Table of ContentsView AllTable of ContentsCGRP AntagonistsBeta-BlockersAnticonvulsantsAntidepressants
Table of ContentsView All
View All
Table of Contents
CGRP Antagonists
Beta-Blockers
Anticonvulsants
Antidepressants
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Currently, only one class of drugs that was developed for the sole purpose of preventing migraine headaches is available. All others, so-called oral migraine prevention medications (OMPMs), primarily are used to treat other conditions but have been found useful as migraine prophylactics.
Finding what’s most effective for your migraines can take time, and it’s important to discuss all the options with your healthcare provider.
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Calcitonin Gene-Related Peptide (CGRP) Antagonists
Biologics and What They’re Used For
The Food and Drug Administration (FDA) has approved six CGRP antagonist medications for migraine prevention: Aimovig (erenumab),Ajovy(fremanezumab-vfrm), Vyepti (eptinezumab-jjmr), Emgality (Galcanezumab-gnlm),Nurtec ODT(rimegepant), and and Qulipta (atogepant).
In May 2021, the FDA expanded approval for Nurtec ODT to include migraine prevention, making it the first and only migraine medication to both treat and prevent migraines.
Aimovig and Ajovy are injectable medications that you can inject into your thigh or abdomen yourself or have someone else inject into your upper arm. Aimovig comes as either a prefilled syringe or an autoinjector (spring-loaded syringe) to be used once a month. Ajovy is available as a prefilled syringe and is taken as a single injection once a month or three consecutive injections every three months.
Nurtec ODT and Qulipta are taken in pill form. Nurtec is taken every other day for the prevention of migraine, but it can also be taken after a migraine starts as long as you haven’t already had a dose that day. Qulipta is taken daily to prevent migraines.
The side effects of this class of drugs are relatively mild.
The beta-blockers found most effective for episodic migraine prevention are Toprol (metoprolol), Inderal LA (propranolol), and timolol. They’re regarded as level A drugs for this purpose, meaning their effectiveness is proven. Two other beta-blockers, Tenormin (atenolol), and Corgard (nadolol), are level B OMPMs, meaning they’re “probably effective.”
Beta-blockersmay not be a safe choice for people who have asthma, diabetes, symptomatic bradycardia (slow heart rate), or low blood pressure. For others, the drugs can have bothersome side effects including low mood, fatigue, and erectile dysfunction.
What You Should Know About Beta-Blockers
Although the physiology of migraine headaches isn’t completely understood, scientists believe some of the same structures and functions in the brain that areaffected in epilepsyare also involved in migraines.
That’s one reason certainmedications for managing epileptic seizuresare considered level A drugs for preventing migraines—specifically valproic acid (available as Depakote and others) and Topamax (topiramate).
Although they can be effective, these medications have the potential to cause side effects that are bothersome enough to cause people to stop taking them, including weight gain or weight loss, fatigue, dizziness, nausea, changes in taste, tremor,paresthesias, and hair loss.
A Word From Verywell
The toll of a day lost to debilitating pain and other symptoms from episodic migraine, such as nausea and vomiting, can be significant. The development of prophylactic migraine headache medications such as the CGRP antagonists should be a welcome relief for anyone who gets frequent migraines, especially those who have trouble tolerating OMPMs.
There are many options, so if one drug doesn’t work for you, talk with your doctopractitioner about trying others until you find one that will, at the very least, decrease the number of days you find yourself down for the count with a migraine.
3 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.Nurtec ODT (rimegepant).Full prescribing information.Kaiser Permanente.Beta-blockers for migraine headaches.Shahien R, Beiruti K.Preventive agents for migraine: Focus on the antiepileptic drugs.Journal of Central Nervous System Disease. 2012 Jan;4(1):37-49. doi:10.4137/JCNSD.S9049Additional ReadingHolland S, Silberstein SD, Freitag F, et al.Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society.Neurology. 2012 Apr;78(17):1346-53. doi:10.1212/WNL.0b013e3182535d0c.Katsarava Z, Buse DC, Manack AN, et al.Defining the differences between episodic migraine and chronic migraine.Curr Pain Headache Rep. 2012 Feb;16(1):86–92. doi:10.1007/s11916-011-0233-zSilberstein SD, Holland S, Freitag F, et al.Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society.Neurology. 2012 Apr;78(17):1337-1345. doi:10.1212/WNL.0b013e3182535d20VanderPluym J, Dodick DW, Lipton RB, et al.Fremanezumab for preventive treatment of migraine: Functional status on headache-free days.Neurology. 2018 Sep;91(12):1152–1165. doi:10.1212/01.wnl.0000544321.19316.40
3 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.Nurtec ODT (rimegepant).Full prescribing information.Kaiser Permanente.Beta-blockers for migraine headaches.Shahien R, Beiruti K.Preventive agents for migraine: Focus on the antiepileptic drugs.Journal of Central Nervous System Disease. 2012 Jan;4(1):37-49. doi:10.4137/JCNSD.S9049Additional ReadingHolland S, Silberstein SD, Freitag F, et al.Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society.Neurology. 2012 Apr;78(17):1346-53. doi:10.1212/WNL.0b013e3182535d0c.Katsarava Z, Buse DC, Manack AN, et al.Defining the differences between episodic migraine and chronic migraine.Curr Pain Headache Rep. 2012 Feb;16(1):86–92. doi:10.1007/s11916-011-0233-zSilberstein SD, Holland S, Freitag F, et al.Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society.Neurology. 2012 Apr;78(17):1337-1345. doi:10.1212/WNL.0b013e3182535d20VanderPluym J, Dodick DW, Lipton RB, et al.Fremanezumab for preventive treatment of migraine: Functional status on headache-free days.Neurology. 2018 Sep;91(12):1152–1165. doi:10.1212/01.wnl.0000544321.19316.40
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.
Nurtec ODT (rimegepant).Full prescribing information.Kaiser Permanente.Beta-blockers for migraine headaches.Shahien R, Beiruti K.Preventive agents for migraine: Focus on the antiepileptic drugs.Journal of Central Nervous System Disease. 2012 Jan;4(1):37-49. doi:10.4137/JCNSD.S9049
Nurtec ODT (rimegepant).Full prescribing information.
Kaiser Permanente.Beta-blockers for migraine headaches.
Shahien R, Beiruti K.Preventive agents for migraine: Focus on the antiepileptic drugs.Journal of Central Nervous System Disease. 2012 Jan;4(1):37-49. doi:10.4137/JCNSD.S9049
Holland S, Silberstein SD, Freitag F, et al.Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society.Neurology. 2012 Apr;78(17):1346-53. doi:10.1212/WNL.0b013e3182535d0c.Katsarava Z, Buse DC, Manack AN, et al.Defining the differences between episodic migraine and chronic migraine.Curr Pain Headache Rep. 2012 Feb;16(1):86–92. doi:10.1007/s11916-011-0233-zSilberstein SD, Holland S, Freitag F, et al.Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society.Neurology. 2012 Apr;78(17):1337-1345. doi:10.1212/WNL.0b013e3182535d20VanderPluym J, Dodick DW, Lipton RB, et al.Fremanezumab for preventive treatment of migraine: Functional status on headache-free days.Neurology. 2018 Sep;91(12):1152–1165. doi:10.1212/01.wnl.0000544321.19316.40
Holland S, Silberstein SD, Freitag F, et al.Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society.Neurology. 2012 Apr;78(17):1346-53. doi:10.1212/WNL.0b013e3182535d0c.
Katsarava Z, Buse DC, Manack AN, et al.Defining the differences between episodic migraine and chronic migraine.Curr Pain Headache Rep. 2012 Feb;16(1):86–92. doi:10.1007/s11916-011-0233-z
Silberstein SD, Holland S, Freitag F, et al.Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society.Neurology. 2012 Apr;78(17):1337-1345. doi:10.1212/WNL.0b013e3182535d20
VanderPluym J, Dodick DW, Lipton RB, et al.Fremanezumab for preventive treatment of migraine: Functional status on headache-free days.Neurology. 2018 Sep;91(12):1152–1165. doi:10.1212/01.wnl.0000544321.19316.40
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