According to the Migraine Research Foundation, migraine headaches affect 39 million adults and children in the United States.
Chronic migraine headaches can be debilitating, and often have a significant impact on quality of life. First-line preventive therapies, or prophylaxis, can help reduce the frequency and severity of these headaches.
In this article, we explore the most common treatment options for migraine prophylaxis, 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.
Effectiveness.
In one study, an ARB 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, an ACE inhibitor called lisinopril showed significant reductions in headache hours, headache days, and migraine days in study participants.
Side effects.
Common side effects of angiotensin blockers may include cough, dizziness, fatigue, lightheadedness, gastrointestinal symptoms, and more.
As migraine prophylaxis, it can take weeks for ACE inhibitors and ARB to show long-term benefits.
Anticonvulsant drugs, also known as antiepileptic drugs AED's, are medications that help treat and prevent epileptic seizures by slowing nerve signals in the brain.
Anticonvulsant drugs may include narrow-spectrum AED's for specific types of seizures, or broad-spectrum AED's for multiple seizures.
Effectiveness.
Divalproex sodium and sodium valproate both showed effectiveness for reducing migraine headache rate 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 AED's may include rash, fatigue, increased energy, gastrointestinal symptoms, paresthesia, weight gain, and hair loss, among others.
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 (SNRI's), as well as other medications.
Effectiveness.
In an early study, an SSRI called fluoxetine was shown to significantly reduce monthly migraine headache hours.
Another study on an SNRI called venlafaxine demonstrated a significant reduction in average headache days for study participants.
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, and more.
As a preventive medication for migraine headaches, 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.
Effectiveness.
Multiple studies have found metoprolol to be effective for reducing migraine frequency by as much as 50 percent.
A 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, and more.
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.
Effectiveness.
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, and neck pain, among others.
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 utilizes monoclonal antibodies to reduce the inflammation and pain associated with chronic migraine headaches.
Erenumab is the most common medication used for migraine prophylaxis, but other medication options are also available.
Effectiveness.
In one large trial, researchers assigned over 900 study participants with chronic migraine with either 70 milligrams erenumab, 140 milligrams 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, and more. CGRP generally shows results for migraine prevention within the first 2 months, with effectiveness becoming stronger over time.
Non-steroidal 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, or migraine attacks that specifically occur with menstruation.
Effectiveness.
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 headaches.
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, and in some cases, organ damage.
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.
Effectiveness.
In a study from 2008, 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 a 2014 study.
Side effects.
Common side effects of triptans may include headache, dizziness, nausea, and fatigue, among other symptoms.
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.
- Butterbur.
- Feverfew.
- Magnesium.
- Melatonin.
- Vitamin B2.
- Vitamin B12.
- Vitamin D.
Effectiveness.
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.
Additional 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 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.
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