If you’re looking for a new preventative, but you aren’t sure where to start here is a quick summary of the most critical information for you to consider. Please always consult with your treating medical professional.
- Who needs a preventative?
- Where to start
- How to tell if a preventative is working
- Are drugs your only option?
- Treatment options:
- Migraine-specific options
- Neurostimulation devices
- Drug classes
- Behavioral approaches
- Lifestyle approaches
Who needs a preventative?
Preventative treatment options are considered for chronic migraine and aim to reduce the frequency and severity of attacks. Preventative medications are a great option for those who are struggling to limit their use of analgesics and triptans to nine days per-month, which puts them at risk for medication overuse headache.
Where to start:
There are a lot of preventatives on the market. The most common preventatives are oral medications that are taken daily. Before starting any of these medications be sure to discuss the list of common and possible side effects with your doctor so you know what to look out for. These medications can take time to start working and your treating physician may recommend that you to stay on a given medication for a period of three-six months. Be aware that some patients struggle with tapering on or off of a medication, so when changing medications or dosages be sure to work with your doctors and have a rescue plan in place in the event that you are struggling. Finally, be sure to discuss any comorbidities that you may have along with migraine.
How do I know if a preventative is successful?
Markers of success for a preventative treatment include a decline in attack frequency by at least 50% within 3 months. Other things to look out for include a reduction in the number of acute medication days and improved responsiveness to acute treatments.
Are drugs my only option?
Not at all. You can explore neuromodulation, supplementation, counseling, exercise, stress management, naturopathic approaches and relaxation techniques. There are also two stimulation devices that can function as preventative treatments, the GammaCore and Cefaly. If you struggle with medication side effects or would prefer not to take daily medication, these are good options to consider.
PREVENTATIVE TREATMENT OPTIONS
I wanted to highlight these treatment options that have been developed specifically for migraine. These treatments commonly have fewer side effects than other drugs that are prescribed for ‘off-label’ use for migraine.
- Monoclonal antibodies targeting CGRP: Ajovy, Emgality, Aimovig, Vyepti
- GEPANTS: Qulipta, Nurtec OTD
- Neuromodulation devices: gammaCore, Cefaly
- Neruostimulation Devices: GammaCore, Cefaly
- CGRP monoclonal antibodies: Ajovy, Emgality, Aimovig, Vyepti
- Botox and Nerve blocks
- Beta blockers (beta-adrenergic blocking agents)
- Nonsteroidal anti-inflammatories (NSAIDS)
- Antiepileptic drugs (AEDs): Topiramate (Topamax, Trokendi XR, Qudexy XR), Divalproex sodium/Sodium valproate (Depakote)
- Angiotensen II receptor blockers
- Tricyclic antidepressants
- Calcium channel blockers
- Serotonin HT2 receptor antagonist
- nNOS inhibitors
- Routine infusions
- Cognitive-behavioral therapy
- Mindfulness practice
- Meditation practice
- Somatic exercises
- Consistent exercise
- Elimination/reintroduction diet