Oh, My Aching Head: How to Prevent Migraines

Oh those miserable migraines. Wouldn’t it be great if we could help the 17% of women and 6% of men who suffer from migraines? This year, The American Academy of Neurology published updated guidelines in the use of medications that will prevent migraines (prophylaxis.) There are some promising new options and yes, there is light at the end of the tunnel.

For patients with more than four migraines a month OR migraines that last longer than 12 hours, taking a prevention medication will reduce your disabling headaches.

Here is your best plan for prevention of migraine headaches.
-The antiepileptic drugs Depakote (divalproex) and Topamax (topiramate) have been evaluated in multiple studies and show the best effectiveness for prevention of migraine headaches.

- Long-term use of Depakote has been associated with weight gain; while as many as 15% of patients treated with Topamax have weight loss. Topamax is a frontrunner for this reason.

- Beta-blockers including metoprolol, propranolol, timolol, atenolol, and nadolol also have been found effective for migraine headache prevention.

- The antidepressant medications amitriptyline and Effexor (venlafaxine) have been shown to be as effective as Topamax for migraine prevention but the side effect profile isn’t as great.

- Frova (Frovatriptan) used around your menstrual cycle to prevent menstrual-associated migraines has been shown to be effective.

- Butterbur extract has strong evidence for prevention of migraine while other “natural” options have less evidence including riboflavin (Vitamin B2) and magnesium. Butterbur 50-75 mg twice a day is a no brainer, so give it a try.

What path has not been shown to be helpful for the prevention of migraines?
- Despite studies, the following medications have not been shown to be effective for prevention: Lamictal (lamotrigine), clomipramine, acebutolol, clonazepam, Relafen (nabumetone), Trileptal (oxcarbazepine), Singulair (Montelukast), and Micardis (Telmisartan.)

- Prozac (fluoxetine) and calcium-channel blockers have not been found to be effective either.

The goal for whatever path you take is to find the medication with a favorable side effect profile that helps you reduce the number and severity of your migraines.

Keep calm and fight migraines.


Check out our Headache and Migraine Center for more information.

How do you fight migraines? Let us know in the comments box below.


File under: Expert Spotlight


Dr. Sharon Orrange

Dr. Orrange received her BA in Biology at the University of California, San Diego, and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health. She received her MD from the USC/Keck School of Medicine and completed residency in Internal Medicine at the University of California, San Diego. Currently, Dr. Orrange is an Assistant Professor of Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine in the Department of Medicine at the USC/Keck School of Medicine. Dr. Orrange spends part of her time as the Attending Physician for medical students and residents during their medicine rotations at LA County-USC Medical Center and USC University Hospital. She also has an active private practice in General Internal Medicine and is board certified in Internal Medicine.

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