Treatments to prevent migraines

In this section
Drug treatments to prevent migraines
Non-drug treatments to prevent migraines

If you have two or more migraines each month, or if your attacks are very bad, you may want to ask your doctor about medicine to prevent attacks.¹

We haven't looked at these treatments in as much detail as the other treatments on our site. But we wanted to include some information about them.

Drug treatments to prevent migraines

Drugs used to prevent migraines include beta-blockers, a type of antihistamine, anti-epilepsy drugs, some individual antidepressants, and after severe migraines, a steroid called dexamethasone.

Beta-blockers are often the first choice. These drugs slow your heart beat and are mainly used to treat high blood pressure. But they also help some people with migraine. Beta blockers used to prevent migraine include propanolol (brand name Inderal), metoprolol (Lopresor), nadolol (Corgard), and timolol (Betim). A study of propanolol showed it cut the number of migraines and reduced people's pain.²

But some people get side effects from beta-blockers. These include stomach upsets, low blood pressure, cold hands and feet, and headache. You shouldn't take beta-blockers if you have asthma, because they can bring on an asthma attack.¹

The antihistamine drug pizotifen (Sanomigran) is also used to prevent migraines. But it can cause drowsiness, and some people find they put on weight while taking it. If it makes you drowsy, your doctor may suggest you take it at night before bed.¹

Anti-epilepsy drugs, including sodium valproate (Epilim), topiramate (Topamax), and gabapentin (Neurontin) may help reduce migraine attacks. You'll usually take a lower dose than you would if you had epilepsy.

Anti-epilepsy drugs can all cause side effects in some people. Side effects of sodium valproate include nausea, stomach upset, putting on weight, and temporary hair loss. Side effects of topiramate include nausea, stomach pain, upset stomach, a dry mouth, loss of appetite, tiredness, pins and needles, and headaches. Side effects of gabapentin include stomach upset, dry mouth, nausea, dizziness, and drowsiness.¹

Some people take an antidepressant called amitriptyline. This is a type of antidepressant called a tricyclic antidepressant. These drugs work well for some types of nerve pain. Side effects are common. They include dry mouth, drowsiness and blurred vision, stomach upsets, and nausea.¹

There is also some evidence that a treatment called venlafaxine works to prevent migraine, and it is recomended as an alternative to amitriptyline.³

Dexamethasone

Dexamethasone is a steroid medicine that can be given as a tablet, by injection, or through a drip. It works by dampening down inflammation. Inflammation is thought to be one reason why migraines happen, and why severe migraines may last several days.

This treatment is not commonly used. But there is some evidence that it works in people whose migraines are so bad that they have to go to hospital.

In one big summary of the evidence (a systematic review), treatment with dexamethasone as well as standard therapy reduced the number of headaches in the first few days after a severe migraine.⁴

A second big summary of studies found similar effects. In the next 72 hours after attending an accident and emergency unit with a severe migraine, those given an injection of dexamethasone as well as standard treatment had fewer headaches.⁵

Non-drug treatments to prevent migraines

Acupuncture

Acupuncture is a complementary treatment used to relieve many painful conditions.

Traditional Chinese acupuncture is based on the theory that energy travels around your body along pathways called meridians. According to this theory, this energy flow can become blocked, and when this happens, you feel pain.

Acupuncturists insert thin, sterile needles through the skin at points where the energy (known as 'chi') is thought to be blocked. These needles are then used (either manually or electrically) to 'unblock' the chi and 'restore balance' in the body. In other forms of acupuncture, needles may be put in at other points. In some forms of ‘sham’ acupuncture needles do not puncture the skin surface.

Nobody really knows why acupuncture might work. Researchers who do not accept the traditional explanation suggest that it may work because it promotes the production of the body's own painkillers, endorphins.⁶ Or that it may, at least in part, be a strong placebo effect.⁷

We have found a summary of research that says acupuncture is slightly better at preventing migraines than standard care or using medicines such as beta blockers.⁸ This summary (a systematic review) looked at 22 individual studies on a total of 4,419 people, and so is regarded as more reliable than findings from individual studies.

It found that those who had acupuncture were more likely to respond to treatment, and to have fewer headaches in the three to four months after treatment than those on standard care or treatment aimed at prevention.

But the review found no differences between ‘true’ acupuncture, in which people have needles put in at precise points to a precise depth, and sham acupuncture in which needles may be put in at other points, to other depths, and may not puncture the skin at all.

Other ways of preventing migraine are being tested all the time. These include:

• Botulinum toxin (Botox) injections. A summary of findings from eight studies suggests that Botox does not prevent migraines.⁹
• An operation to correct a small, very common heart defect. This defect is called PFO closure. 'PFO' stands for patent foramen ovale. PFO seems to be more common in people with migraine.
• An injection to block the nerves involved in migraine pain. This is called an occipital nerve block.

We don't know whether these new ways of preventing migraine help. We need to see more research.