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Preventive Medications For Headache

Patients with chronic daily headache, or those having more than three migraines per month that are not well-controlled, may be candidates for preventives.
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Author’s note: this guide presents the author’s opinion and clinical experience. Medications must be individually prescribed and used only in conjunction with treatment by a physician. Side effects, as listed in each medication’s PDR description, must be accepted and understood. Some of the medications and treatments listed do not have an official FDA indication for the condition discussed. This guide is not a prescription and does not represent a standard consensus of treatment.

A preventive is chosen with regard to the type of headache and presenting comorbidities—e.g., anxiety, depression, GI upset, medication sensitivities, etc.—and is individualized toward the patient’s needs. In using such medication, a realistic goal is to decrease the tension headache severity by 70%, not to completely eliminate the headaches. It is wonderful when the headaches are 90% improved, but the idea is to keep the medication and any side effects to a minimum. Trial and error is often used to find the best preventive approach for a person and preventive medications may take weeks to become effective. The doses often need to be adjusted and thus patience is necessary with these medications. The physician needs to be available for phone consultations pertaining to the patient’s headaches and medicine. In the long run, preventive medications are effective for approximately 50% of patients.

What Patients Need to Know Prior to Starting a Preventive

Most patients need to be willing to settle for moderate improvement in their head-aches. Preventives may take three to six weeks to work, and there may be only a 50% improvement. The patient must accept this, and be willing to tolerate the possible side effects. Further, patients must be willing to change medications when necessary. They need to be aware that what is effective for someone else may not work for them. Most preventive medications are utilized in medicine for another purpose. Patients should be informed that amitriptyline (Elavil®), for instance, is also used for depression, usually in much higher doses. Patients using Elavil should be told why and be reassured that it is not because they are depressed.

Side effects are possible with any medication. A patient has to be prepared to endure mild side effects in order to achieve results. We cannot stop one medication and switch to another because of very mild side effects. Most patients are usually willing to put up with mildly annoying side effects. Fatigue, however, is a major reason for patients abandoning a preventive medication. Headache patients commonly complain of fatigue, and tend to give up on medications that increase tiredness.

Natural Supplements and Herbs for Headache

Feverfew, Petadolex® (butterbur), and magnesium oxide have all proven effective in double-blind studies as migraine preventives. Of these, Petadolex has been the most effective. Omega-3 fatty acids may help headaches, and are an excellent supplement for general good health.

Last updated on: March 7, 2011
First published on: October 1, 2010