Headaches: Should I Take Medicine to Prevent Migraines?

Migraines are painful, throbbing headaches that last from 4 to 72 hours. They often occur on only one side of your head. But the pain may move from one side of your head to the other, or you may feel it on both sides at the same time. Migraines may be so painful that you aren't able to do your daily activities.

When you have a migraine, you may also feel sick to your stomach and vomit. Activity, light, noise, or certain smells may make your migraine worse.

Some people have an aura before their migraine starts. When you have an aura, you may first see spots, wavy lines, or flashing lights. Your hands, arms, or face may tingle or feel numb. The aura usually starts about 30 minutes before your headache. But most people don't have auras.

Migraines run in families. But it's not clear why some people get them and others don't.

The cause of migraines is not well understood. But experts think that they may have something to do with the blood vessels in your brain, certain foods, alcohol, and stress.

If your migraine symptoms are mild to moderate, doctors recommend that you first try over-the-counter pain medicines to manage your headaches. These medicines are safe and cost less than prescription migraine medicines. They include:

• Acetaminophen (such as Tylenol).
• Aspirin (such as Bayer).
• Ibuprofen (such as Advil).
• Naproxen (such as Aleve).

Some over-the-counter medicines (for example, Excedrin) combine acetaminophen, aspirin, and caffeine. Be safe with medicines. Read and follow all instructions on the label.

If these medicines don't help, your doctor may prescribe a medicine that can quickly stop a migraine after it has started. A group of drugs called triptans is most often tried first. But these can cause serious side effects, especially for people who have heart disease and high blood pressure.

If over-the-counter pain medicines or triptans don't work, and if you get bad migraines often, you may want to take a daily medicine to help prevent them.

There are several types of medicines that help prevent migraines. These medicines were first approved to treat other medical problems such as seizures, depression, high blood pressure, and heart disease. But they also help to prevent migraines.

Medicines used to prevent migraines include:

• Anticonvulsants (antiseizure medicines), including valproate (such as Depakene)
• Antidepressants, including amitriptyline
• Beta-blockers, including propranolol (such as Inderal)
• Calcium channel blockers, including verapamil (such as Calan)
• Botulinum toxin, such as Botox.

Medicines to prevent migraines may not stop every migraine. But studies have shown that:^{footnote 1}

• The antiseizure medicines topiramate and valproate can reduce the number of migraines you get each month by more than half. This happened in about 50 out of 100 people who took one of these medicines. Beta-blockers such as propranolol have also been shown to help prevent migraines.
• Some antidepressants, such as amitriptyline, can help prevent migraines in some people.

Even though calcium channel blockers may be used to prevent migraines, the evidence for how well they work is not as strong as it is for these other medicines.^{footnote 1}

In studies, Botox shots worked to reduce the number of migraines people had only if they were having more than 15 migraines a month before treatment. These people had about 2 fewer migraines a month after treatment with Botox.^{footnote 2}

For most of these medicines, you'll need to take pills every day-even when you don't have a headache. Botox for chronic migraines involves getting up to 31 injections in the face and neck every year. This can be expensive.

It could take up to 2 to 3 months for the medicine to work. If you don't see any improvement after several weeks, talk to your doctor. You may need to try several different medicines to find one that works for you.

Medicine that you take daily may not prevent all migraines, so there may be times when you need to take another medicine to stop a migraine after it has started.

Medicines to prevent migraines may cause side effects. Some of these side effects may last for as long as you take the medicine. Or they may go away within a few weeks. You may need to decide which bothers you more-the side effects of the medicine or your migraines.

Common side effects include:

• Sleep and memory problems.
• An upset stomach.
• Dry mouth.
• Constipation.
• Weight gain or loss.
• Fatigue.
• Dizziness.
• A fast heart rate.
• A drooping eyelid (Botox).
• Bruising on the face (Botox).

Serious side effects can also happen. Anticonvulsants can cause birth defects when they are taken during pregnancy. Botox can cause severe weakness in the muscles of the face or head. In very rare cases, the botulinum toxin can spread and cause weakness in the muscles that control breathing or swallowing.

What else can you do to prevent migraines?

There are other things you can try to prevent migraines. These work for some people:

• Acupuncture. This involves putting very thin needles into the skin at certain points on the body. Research shows that acupuncture can help prevent some headaches.^{footnote 3}
• Biofeedback. This is a way to control a body function-such as muscle tension-that you don't normally control.
• Feverfew. This is an herb that-some small studies show-may help prevent migraines in some people.^{footnote 4}
• Magnesium. Studies have found that some people with migraines have low levels of magnesium in the brain. Taking magnesium may help prevent migraines.^{footnote 4}
• Menthol. There is some evidence that a menthol solution rubbed on the forehead can stop or reduce migraine headache pain.^{footnote 5}
• Riboflavin (vitamin B2). This vitamin may help prevent migraines.^{footnote 4}
• Coenzyme Q10. A small study showed that this supplement worked to reduce the number of migraines some people had.^{footnote 4}

Here are some things you can do at home:

• Identify and avoid triggers, such as certain foods, alcohol, and smoking. It may help to keep a headache diary to track how often you have migraines, how painful they are, and what you think might be causing them.
• Practice relaxation and breathing exercises, such as meditation, guided imagery, tai chi, or qi gong, to help reduce stress and relax your mind and muscles.
• Exercise regularly, eat healthy foods, and get enough sleep.

Why might your doctor recommend medicine to prevent your migraines?

Your doctor may advise you to take medicine every day to prevent migraines if:

• You get bad migraines often.
• Your migraines are so painful that you're not able to do your daily activities.
• You use medicine more than twice a week to stop a migraine after it has started.
• You have tried medicines to stop a migraine, but they don't help.