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Preventive migraine drugs are used to reduce the frequency, duration, and intensity of migraine attacks, but they aren’t right for everyone. Studies suggest that less than 50 percent of people who could benefit from them actually take them.If you think you may be in this group, talk to your healthcare provider about exploring these FDA-approved medications. You may discover that when taken as directed, the right one for you may significantly prevent your migraines and generally improve your quality of life.
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Drugs Approved for Episodic Migraine Prevention
Beta-Blockers
These are drugs that originally were developed to treathypertension(high blood pressure), since they block adrenaline receptors, causing the vessels to relax. Researchers still do not fully understand how beta-blockers work for migraine prevention.
Anticonvulsants
Researchers aren’t certain how this process works to prevent migraine headaches, but it does so safely and effectively for most patients. The specific anti-seizure drugs that have FDA approval for migraine prophylaxis are:
As with the FDA-approved beta-blockers, these two anticonvulsants are listed as Level A medications for preventing migraines.
In order to reduce the risk of side effects, most healthcare providers will initially prescribe a low dose of an anticonvulsant drug—typically 25 mg per day—and gradually increase it until an effective dose is reached.
Calcitonin Gene-Related Peptide (CGRP) Inhibitors
These relatively new medications differ from beta-blockers and anticonvulsants in a significant way: They were developed solely for preventing chronic and episodic migraine headaches (with or withoutaura).
Six CGRP inhibitors have gained FDA approval for migraine prophylaxis:
Most of these medications, except for Vyepti and Nurtec ODT, are administered as a shot with a thin needle just beneath the skin (subcutaneous injection) of the thigh or abdomen. With instruction, most people are able to learn to give themselves the shots.
Vyepti is given intravenously (IV), while Nurtec ODT and Qulipta are taken in pill form. Nurtec ODT is also approved to treat a migraine after it starts, making it the only medication available to both treat and prevent migraines.
Notably, all these mentioned CGRP medications were developed after the AHS/AAN guidelines were published, and so they do not have an effectiveness rating.
CGRP Inhibitors for Migraine Treatment
Drugs Approved for Preventing Chronic Migraines
In addition to being approved for preventing episodic migraine headaches, each of the CGRP inhibitors is also approved for preventingchronic(or transformed) migraine—when at least 15 migraine attacks occur per month for at least three months.
Botox (also called Onabotulinum-A) is a diluted form of a bacterial toxin that paralyzes muscles. Originally injected into the face to relax muscles and temporarily smooth out wrinkles, Botox was found to reduce the frequency of migraine headaches in people prone to them who used the drug for cosmetic purposes.
This prompted researchers to study Botox injections as a preventive treatment for migraines. It was found to be effective only for chronic migraines, a use that the FDA ultimately approved.
Typical Botox ProtocolAccording to the American Migraine Foundation, botox treatment for migraine prevention usually involves 31 separate injections into seven key muscles of the face and neck every 12 weeks. It can take up to six months to get the full therapeutic effects.
Typical Botox Protocol
According to the American Migraine Foundation, botox treatment for migraine prevention usually involves 31 separate injections into seven key muscles of the face and neck every 12 weeks. It can take up to six months to get the full therapeutic effects.
The Benefits of Choosing an FDA-Approved Drug
Using a drug off-label may be effective and perfectly safe for you. But given that the FDA cannot verify that its pros outweigh its cons for the purpose for which you’re using it, there is more reason to use caution.
A Word From Verywell
Prophylaxis is a vital part of migraine management. The FDA-approved medications aren’t the only drugs that may be prescribed to prevent headaches or to at least reduce the number of headaches that occur per month, but they are the ones that have been studied the most and found to be effective. If you aren’t able to tolerate any of them or if none work for you, there are plenty of other options to discuss with your healthcare provider.
6 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Ha H, Gonzalez A.Migraine headache prophylaxis.Am Fam Physician. 2019;99(1):17-24.American Migraine Foundation.Prevention of migraine.Loder E, Burch R, Rizzoli P.The 2012 AHS/AAN guidelines for prevention of episodic migraine: A summary and comparison with other recent clinical practice guidelines.Headache.2012;52(6):930-945. doi:10.1111/j.1526-4610.2012.02185.xShahien R, Beiruti K.Preventive agents for migraine: Focus on the antiepileptic drugs.J Cent Nerv Syst Dis. 2012;4:37-49. doi:10.4137%2FJCNSD.S9049American Migraine Foundation.Botox for migraine.U.S. Food & Drug Administration.Consumer updates: Is it really FDA approved?Additional ReadingMarmura MJ, Kumpinsky AS.Refining the benefit/risk profile of anti-epileptic drugs in headache disorders.CNS Drugs. 2018;32(8):735-746. doi:10.1007/s40263-018-0555-zRapoport, AM.How to choose a preventive medication for migraine. Information for Health Care Professionals. The American Headache Society.
6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Ha H, Gonzalez A.Migraine headache prophylaxis.Am Fam Physician. 2019;99(1):17-24.American Migraine Foundation.Prevention of migraine.Loder E, Burch R, Rizzoli P.The 2012 AHS/AAN guidelines for prevention of episodic migraine: A summary and comparison with other recent clinical practice guidelines.Headache.2012;52(6):930-945. doi:10.1111/j.1526-4610.2012.02185.xShahien R, Beiruti K.Preventive agents for migraine: Focus on the antiepileptic drugs.J Cent Nerv Syst Dis. 2012;4:37-49. doi:10.4137%2FJCNSD.S9049American Migraine Foundation.Botox for migraine.U.S. Food & Drug Administration.Consumer updates: Is it really FDA approved?Additional ReadingMarmura MJ, Kumpinsky AS.Refining the benefit/risk profile of anti-epileptic drugs in headache disorders.CNS Drugs. 2018;32(8):735-746. doi:10.1007/s40263-018-0555-zRapoport, AM.How to choose a preventive medication for migraine. Information for Health Care Professionals. The American Headache Society.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Ha H, Gonzalez A.Migraine headache prophylaxis.Am Fam Physician. 2019;99(1):17-24.American Migraine Foundation.Prevention of migraine.Loder E, Burch R, Rizzoli P.The 2012 AHS/AAN guidelines for prevention of episodic migraine: A summary and comparison with other recent clinical practice guidelines.Headache.2012;52(6):930-945. doi:10.1111/j.1526-4610.2012.02185.xShahien R, Beiruti K.Preventive agents for migraine: Focus on the antiepileptic drugs.J Cent Nerv Syst Dis. 2012;4:37-49. doi:10.4137%2FJCNSD.S9049American Migraine Foundation.Botox for migraine.U.S. Food & Drug Administration.Consumer updates: Is it really FDA approved?
Ha H, Gonzalez A.Migraine headache prophylaxis.Am Fam Physician. 2019;99(1):17-24.
American Migraine Foundation.Prevention of migraine.
Loder E, Burch R, Rizzoli P.The 2012 AHS/AAN guidelines for prevention of episodic migraine: A summary and comparison with other recent clinical practice guidelines.Headache.2012;52(6):930-945. doi:10.1111/j.1526-4610.2012.02185.x
Shahien R, Beiruti K.Preventive agents for migraine: Focus on the antiepileptic drugs.J Cent Nerv Syst Dis. 2012;4:37-49. doi:10.4137%2FJCNSD.S9049
American Migraine Foundation.Botox for migraine.
U.S. Food & Drug Administration.Consumer updates: Is it really FDA approved?
Marmura MJ, Kumpinsky AS.Refining the benefit/risk profile of anti-epileptic drugs in headache disorders.CNS Drugs. 2018;32(8):735-746. doi:10.1007/s40263-018-0555-zRapoport, AM.How to choose a preventive medication for migraine. Information for Health Care Professionals. The American Headache Society.
Marmura MJ, Kumpinsky AS.Refining the benefit/risk profile of anti-epileptic drugs in headache disorders.CNS Drugs. 2018;32(8):735-746. doi:10.1007/s40263-018-0555-z
Rapoport, AM.How to choose a preventive medication for migraine. Information for Health Care Professionals. The American Headache Society.
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