Ask Dr. Armstrong: What are some preventative medications that aim to prevent migraines?

Preventive migraine medications aim to reduce the frequency, severity, and duration of migraines. They’re typically considered for individuals who have frequent migraine attacks, those whose migraines are severe or prolonged, or when acute treatments are contraindicated or ineffective. Here are some of the preventive medications for migraines:

1. Cardiovascular Drugs:

· Beta-blockers: Propranolol and metoprolol tartrate

· Calcium channel blockers: Verapamil (Calan, Verelan) is sometimes helpful in migraine prevention.

· Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers: Medications like lisinopril (Zestril) might help some individuals prevent migraines.

2. Antidepressants:

· Tricyclic antidepressants: Amitriptyline and nortriptyline (Pamelor) can be effective for migraine prevention. They might cause side effects like drowsiness and dry mouth.

· SSRIs and SNRIs: While selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac) and serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine (Effexor XR) might help some people, their overall effectiveness for migraine prevention remains debated.

3. Anti-seizure Drugs:

· Valproate (Depakote) and topiramate (Topamax) have shown efficacy in reducing the frequency of migraines. However, these medications might lead to side effects like dizziness, weight changes, and drowsiness.

4. Botox (OnabotulinumtoxinA): Chronic migraine sufferers (those who have a headache on 15 or more days per month) might benefit from injections of this neurotoxin. The treatment involves multiple injections around the head and neck every 12 weeks.

5. CGRP Monoclonal Antibodies: These are a newer class of preventive medications. They target the calcitonin gene-related peptide (CGRP), which is involved in migraine pain pathways.

· Erenumab (Aimovig)

· Fremanezumab (Ajovy)

· Galcanezumab (Emgality)

· Eptinezumab (Vyepti)

It’s essential to note that preventive medications might take several weeks to start having an effect, and no single medication works for everyone. Side effects can occur, and some medications might interact with other medications or have contraindications based on individual health conditions. It’s always important to discuss any concerns and potential side effects with a physician.