The goal of preventative therapy is to reduce the frequency and severity of migraine attacks.
Preventative therapy may be right for you, if you are:
- ➜ Taking acute medications (e.g., ADVIL®, triptans] often (at least 10 days per month)
- ➜ Still having migraine attacks that significantly impact your life
There are prescription medications that may help reduce the number of migraines:
OnabotulinumtoxinA (BOTOX®)
- Physician Administered Injection
- Dosing: Every 3 months (12 weeks)
- Possible side effects: Headache, facial muscle weakness, drooping of the eyelids, muscle spasm, muscle tightness, injection pain, rash*
Topiramate (TOPAMAX®)
- Oral Medication
- Dosing: Daily
- Possible side effects: Co-ordination problems, difficulty concentrating, slow thinking, confusion and forgetfulness, dizziness, tiredness, tingling, headache, upper respiratory tract infection (e.g., colds, bronchitis), drowsiness*
Erenumab (AIMOVIG®)
- Patient Administered Injection
- Dosing: Once per month
- Possible side effects: Injection site reactions including pain and redness, constipation, muscle spasm, itching.*
Galcanezumab (EMGALITY™)
- Patient Administered Injection
- Dosing: Initial 2 consecutive injections as loading dose followed by once per month
- Possible side effects: Injection site reactions including pain, redness, bruising and injection site swelling, constipation, vertigo, hives.*
Fremanezumab (AJOVY™)
- Patient Administered Injection
- Dosing: Once per month or once every 3 months (quarterly)
- Possible side effects: Injection site reactions including pain, redness, itchiness and injection site tenderness, rash, hives, weight gain, depression.*
Propranolol
- Oral Medication
- Dosing: Daily
- Possible side effects: Congestive heart failure, slow heart beat, bronchospasm (spasms of the bronchiole tubes in the lungs), anorexia (weight loss), nausea and vomiting, diarrhea, abdominal pain, fatigue, cold extremities, dizziness or lightheadedness*
Metoprolol
- Oral Medication
- Dosing: Daily
- Possible side effects: Tiredness, dizziness, diarrhea, constipation, breathing problems such as shortness of breath, cough, and wheezing, bradycardia (heart rate that slower than normal), reduced interest in sex, rash.*
Nadolol
- Oral Medication
- Dosing: Daily
- Possible side effects: Blurred vision or other vision problems, fainting, severe dizziness or lightheadedness, fever, chills, sore throat, shortness of breath, chest pain or discomfort, slow or irregular heartbeat, sudden, unexplained weight gain.*
Atenolol
- Oral Medication
- Dosing: Daily
- Possible side effects: Tiredness, low blood pressure (hypotension), slow heart rate, cold extremities, dizziness upon standing, depression, nausea, dreaming.*
Gabapentin
- Oral Medication
- Dosing: Daily
- Possible side effects: Impaired coordination, dizziness, drowsiness, fatigue, fever, involuntary eye movement disorder, sedated state, and viral infection, blurred vision, double vision, swelling, tremor, lazy eye, irritability, and dry mouth.*
Candasartan
- Oral Medication
- Dosing: Daily
- Possible side effects: headache, back pain, rash, dizziness, cold symptoms such as stuffy nose sneezing or sore throat, low blood pressure (hypotension)*
Amitriptyline
- Oral Medication
- Dosing: Daily
- Possible side effects: Constipation, dizziness, dry mouth, feeling sleepy, difficulty urinating, fast or irregular heartbeats.
Venlafaxine
- Oral Medication
- Dosing: Daily
- Possible side effects: Nausea, vomiting, diarrhea, changes in appetite or weight, dry mouth, yawning, dizziness, headache, anxiety, feeling nervous fast heartbeats, tremors or shaking, sleep problems (insomnia), strange dreams, tired feeling, vision changes, increased sweating.*
* This is not an exhaustive list. Please consult your doctor to find out if the product is right for you.
There is some evidence that certain vitamins, minerals and herbal supplements can help prevent migraines. These include:
Alternative Treatments
Magnesium citrate
- Oral Medication
- Dosing: Daily
- Possible side effects: Abdominal cramping. diarrhea. electrolyte imbalance. high levels of magnesium in the blood (hypermagnesemia), gas (flatulence), nausea., vomiting.*
Riboflavin
- Oral Medication
- Dosing: Daily for at least 3 months
- Possible side effects: May cause urine to have a more yellow colour than normal, especially if large doses are taken. This is to be expected and is no cause for alarm.*
Coenzymes Q10 (e.g. TROPHIC™ Coenzyme Q10, 80mg; CoQ10, Co-Q10; Clear-Q; BPT™ Ubidecarenone Capsules USP 100mg)
- Oral Medication
- Dosing: Daily
- Possible side effects: Stomach upset, vomiting, nausea, diarrhea, appetite suppression, allergic reactions; consult your doctor if migraine frequency increases, and associated nausea and vomiting persist or worsen*
* This is not an exhaustive list. Please consult your doctor to find out if the product is right for you.
Tablets and natural treatments are often recommended as the first step in migraine prevention. Ask your doctor which treatments may be right for you.
The goal of acute therapy is to relieve you of pain (ideally, within 2 hours) so you can get back to your daily activities. This type of therapy treats individual migraine attacks as they are occurring.
Acute treatment options for migraines or headaches include:
Acute migraine treatment
Analgesics-Mild to Moderate migraine
Ibuprofen (e.g., ADVIL® Liqui-Gels)
- Possible side effects: Abdominal pain, heartburn, nausea or vomiting, bloating, diarrhea or constipation, ringing or buzzing in the ears, nervousness, sleeplessness, dizziness or a change in vision, itching, fluid retention, skin rashes, skin reddening, blisters, blood in vomit, bloody or black stools*
ASPIRIN® Extra Strength
- Possible side effects: Nausea, vomiting; stomach irritation or pain; bruising; gastrointestinal bleeding; allergic reaction; loss of hearing, ringing or buzzing in the ears, or bleeding*
Acetaminophen (e.g., TYLENOL®)
- Possible side effects: Allergic reaction (wheezing, rash, or itching). Taking more than the maximum daily dose may cause severe or possibly fatal liver damage*
Analgesic + Caffeine (e.g., TYLENOL® Ultra)
- Possible side effects: Allergic reaction (wheezing, rash, or itching), rapid heart rate, nervousness, and sleeplessness. Taking more than the maximum daily dose may cause severe or possibly fatal liver damage*
Diclofenac (VOLTAREN RAPIDE®, CAMBIA®)
- Possible side effects: indigestion, gas, nausea, vomiting, stomach pain, diarrhea, constipation, headache, dizziness, drowsiness; itching, sweating; stuffy nose, increased blood pressure, or swelling or pain in your arms or legs.
Triptans (Serotonin Receptor Agonists-Moderate to Severe migraine)
Sumatriptan (IMITREX®)
- Possible side effects: Pain, pressure or tightness in any part of the body (including chest and throat); sensations of heaviness; unusual sensations including numbness, tingling; heat/burning or cold; flushing (redness of the face lasting for a short time); nausea or vomiting; dizziness; drowsiness; tiredness; weakness; irregular or rapid heart beat*
Zolmitriptan (ZOMIG®)
- Possible side effects: Sensations of pain, pressure, or tightness in the chest, neck, throat, jaws, arms or leg; sensation of tingling, heat, heaviness, or pressure; nausea or vomiting; dizziness; drowsiness; tiredness; muscle weakness; muscle aches and pains; difficulty swallowing; dry mouth; headache; stomach pain; discomfort inside the nose (nasal spray); nose-bleed (nasal spray); irregular or rapid heart beat*
Rizatriptan (MAXALT®)
- Possible side effects: Dry mouth; sensations of pain, pressure or tightness in the chest, neck, throat, jaw, arms or legs; sensations of tingling, heat, heaviness or pressure; headache; dizziness; tiredness; muscle pain; nausea or vomiting; drowsiness; irregular or rapid heart beats*
Almotriptan (AXERT®)
- Possible side effects: Nausea, sleepiness, dizziness, tingling sensation, headache, dry mouth, shortness of breath, wheeziness, heart throbbing, increased blood pressure, fast heart rate or irregular heart beat*
Eletriptan (RELPAX®)
- Possible side effects: Sensations of pain, pressure or tightness in the chest, neck, throat, jaw or arms; shortness of breath, wheezing, heart throbbing; swelling of face, lips, eyelids; skin rash, skin lumps, or hives; feeling weak, dizziness, feeling sleepy or drowsy, tingling, difficulty swallowing, nausea and stomach pain/cramps*
Frovatriptan (FROVA®)
- Potential side effects: Sensations of pain or pressure in the chest, throat, neck, or jaw; dizziness; tiredness; headache (other than a migraine headache); feeling of tingling; numbness; feeling hot or cold; allergic reaction*
Naratriptan (AMERGE®)
- Potential side effects: Sensations of heaviness, pressure, tightness or pain in the chest, throat, neck, jaw and/or upper limb; dizziness; drowsiness; ear, nose, and throat infections; nausea and vomiting; headache; dry mouth; sensation of numbness, tingling, feeling hot, pain in any part of the body including chest, neck, jaw and throat; feeling of tingling; feeling of warmth or flushing; general sick feeling and tiredness*
If acute treatment medications and lifestyle changes are not enough, migraine preventative therapy may be an option.
To get the most from your treatment, it is important to take your medication(s) as prescribed and as soon as you experience symptoms.
Taking your medication more often than recommended can lead to complications, including an increase in your number of headaches.
* This is not an exhaustive list. Please consult your doctor to find out if the product is right for you.
Can too much acute treatment be a bad thing?
Yes, taking acute headache medications – including over-the-counter painkillers and prescription medications, such as diclofenac and triptans – too often can result in more frequent headaches. This is called medication overuse headache.
How can using too much medication cause headaches?
To control migraine pain, people may turn to pain medications for relief. Over time, it’s believed that their bodies get used to this medication, and the brain “resets” its pain control system.
The result? Medications aren’t as effective, and the body “reacts” with another headache. Over time, medications become less and less effective and work for shorter periods of time.
What does a medication overuse headache feel like?
Medication overuse headaches tend to feel like a tight, band-like pressure around the head. The pain is not as severe as a migraine, but can be constant. Many report waking up with a headache and feeling it all day, and sometimes every day. Certain migraine treatments, including ones used to prevent migraine, do not work as well for people with these types of headaches.
Can I do anything to prevent them?
Yes. To help prevent medication overuse headaches, it is recommended that you limit taking acute treatments to no more than 9 days/month.
There are options other than medications that may help reduce how often you have migraines, including:
- Relaxation (e.g., meditation, deep breathing)
- Bio-feedback
- Cognitive Behavioural Therapy
If you're living with Chronic Migraine and think you could be doing better, talk to your doctor about finding the treatment that's right for you.
For tips and tools designed to help you start the conversation with your doctor, visit the Talking to Your Doctor section.