Migraine Prevention Medication: A List of Options

Migraines are one of the most common diseases in the world, according to the American Migraine Foundation. This disabling headache disorder can be hard to treat. But fortunately, there are many different migraine preventive medications that can help keep migraines at bay (also called migraine prophylaxis meds). 

Let’s take a closer look at migraines, and how you can prevent them. 

What is a migraine?

A migraine is more than just a headache. It’s a brain condition that causes head pain and other symptoms, such as nausea, light sensitivity, and brain fog. And for many people with migraine, these symptoms can have a big effect on day-to-day life. 

When it comes to migraine treatments, there are many different options — including medication. Some medications can stop a migraine when it’s happening (acute medication). Others can prevent migraines from happening (preventive medication).  

Preventive migraine medication can potentially help you have:

• Fewer, less intense, and shorter-lasting migraines

• Less dependence on acute migraine treatments

• Better quality of life and improved function

• A feeling of better control over your migraines

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Here’s a list of the best migraine prevention medications currently available. 

CGRP inhibitors

CGRP inhibitors are medications that block the effects of CGRP in your brain. They’re the only type of medications that have been created specifically to prevent and treat migraines. 

There are two types of CGRP inhibitors: CGRP monoclonal antibodies (mAbs) and CGRP receptor agonists (gepants). Both block the action of CGRP in your body in a slightly different way. 

There are a couple of other key differences, too. MAbs are given as an injection or infusion, while gepants come as tablets. And while both can be used to prevent migraines, some gepants are used as acute medication, too.  

CGRP mAbs include:

• Fremanezumab (Ajovy)

• Galcanezumab (Emgality)

• Erenumab (Aimovig)

• Eptinezumab (Vyepti)

CGRP gepants include:

• Rimegepant (Nurtec) — acute or preventive treatment

• Urogepant (Ubrevly) — acute treatment

• Atogepant (Qulipta) — preventive treatment

• Zavegepant (Zavzpret) — acute treatment

Compared with other medications, CGRP antagonists may have fewer side effects. But since they’re still pretty new, we don’t know much yet about the long-term effects. They are also expensive, and generics aren’t available yet. 

You may also need to try at least two other kinds of medication before your prescriber or insurance will approve you for CGRP antagonist. But hopefully this rule will change in the future. 

Botox for migraine prevention

Botox is well known for its cosmetic, wrinkle-smoothing effects. But it’s also an FDA-approved treatment for chronic migraine (more than 15 headache days per month). 

For migraine prevention, it’s injected into neck and head muscles every 12 weeks. It’s still not clear how Botox works for migraines, but it might inhibit the release of CGRP and another neuropeptide called substance P. 

Just like CGRP inhibitors, Botox can be expensive. Again, you might also need to try one or two other preventive medications first before you can get approved for Botox. 

Beta blockers for migraine prevention

These medications are most commonly used to manage blood pressure. It’s not clear why beta blockers work for migraine prevention, but research suggests they may affect nerve cell communication in the brain. 

Beta blockers that are used for migraine prevention include:

• Metoprolol

• Propranolol

• Timolol

• Atenolol

• Nadolol

Antidepressants for migraine prevention

A few — not all — antidepressant medications are used for migraine prevention. Just like with beta blockers, exactly how they work to prevent migraine isn’t clear. 

Antidepressants that are used for migraine prevention are:

• Amitriptyline (Elavil)

• Nortriptyline (Pamelor)

• Venlafaxine (Effexor)

• Duloxetine (Cymbalta)

Antiepileptics for migraine prevention

Antiepileptics are medications that help treat and prevent seizures. They have multiple effects on the brain and are effective in migraine prevention. 

Antiepileptics used for migraine prevention include:

• Divalproex sodium (Depakote) 

• Topiramate (Topamax)

Supplements for migraine prevention

In addition to prescription medications, some over-the-counter (OTC) supplements can also help with migraine prevention. These include:

• Magnesium

• Coenzyme Q10 (CoQ10)

• Riboflavin (vitamin B2) 

But keep in mind: The FDA doesn’t regulate supplements, and they may interact with other medications. You should always speak with a healthcare professional before starting one. 

Other options for migraine prevention

Acupuncture

Acupuncture is a traditional Chinese medicine practice where tiny needles are inserted into the skin. The needles are thought to stimulate various pressure points throughout the body to promote healing. 

A recent review of several clinical studies suggested that at least six visits of acupuncture treatment may help reduce the frequency of migraines. And it may be as effective as some preventive medications.

Lifestyle

Avoiding triggers can also help prevent migraines. Things like lack of sleep or certain foods and drinks may trigger migraines, so tracking your patterns with a headache diary can be helpful. You may notice that things like alcohol or caffeine are to blame, which will help you know what to avoid. 

Some lifestyle tweaks or changes may also be helpful. Experts believe that getting regular exercise and plenty of sleep, avoiding stress, and eating at regular intervals can help.

Behavioral techniques

There’s evidence that behavioral techniques can prevent migraines and reduce headache intensity. Behavioral techniques focus on the link between stress and headaches, and give you the tools to better cope with stress. 

Examples of behavioral techniques include:

• Biofeedback: This is a mind-body technique that uses information from your body (like heart rate and temperature) to help you learn to manage your response to stress.

• Relaxation training: This consists of learning how to relax your body when faced with stress.

• Cognitive behavioral therapy (CBT): CBT is a type of therapy that helps to reshape thoughts you have in response to stress, and improve how you cope.

Should you try migraine prevention medication?

Whether you should try preventive medication depends on how often your migraines occur and how bad they are. 

You might consider preventive medication if you have any of the following:

• More than 4 headache days per month

• Migraines that still interfere with your life despite treatment

• No response to acute treatment

• Severe side effects from acute treatment

• Medication overuse headache, which is using acute treatment(s) too often

If you meet any of those criteria, consider reaching out to a healthcare professional to talk about preventive treatment.  

Keeping a headache diary

If you aren’t sure about your number of headache days per month or exactly how much medication you’re taking, consider starting a headache diary. A headache diary can help you keep track of your headaches and migraines, such as when they occur and how long they last. It can also help you see how you are (or aren’t) responding to treatment. 

Frequently asked questions

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Written by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

Reviewed by:

Sarah Gupta, MD

Sarah Gupta, MD, is a licensed physician with a special interest in mental health, sex and gender, eating disorders, and the human microbiome. She is currently board certified by the American Board of Psychiatry and Neurology.

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