Migraine Preventives: Where to Start?

Whether you’ve never taken a migraine preventive or have tried many, choosing which one to try next can be daunting. A great place to start is with recommendations the American Academy of Neurology and the American Headache Society.

Recommendations include both prescription medications and supplements and were based on an extensive review of studies published between 1999 and 2009. Researchers and headache specialists assessed the strength of study findings for each drug and came up with the following list.

Some things to keep in mind when you review the list:

Recommendations are categorized as level A (established as effective), B (probably effective) or C (possibly effective). Many health care providers will start with level A treatments and work down the list.
Generic drug names are listed first with brand names frequently used in the U.S. in parentheses.
This project focused on episodic migraine prevention. Many of the drugs and supplements are used for chronic migraine as well, but study participants had episodic migraine. A list of preventives that have been studied and shown to be effective for chronic migraine follows the main list.

Chronic Migraine Prevention

Drugs that have been researched for chronic migraine and shown to be effective3 include:
Anticonvulsants: topiramate (Topamax), gabapentin (Neurontin)
Antidepressants: amitriptyline (Elavil), fluoxetine (Prozac)
Muscle relaxant: tizanidine (Zanaflex)
Botox

(All the drugs on the main list are also potentially effective for chronic migraine, but they haven’t been studied for it specifically, Migraine Tablet Tegretol 100 mg)

What if someone has tried all of these (or can’t take a certain type of drug for another health reason)?

Don’t despair! There are more than 100 drugs in use for migraine prevention. You are likely a tougher case than the average migraine patient, so seeing a qualified headache specialist is the best way to find the right treatment(s) for you. Also, it’s worth looking into one of the many non-drug therapies that have a good track record for migraine prevention.

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