Headaches: Should I Take Medicine to Prevent Migraines?

Headaches: Should I Take Medicine to Prevent Migraines?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Headaches: Should I Take Medicine to Prevent Migraines?

Get the facts

Your options

  • Use treatment, such as medicine, to prevent migraines.
  • Don't use preventive treatment. Instead, treat your migraines only when you have them.

Key points to remember

  • If your migraine symptoms are mild to moderate, doctors recommend that you first try an over-the-counter pain medicine, such as aspirin, ibuprofen, naproxen, or acetaminophen. If that doesn't work, then you can try a prescription medicine that can either prevent a migraine or stop a migraine after it has started.
  • If you get bad migraines often, you may want to take medicine to help prevent them.
  • Medicines to prevent migraines may not stop every migraine. So you may still need to take another kind of medicine that can stop a migraine after it has started. But prevention medicines can reduce how many migraines you get, reduce how long they last, and make your symptoms less severe.
  • Medicines that prevent migraines may cause side effects. Some of these side effects may last for as long as you take the medicine. Or they may go away within a few weeks.
  • You may have options other than a medicine that you can use to prevent migraine headaches. You may try things at home such as identifying and avoiding triggers. You can exercise regularly and get enough sleep. You may try acupuncture or biofeedback.
FAQs

What are migraines?

Migraines are painful, throbbing headaches that last from 4 to 72 hours. They often occur on only one side of your head. But the pain may move from one side of your head to the other, or you may feel it on both sides at the same time. Migraines may be so painful that you aren't able to do your daily activities.

When you have a migraine, you may also feel sick to your stomach and vomit. Activity, light, noise, or certain smells may make your migraine worse.

Some people have an aura before their migraine starts. When you have an aura, you may first see spots, wavy lines, or flashing lights. Your hands, arms, or face may tingle or feel numb. The aura usually starts about 30 minutes before your headache. But most people don't have auras.

Migraines run in families. But it's not clear why some people get them and others don't.

The cause of migraines is not well understood. But experts think that it may have something to do with changes in the activity of brain cells. These changes may lead to inflammation of certain nerves, which then causes pain. Some things called triggers can cause migraines to start. Examples of triggers include certain foods, alcohol, and stress.

How are migraines treated?

If your migraine symptoms are mild to moderate, doctors recommend that you first try over-the-counter pain medicines to manage your headaches. These medicines are safe and cost less than prescription migraine medicines. They include:

  • Acetaminophen (such as Tylenol).
  • Aspirin (such as Entrophen).
  • Ibuprofen (such as Advil).
  • Naproxen (such as Aleve).

If these medicines don't help, your doctor may prescribe a medicine that can quickly stop a migraine after it has started. A group of drugs called triptans is most often tried first. But these can cause serious side effects, especially for people who have heart disease and high blood pressure.

If over-the-counter pain medicines or triptans don't work, and if you get bad migraines often, you may want to take medicine to help prevent them.

What are the medicines that prevent migraines?

There are several types of medicines that help prevent migraines. Some of these medicines were first approved to treat other medical problems such as seizures, depression, high blood pressure, and heart disease. But they also help to prevent migraines.

Medicines used to prevent migraines include:

  • Anticonvulsants (antiseizure medicines).
  • Antidepressants.
  • Beta-blockers.
  • Botulinum toxin, such as Botox. This may be used to prevent chronic migraines.
  • CGRP antagonists.

How well do medicines for preventing migraines work?

Medicines to prevent migraines may not stop every migraine. But prescription medicines may reduce the number of migraines that you have. The medicine may also reduce how long a migraine lasts or make your symptoms less severe.

Botulinum shots can help reduce the number of migraines people have if they were having chronic migraines (more than 15 migraines a month) before treatment.

What can you expect if you take medicine to prevent migraines?

You may take pills every day—even when you don't have a headache. Or you may get regular injections or infusions of the medicine.

The medicine may be started at a low dose. Your doctor may increase the dose over time to find a dose that helps prevent migraines for you.

If you don't see any improvement after several weeks, talk to your doctor. You may need to take a medicine for a few months before it works well for you. Or you may need to try several different medicines to find one that works for you.

A medicine may not prevent all migraines, so there may be times when you need to take another medicine to stop a migraine after it has started.

Medicines to prevent migraines may cause side effects. Some of these side effects may last for as long as you take the medicine. Or they may go away within a few weeks. You may need to decide which bothers you more—the side effects of the medicine or your migraines.

Common side effects include:

  • Sleep and memory problems.
  • An upset stomach.
  • Dry mouth.
  • Constipation.
  • Weight gain or loss.
  • Fatigue.
  • Dizziness.
  • A fast heart rate.
  • Problems at the injection site.
  • A drooping eyelid (Botox).
  • Bruising on the face (Botox).

Serious side effects can also happen. For example, anticonvulsants can cause birth defects if they are taken during pregnancy. Botox can cause severe weakness in the muscles of the face or head. In very rare cases, the botulinum toxin can spread and cause weakness in the muscles that control breathing or swallowing.

What else can you do to prevent migraines?

There are other things you can try to prevent migraines.

  • Identify and try to avoid triggers, such as certain foods, alcohol, and smoking. It may help to keep a headache diary to track how often you have migraines, how painful they are, and what you think might be causing them.
  • Have a healthy lifestyle. Exercise regularly, eat healthy foods, and get enough sleep. Avoid alcohol and drugs. Avoid foods that may trigger your headaches.
  • Practice relaxation and breathing exercises, such as meditation, guided imagery, tai chi, or qi gong, to help reduce stress and relax your mind and muscles.
  • Ask your doctor about device therapy. There are different kinds of these devices. They use an electrical current or magnets to change nerve activity.
  • Try acupuncture. This involves putting very thin needles into the skin at certain points on the body.
  • Try biofeedback. This is a way to control a body function—such as muscle tension—that you don't normally control.
  • Talk with your doctor before you try supplements or natural health products, such as the herb feverfew, magnesium, or riboflavin (vitamin B2).

Why might your doctor recommend medicine to prevent your migraines?

Your doctor may advise you to take medicine to prevent migraines if:

  • You get bad migraines often.
  • Your migraines are so painful that you're not able to do your daily activities.
  • You use medicine more than twice a week to stop a migraine after it has started.
  • You have tried medicines to stop a migraine, but they don't help.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Take medicine to prevent migraines Take medicine to prevent migraines
  • You take medicine to help prevent migraines.
  • You try to avoid things that trigger your migraines, such as certain foods, alcohol, and smoking.
  • Benefits include:
    • Fewer or no migraines.
    • Shorter migraines.
    • Migraines that aren't as severe.
  • Possible side effects include:
    • Upset stomach.
    • Dry mouth.
    • Constipation.
    • Fatigue.
    • Dizziness.
    • A fast heart rate.
    • Sleep and memory problems.
    • Weight gain or loss.
    • Birth defects.
    • Facial weakness or bruising.
Don't take medicine to prevent migraines Don't take medicine to prevent migraines
  • You only take medicine to stop a migraine after it has started and to relieve your symptoms.
  • You try to avoid things that may trigger your migraines, such as certain foods, alcohol, and smoking.
  • If your symptoms don't improve with home treatment, you can decide later to take medicine to help prevent migraines.
  • You avoid the side effects of the medicine.
  • You keep getting migraines.
  • When you get a migraine, you may not be able to do your daily activities, and you may miss several days of work or school.

Personal stories about migraine medicines

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I had my first migraine when I started taking birth control pills. I saw wavy lines and had distorted vision at first, then I felt nauseous, and then developed a horrible, throbbing headache on one side of my head. I took some ibuprofen and laid down in a dark room. Even when the headache went away the next day, I felt achy all over and "fuzzy" in my head. I have had two migraines since I started taking the pill 3 months ago. I never had a migraine before that. My doctor recommended that I stop taking the pill and wait to see if my migraines stop too. I'm going to wait and see if that helps before I decide about taking medicine.

Shelby, age 24

I first got migraines when I was a teenager. I had a hard time remembering to take medicine to prevent migraines back then, so I quit taking it. I still get migraines at least a few times a month. Recently, I developed high blood pressure that we can't seem to get under control without medicine. When I was at my doctor's office for my high blood pressure, we also talked about my migraines. My doctor suggested treating my high blood pressure and trying to prevent migraines with a single medicine such as a beta-blocker.

Helen, age 45

I started getting migraines when I was a kid, although they didn't occur very often. Recently, my migraine attacks are much more frequent, about two a month. I tried taking ibuprofen, but it didn't help. The symptoms have been so bad that I had to go to the emergency room for a shot several times in the past few months. My doctor recommends that I start taking a preventive medicine every day to try to prevent the migraine attacks. He also recommends I have medicine close by to stop headaches that I might still get. Since I have missed so much work due to the migraines, I have decided to take preventive medicines to see if this helps.

George, age 35

I have had migraines off and on for years. I was usually able to control them by taking ibuprofen and lying down, but that is not helping anymore. I am also getting them close to my menstrual cycle and nearly every month. I am not taking birth control pills, and I don't smoke. I am in pretty good health other than for these migraines. My doctor recommended I try taking a medicine to prevent migraines just around my menstrual cycle (right before and during the first few days).

Kasey, age 32

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take medicine to prevent migraines

Reasons not to take medicine to prevent migraines

I'm willing to take medicine if it will help my symptoms.

I don't want to take medicine.

More important
Equally important
More important

I don't think the side effects of the medicine could be as bad as my migraine symptoms.

I think the side effects of the medicine may bother me more than my symptoms.

More important
Equally important
More important

My migraines are affecting my work and relationships with friends and family.

My migraines are not affecting my work and relationships with friends and family.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking medicine to prevent migraines

NOT taking medicine to prevent migraines

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1, I may still get a migraine, even if I take medicine to prevent them.
2, If I only get a migraine every now and then, and if my symptoms don't bother me too much, I should take medicine to prevent them.

Decide what's next

1,Do you understand the options available to you?
2,Are you clear about which benefits and side effects matter most to you?
3,Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure

3. Use the following space to list questions, concerns, and next steps.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision 

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts 

Key concepts that you understood

Key concepts that may need review

Getting ready to act 

Patient choices

Credits

Credits
AuthorHealthwise Staff
Primary Medical ReviewerAnne C. Poinier MD - Internal Medicine
Primary Medical ReviewerE. Gregory Thompson MD - Internal Medicine
Primary Medical ReviewerAdam Husney MD - Family Medicine
Primary Medical ReviewerMartin J. Gabica MD - Family Medicine
Primary Medical ReviewerKathleen Romito MD - Family Medicine
Primary Medical ReviewerColin Chalk MD, CM, FRCPC - Neurology
Primary Medical ReviewerLesley Ryan MD - Family Medicine
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Headaches: Should I Take Medicine to Prevent Migraines?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Use treatment, such as medicine, to prevent migraines.
  • Don't use preventive treatment. Instead, treat your migraines only when you have them.

Key points to remember

  • If your migraine symptoms are mild to moderate, doctors recommend that you first try an over-the-counter pain medicine, such as aspirin, ibuprofen, naproxen, or acetaminophen. If that doesn't work, then you can try a prescription medicine that can either prevent a migraine or stop a migraine after it has started.
  • If you get bad migraines often, you may want to take medicine to help prevent them.
  • Medicines to prevent migraines may not stop every migraine. So you may still need to take another kind of medicine that can stop a migraine after it has started. But prevention medicines can reduce how many migraines you get, reduce how long they last, and make your symptoms less severe.
  • Medicines that prevent migraines may cause side effects. Some of these side effects may last for as long as you take the medicine. Or they may go away within a few weeks.
  • You may have options other than a medicine that you can use to prevent migraine headaches. You may try things at home such as identifying and avoiding triggers. You can exercise regularly and get enough sleep. You may try acupuncture or biofeedback.
FAQs

What are migraines?

Migraines are painful, throbbing headaches that last from 4 to 72 hours. They often occur on only one side of your head. But the pain may move from one side of your head to the other, or you may feel it on both sides at the same time. Migraines may be so painful that you aren't able to do your daily activities.

When you have a migraine, you may also feel sick to your stomach and vomit. Activity, light, noise, or certain smells may make your migraine worse.

Some people have an aura before their migraine starts. When you have an aura, you may first see spots, wavy lines, or flashing lights. Your hands, arms, or face may tingle or feel numb. The aura usually starts about 30 minutes before your headache. But most people don't have auras.

Migraines run in families. But it's not clear why some people get them and others don't.

The cause of migraines is not well understood. But experts think that it may have something to do with changes in the activity of brain cells. These changes may lead to inflammation of certain nerves, which then causes pain. Some things called triggers can cause migraines to start. Examples of triggers include certain foods, alcohol, and stress.

How are migraines treated?

If your migraine symptoms are mild to moderate, doctors recommend that you first try over-the-counter pain medicines to manage your headaches. These medicines are safe and cost less than prescription migraine medicines. They include:

  • Acetaminophen (such as Tylenol).
  • Aspirin (such as Entrophen).
  • Ibuprofen (such as Advil).
  • Naproxen (such as Aleve).

If these medicines don't help, your doctor may prescribe a medicine that can quickly stop a migraine after it has started. A group of drugs called triptans is most often tried first. But these can cause serious side effects, especially for people who have heart disease and high blood pressure.

If over-the-counter pain medicines or triptans don't work, and if you get bad migraines often, you may want to take medicine to help prevent them.

What are the medicines that prevent migraines?

There are several types of medicines that help prevent migraines. Some of these medicines were first approved to treat other medical problems such as seizures, depression, high blood pressure, and heart disease. But they also help to prevent migraines.

Medicines used to prevent migraines include:

  • Anticonvulsants (antiseizure medicines).
  • Antidepressants.
  • Beta-blockers.
  • Botulinum toxin, such as Botox. This may be used to prevent chronic migraines.
  • CGRP antagonists.

How well do medicines for preventing migraines work?

Medicines to prevent migraines may not stop every migraine. But prescription medicines may reduce the number of migraines that you have. The medicine may also reduce how long a migraine lasts or make your symptoms less severe.

Botulinum shots can help reduce the number of migraines people have if they were having chronic migraines (more than 15 migraines a month) before treatment.

What can you expect if you take medicine to prevent migraines?

You may take pills every day—even when you don't have a headache. Or you may get regular injections or infusions of the medicine.

The medicine may be started at a low dose. Your doctor may increase the dose over time to find a dose that helps prevent migraines for you.

If you don't see any improvement after several weeks, talk to your doctor. You may need to take a medicine for a few months before it works well for you. Or you may need to try several different medicines to find one that works for you.

A medicine may not prevent all migraines, so there may be times when you need to take another medicine to stop a migraine after it has started.

Medicines to prevent migraines may cause side effects. Some of these side effects may last for as long as you take the medicine. Or they may go away within a few weeks. You may need to decide which bothers you more—the side effects of the medicine or your migraines.

Common side effects include:

  • Sleep and memory problems.
  • An upset stomach.
  • Dry mouth.
  • Constipation.
  • Weight gain or loss.
  • Fatigue.
  • Dizziness.
  • A fast heart rate.
  • Problems at the injection site.
  • A drooping eyelid (Botox).
  • Bruising on the face (Botox).

Serious side effects can also happen. For example, anticonvulsants can cause birth defects if they are taken during pregnancy. Botox can cause severe weakness in the muscles of the face or head. In very rare cases, the botulinum toxin can spread and cause weakness in the muscles that control breathing or swallowing.

What else can you do to prevent migraines?

There are other things you can try to prevent migraines.

  • Identify and try to avoid triggers, such as certain foods, alcohol, and smoking. It may help to keep a headache diary to track how often you have migraines, how painful they are, and what you think might be causing them.
  • Have a healthy lifestyle. Exercise regularly, eat healthy foods, and get enough sleep. Avoid alcohol and drugs. Avoid foods that may trigger your headaches.
  • Practice relaxation and breathing exercises, such as meditation, guided imagery, tai chi, or qi gong, to help reduce stress and relax your mind and muscles.
  • Ask your doctor about device therapy. There are different kinds of these devices. They use an electrical current or magnets to change nerve activity.
  • Try acupuncture. This involves putting very thin needles into the skin at certain points on the body.
  • Try biofeedback. This is a way to control a body function—such as muscle tension—that you don't normally control.
  • Talk with your doctor before you try supplements or natural health products, such as the herb feverfew, magnesium, or riboflavin (vitamin B2).

Why might your doctor recommend medicine to prevent your migraines?

Your doctor may advise you to take medicine to prevent migraines if:

  • You get bad migraines often.
  • Your migraines are so painful that you're not able to do your daily activities.
  • You use medicine more than twice a week to stop a migraine after it has started.
  • You have tried medicines to stop a migraine, but they don't help.

2. Compare your options

 Take medicine to prevent migrainesDon't take medicine to prevent migraines
What is usually involved?
  • You take medicine to help prevent migraines.
  • You try to avoid things that trigger your migraines, such as certain foods, alcohol, and smoking.
  • You only take medicine to stop a migraine after it has started and to relieve your symptoms.
  • You try to avoid things that may trigger your migraines, such as certain foods, alcohol, and smoking.
What are the benefits?
  • Benefits include:
    • Fewer or no migraines.
    • Shorter migraines.
    • Migraines that aren't as severe.
  • If your symptoms don't improve with home treatment, you can decide later to take medicine to help prevent migraines.
  • You avoid the side effects of the medicine.
What are the risks and side effects?
  • Possible side effects include:
    • Upset stomach.
    • Dry mouth.
    • Constipation.
    • Fatigue.
    • Dizziness.
    • A fast heart rate.
    • Sleep and memory problems.
    • Weight gain or loss.
    • Birth defects.
    • Facial weakness or bruising.
  • You keep getting migraines.
  • When you get a migraine, you may not be able to do your daily activities, and you may miss several days of work or school.

Personal stories

Personal stories about migraine medicines

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I had my first migraine when I started taking birth control pills. I saw wavy lines and had distorted vision at first, then I felt nauseous, and then developed a horrible, throbbing headache on one side of my head. I took some ibuprofen and laid down in a dark room. Even when the headache went away the next day, I felt achy all over and "fuzzy" in my head. I have had two migraines since I started taking the pill 3 months ago. I never had a migraine before that. My doctor recommended that I stop taking the pill and wait to see if my migraines stop too. I'm going to wait and see if that helps before I decide about taking medicine."

— Shelby, age 24

"I first got migraines when I was a teenager. I had a hard time remembering to take medicine to prevent migraines back then, so I quit taking it. I still get migraines at least a few times a month. Recently, I developed high blood pressure that we can't seem to get under control without medicine. When I was at my doctor's office for my high blood pressure, we also talked about my migraines. My doctor suggested treating my high blood pressure and trying to prevent migraines with a single medicine such as a beta-blocker."

— Helen, age 45

"I started getting migraines when I was a kid, although they didn't occur very often. Recently, my migraine attacks are much more frequent, about two a month. I tried taking ibuprofen, but it didn't help. The symptoms have been so bad that I had to go to the emergency room for a shot several times in the past few months. My doctor recommends that I start taking a preventive medicine every day to try to prevent the migraine attacks. He also recommends I have medicine close by to stop headaches that I might still get. Since I have missed so much work due to the migraines, I have decided to take preventive medicines to see if this helps."

— George, age 35

"I have had migraines off and on for years. I was usually able to control them by taking ibuprofen and lying down, but that is not helping anymore. I am also getting them close to my menstrual cycle and nearly every month. I am not taking birth control pills, and I don't smoke. I am in pretty good health other than for these migraines. My doctor recommended I try taking a medicine to prevent migraines just around my menstrual cycle (right before and during the first few days)."

— Kasey, age 32

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take medicine to prevent migraines

Reasons not to take medicine to prevent migraines

I'm willing to take medicine if it will help my symptoms.

I don't want to take medicine.

       
More important
Equally important
More important

I don't think the side effects of the medicine could be as bad as my migraine symptoms.

I think the side effects of the medicine may bother me more than my symptoms.

       
More important
Equally important
More important

My migraines are affecting my work and relationships with friends and family.

My migraines are not affecting my work and relationships with friends and family.

       
More important
Equally important
More important

My other important reasons:

My other important reasons:

  
       
More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking medicine to prevent migraines

NOT taking medicine to prevent migraines

       
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. I may still get a migraine, even if I take medicine to prevent them.

  • True
  • False
  • I'm not sure
That's right. Medicine may not prevent every migraine. But it can reduce how many migraines you get, reduce the number of days that they last, and make your symptoms less severe.

2. If I only get a migraine every now and then, and if my symptoms don't bother me too much, I should take medicine to prevent them.

  • True
  • False
  • I'm not sure
That's right. Doctors recommend that you first try an over-the-counter pain medicine before you try a prescription medicine that can either prevent a migraine or stop a migraine after it has started.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

     
Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

 
Credits
ByHealthwise Staff
Primary Medical ReviewerAnne C. Poinier MD - Internal Medicine
Primary Medical ReviewerE. Gregory Thompson MD - Internal Medicine
Primary Medical ReviewerAdam Husney MD - Family Medicine
Primary Medical ReviewerMartin J. Gabica MD - Family Medicine
Primary Medical ReviewerKathleen Romito MD - Family Medicine
Primary Medical ReviewerColin Chalk MD, CM, FRCPC - Neurology
Primary Medical ReviewerLesley Ryan MD - Family Medicine

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.