Prophylactic treatment options for migraine

Migraine headache is the bane of existence of many individuals—including 39 million people in the United States alone. These debilitating headaches are managed with the help of abortive, as well as, preventive drugs. The prophylactic therapy that works best for the patient is determined by Best Neurologist in Lahore based on the patient profile. Read on to know more about the prophylactic treatment options for migraine:

Who is prophylactic medication for?

Preventive medication is recommended based on the frequency and severity of the migraine headache. It works best for people who want to improve their quality of life, and headache-related distress. In some cases, healthcare providers prescribe prophylactic medications to prevent progression to chronic migraine.

Criteria for prophylactic medication is: more than four headaches a month, debilitating headaches, onset of side-effects of pain relieving medication. Patient preference and cost is also taken in consideration before prescribing prophylactic medication.

What drugs are used for prophylaxis?

The following class of drugs is used for prophylaxis:


These drugs mimic the action of neurotransmitter—serotonin, and are effective prophylactic medication for short-term headaches like menstrual migraines. Many studies have shown triptans like frovatriptan to be effective at migraine prevention, when taken a couple of days before the onset of menses. Triptans induce dizziness, fatigue, nausea and vomiting, among other symptoms. When used for migraine prophylaxis, they show effects within hours.


These are the drugs prescribed for managing mental health disorders. However, they are also good for preventing migraine attacks. The commonly prescribed prophylactic antidepressants include: SSRIs and SNRIs. Studies show that the SSRI, fluoxetine significantly reduces the headache hours of migraine, along with venlafaxine, an effective SNRI. The side-effect profile of these drugs includes: tachycardia, difficulty in concentration, drowsiness, nausea and vomiting.

Beta blockers

These drugs oppose the action of adrenaline hormone in the body. These drugs are one of the commonly used class for migraine prophylaxis. Studies have shown metoprolol and propranolol to be effective in reducing migraine severity, frequency and duration. Beta blockers may cause sleep disturbances, fatigue and weight-gain, and can take months to be effective.


NSAIDs like aspirin are most commonly prescribed for menstrual migraine—the headache associated with hormonal changes. NSAIDs work by blocking certain prostaglandins that mediate pain and inflammation. Evidence from the American Academy of Neurology shows modest benefits of NSAIDs in migraine prophylaxis. Long term use of NSAIDs is associated with gastric side effects and organ damage.

Angiotensin blockers

Blockers of angiotensin act to counter the narrowing of blood vessels. ARBs are shown to effectively reduce the headache hours and days due to migraine. These drugs commonly cause cough, gastrointestinal side-effects and fatigue. After initiation of ARBs, the effects are evident in a few weeks.

Antiepileptic drugs

Clinical trials have shown antiepileptics—topiramate, sodium valproate and divalproex sodium effective as prophylactic medication for migraine. 11 different studies have shown topiramate to reduce the frequency of migraine, while other drugs like lamotrigine and gabapentin have shown mixed results. Anticonvulsants are associated with a number of side-effects, like fatigue, hair loss, rash, and paresthesia. Like other prophylactic medication, they take weeks to be effective.

Vitamin supplements

Supplements like magnesium, vitamin D, vitamin B2, vitamin B12, melatonin and coQ10 are helpful in migraine prophylaxis. If taken as directed by the healthcare provider, these supplements pose no threats.

These drugs prevent monoclonal antibodies formation, which mitigates the pain associated with chronic headaches. One of the commonly prescribed cGRP is erenumab, which proved its effectiveness in a large clinical trial.

The best prophylactic medication can only be chosen by an expert neurologist, available for online booking at


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