Finding the Right Migraine Treatment

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What to Expect When Trying Migraine Prevention Treatment

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Migraine headaches can be incredibly painful, as well as debilitating. If you have chronic migraine, or if your migraine attacks don’t respond well to acute treatments, your doctor may want to put you on a preventive medication. The goal of preventive treatment for migraines is to reduce the frequency, duration, and severity of your migraines, but ultimately, it’s about improving your quality of life. While it may not completely eradicate your chronic migraine attacks, preventive treatment can definitely help.

Expect potential side effects.

Until recently, most people who suffered from migraine attacks would get a prescription for a medication that was originally intended to address other medical conditions. One that’s commonly prescribed is topiramate (Topamax), which is an antiepileptic or anticonvulsant medication. The list also included meds such as:

  • Other anticonvulsants
  • Beta blockers, which are a type of blood pressure medication
  • Calcium channel blockers, which are also blood pressure meds
  • Antidepressants
  • Serotonin antagonists
  • Magnesium

These drugs can be very useful in helping prevent migraine attacks, and some people do just fine with them. Unfortunately, they often come with side effects. For example, many people who take topiramate complain of experiencing a tingling or prickling sensation in their extremities, while others feel tired or nauseated or develop concentration problems. Other examples of side effects: some people who take antidepressants might find themselves gaining weight, while people who take beta blockers might experience some fatigue, dizziness, insomnia, and nausea. Even magnesium salts can sometimes cause people to have diarrhea.

So, your doctor might suggest a newer drug, one that’s been specifically approved for migraine prevention. In 2018, the U.S. Food and Drug Administration (FDA) approved several new medications designed expressly for the prevention of migraines, including erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality). These drugs all belong to a category of medications called CGRP antagonists. They interfere with the action of a protein called calcitonin gene-related peptide, or CGRP, that tends to lead to the development of migraines. They’re injectable medications, either once a month or once every three months.Another CGRP inhibitor, eptinezumab (Vyepti), is also an option. Unlike the others, it’s administered intravenously.

One of the biggest benefits of these migraine prevention injections (and intravenous treatment) is that they work well with fewer side effects. But “fewer” doesn’t necessarily mean “none.” Gastrointestinal disorders, like constipation, seem to be the most common side effect. Research also suggests people who are also taking other medications that affect their GI tract may be more likely to experience this particular side effect. Also, since these medicines are relatively new, we are still learning about the long-term effects of using them.

But you may decide the effectiveness outweighs any minor side effects. Just be aware that they are possible. You can always talk to your doctor about them if you’re concerned.

If injections don’t bother you, and your doctor has confirmed that you have chronic migraine–that is, migraine headaches for at least 15 days out of the month–you might be a candidate for botulinum toxin (Botox) injections. This neurotoxin temporarily paralyzes your muscles and reduces contractions, and can actually prevent migraines from occurring in some people. Like with other preventive treatments, there is a possibility of side effects. With botulinum toxin injections, the most common complaint is muscle weakness or a temporarily droopy eyelid.

Expect some trial and error.

As with many medications, the dosage amount of your preventive medication might need to be adjusted from time to time. Or, eventually, you may want to switch medications because you don’t like or can’t tolerate the side effects, or you may want a drug that might be more effective at preventing severe migraine attacks. You don’t have to stick with a medication that’s not working well for you. Talk to your doctor so you can discuss the best options available to you. But keep in mind, it can take time for a new treatment to start working. Ask your doctor about the timeline ahead of you so you know when you might realistically experience relief.

Expect to feel a lot better.

Ultimately, the goal of migraine prevention treatment is to reduce the impact that migraine headaches have on your life. With some trial and error, you may realize you’re feeling a lot better than you did before you started prevention therapy. You may not need to take pain-relieving medication nearly as often as you once did. You may find yourself with fewer headache days, or less intense migraine attacks. If you don’t experience any improvement, though, connect with your doctor to discuss making a change.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Feb 26
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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