the medication that will work for you.

Generally, preventive medications are started at a low dose and adjusted up to a higher dose over time. Most medications for migraine prophylaxis can take anywhere from 2 to 3 months to see full results, with the best results after about 6 months.

Ultimately, the goal of migraine prophylaxis is a 50 percent reduction in migraine frequency over a full year.

Migraine prevention often involves more than just preventive medications. Lifestyle changes can also play an important part in preventing recurring migraine.

Here are some best practices for preventing chronic migraine:

  • Keep a diary of known triggers. Creating a headache diary is an important step in being able to identify and avoid your migraine triggers. Consider trying a migraine app for tracking migraine triggers and patterns.
  • Consider complementary therapies. Complementary treatment options for migraine, such as acupuncture or acupressure, may provide additional symptom relief.
  • Practice good sleep hygiene. Poor sleep is one of the most common triggers for migraine, so practicing good sleep hygiene plays a crucial role in migraine prevention.
  • Engage in regular exercise. Research has shown that gentle exercise practices, such as yoga, may help reduce the frequency and severity of chronic migraine.
  • Prioritize relaxation. Stress is another known trigger for people with recurrent migraine attacks, so stress management skills are an important tool for prevention.
  • Treat migraine attacks as soon as possible. Migraine prophylaxis doesn’t mean that you’ll never have another migraine, so it’s important to keep emergency medication on hand for when migraine attacks inevitably develop.

As always, you should work closely with a doctor to create a migraine prevention plan that works for you.

What is the meaning of migraine prophylaxis?

Any treatment or medication that is used in order to prevent migraine episodes from happening is referred to as migraine prophylaxis.

Which drug is used for prophylaxis of migraine?

As noted above, there are quite a few medication options for the prevention of migraine, including:

  • angiotensin blockers
  • anticonvulsants
  • antidepressants
  • beta-blockers
  • Botox
  • calcitonin gene-related peptide (CGRP) therapy
  • nonsteroidal anti-inflammatory drugs (NSAIDs)
  • triptans
  • vitamins and supplements

What is the best prophylaxis for migraine?

The best prophylaxis for migraine is the one that works for you. Different people may have different medication and treatment needs. Over time, you may find that a combination of strategies is the most useful.

Migraine prophylaxis is one of the most important treatment approaches for reducing the frequency of recurrent migraine episodes.

Preventive treatment options for migraine include medications such as antidepressants, anticonvulsants, beta-blockers, and more.

In addition to medication options, lifestyle changes also play an important role in migraine prophylaxis.

If you’ve been dealing with chronic migraine attacks that have significantly decreased your quality of life, talk with a doctor about which preventive treatment options are available to you.