Preventive Medications for Migraines and Headaches
Working to Stop Migraines and Headaches Before They Start
Before taking new medications to prevent your headaches and/or migraines, tell your doctor if you’re taking other medications or supplements because they may interact with the medications you already take.
Preventive Medications for Cluster Headaches
Chronic cluster headaches are often difficult to treat once they strike: That’s why so much emphasis is placed on preventing them.
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Before recommending a prescription preventive medication for cluster headaches, your doctor may want you to try indomethacin. This powerful over-the-counter non-steroidal anti-inflammatory drug (NSAID) is helpful for preventing cluster headaches in some people. Indocid is an example of indomethacin.
As part of your overall cluster headache prevention plan, your doctor may prescribe a combination of the following medications.
- Calcium channel blockers: These are often the first choice when it comes to preventing cluster headaches, and they’re typically used with other medications. Verapamil (Calan) is an example of a calcium channel blocker used to treat cluster headaches.
Because of its effectiveness and minimal side effects, Verapamil is a mainstay of cluster headache prevention.1 However, it can take a few weeks for this medication to be effective, so you may need to take corticosteroids in between to ease your symptoms.
- Corticosteroids: As part of the steroid family, corticosteroids are used as quick-acting preventive medications to reduce inflammation. They’re primarily used for episodic cluster headaches.
Prednisone (Deltasone) is an example of a corticosteroid. Corticosteroids are a good short-term option, but when used long term, they can have major side effects, such as elevated blood pressure, high blood glucose levels (which can trigger diabetes), and weight gain (especially around the abdomen).
- Lithium carbonate: This medication—often used to treat bipolar disorder—can also be used as an alternative to calcium channel blockers. It’s used for long-term treatment of chronic cluster headaches.
Lithium may be used in combination with a corticosteroid and calcium channel blocker.
An example of lithium carbonate is Lithobid. You’ll need to get regular blood tests while taking this medication to check for serious side effects, such as kidney damage. But don’t worry—your doctor will monitor your dosage carefully.
Preventive Medications for Tension Headaches
Chronic tension headaches commonly happen at work, when you’re driving, or when you’re stressed. Fortunately, some medications—when taken regularly—can significantly decrease your symptoms as well as how often you have a tension headache.
Your doctor may want to start you off taking an over-the-counter NSAID, such as ibuprofen, before recommending a prescription preventive medication for tension headaches.
If over-the-counter NSAIDs as well as stress management and relaxation techniques, such as yoga and breathing exercises, don’t work for you, your doctor may prescribe a preventive medication to treat your tension headaches.
- Anti-seizure medications: You don’t have to have seizures to be prescribed this medication. When taken for chronic tension headaches, anti-seizure medications work to prevent the duration and frequency of these headaches. Topiramate (Topamax) is an example of an anti-seizure medication.
- Anti-depressants: You don’t have to have to be diagnosed with depression for your doctor to prescribe an anti-depressant. These medications work by stabilizing certain chemicals in your brain (eg, serotonin). A lack of serotonin may trigger chronic tension headaches.
Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) are example of anti-depressants that can treat tension headaches. SSRIS have fewer side effects than TCAs but aren’t as effective for preventing tension headaches An example of an SSRI is paroxetine (Paxil), and an example of a TCA nortriptyline (Pamelor).
- Muscle relaxants: These medications can reduce tight, tense muscles in your head and neck. Tizanidine (Zanaflex) is an example of a muscle relaxant used to treat tension headaches.
Preventive Medications for Migraines
If you experience chronic, debilitating migraines, preventive medications can reduce how often you get them as well as the severity of your symptoms.
As with cluster headaches and tension headaches, your doctor may want to try an over-the-counter NSAID to see if that helps to prevent migraine symptoms. If that’s not effective at preventing migraines, your our doctor may prescribe the following preventive medications to treat your migraines.
- Anti-seizure medications: Certain anti-seizure medications can help decrease the frequency of migraines. Topiramate (Topamax), divalproex (Depakote), and gabapentin (Neurontin) are examples of anti-seizure medications used to treat migraines.
- Anti-depressants: The 3 types of anti-depressants—selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs) can help prevent migraines.
SSRIs and SNRIs aren’t as effective at treating migraine-related pain and other symptoms. Amitriptyline (Elavil) and nortriptyline (Aventyl) are examples of TCAs that can effectively prevent migraines.
- Cardiovascular drugs: Beta blockers, medications used to treat high blood pressure and heart disease, can also decrease severity and frequency of migraines. Propranolol (Inderal LA) is an example of a beta blocker used to treat migraines.
Another type of cardiovascular medication—calcium channel blockers—can help prevent migraines and relieve symptoms such as aura. Verapamil (Verelan) is an example of a calcium channel blocker that can help prevent chronic migraines.
- Botox: Botulinum toxin type A—better known as Botox—is FDA approved for treating chronic migraines in adults. Your doctor will inject Botox into your forehead and neck muscles, and you’ll need to get regular Botox injections (usually every 3 months) for this treatment to be effective.
- Hormone therapy: This treatment, which involves taking a hormone such as estrogen (usually in pill form), is sometimes used in women who experience migraines linked to menstruation. Hormone therapy, as well as birth control pills, can help steady hormone levels and prevent future migraine episodes in some women.
Your body may need a few months to become accustomed to preventive medications for migraines and/or headaches. If you still have pain after several weeks, don’t get frustrated. It may take longer for your body to feel the effects of the medication. Also, be aware that certain things, such as too much caffeine, may reduce the effect of some preventive medications.
The preventive medications mentioned above don’t completely eliminate migraines and/or headaches. However, they do significantly help you manage your migraine and/or headache symptoms and the frequency of attacks.