If migraines are occurring frequently, more than once or twice a week, preventive treatments should be considered. The medications used for migraine prevention must be taken regularly, even in the absence of migraine attacks. The goal of this approach is to reduce the frequency and severity of migraines and, potentially, to eliminate them altogether.
A number of medications have been used for this purpose. They are listed below:
Beta Blockers:
- Propranolol (Brand Name: Inderal)
- Metoprolol (Brand Names: Lopressor, Toprol-XL)
- Atenolol (Brand Name: Tenormin)
Calcium Channel Blockers:
- Verapamil (Brand Names: Calan, Verelan)
Antidepressants:
- Amitriptyline (Brand Name: Elavil)
- Nortriptyline (Brand Name: Pamelor)
- Venlafaxine (Brand Name: Effexor XR)
Anticonvulsants:
- Topiramate (Brand Name: Topamax)
- Valproic Acid (Brand Name: Depakote)
- Divalproex Sodium (Brand Name: Depakene)
CGRP Inhibitors:
- Erenumab (Brand Name: Aimovig)
- Fremanezumab (Brand Name: Ajovy)
- Galcanezumab (Brand Name: Emgality)
- Eptinezumab (Brand Name: Vyepti)
Botulinum Toxin:
- OnabotulinumtoxinA (Brand Name: Botox)
Other Medications:
- Candesartan (Brand Name: Atacand) – An angiotensin II receptor blocker (ARB)
- Flunarizine (Brand Name: Sibelium) – A calcium channel blocker not available in the U.S., but used in other countries.
The selection of these medications requires careful consideration. They may have side effects or interact with other medications. Additionally, they may not be safe for patients with certain medical conditions.
Answers:
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There is no one medication that works for everybody. Choosing a preventive medication to treat migraines is determined by several factors. The most important thing to consider is the individual’s health conditions. Some medications may be contraindicated if an individual has certain medical illnesses. It is also very important to let your physician know what medications you are taking. Some medications may interact with each other. It is hard to determine how an individual will respond to an given medication, It may be a try-and-error process, Preventive medications usually take a few weeks before showing benefits. Regular follow-ups or reviews are necessary to find the right medication to prevent migraines,
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Botox (botulinum toxin) injections are an FDA-approved treatment for chronic migraines. Botox has shown to be effective in reducing the frequency and severity of migraines for many people, particularly those who suffer from chronic migraines.
Botox is injected into specific areas of the head and neck. It works by blocking the release of chemicals involved in pain transmission and preventing the activation of pain networks in the head and neck regions.
Many studies have shown that Botox can reduce the number of migraine days per month by about 50% or more in some individuals. Some patients see improvements after a few weeks, while others may need multiple rounds of injections to notice significant changes. On average, patients experience 8-9 fewer headache days per month after Botox treatment. It can take 2-3 weeks for Botox to start working, and full effects may not be apparent until after the second or third treatment cycle (around 6-9 months).
Botox is generally administered every 12 weeks (about 3 months), and many patients report continued improvement with repeated treatments over time. In some cases, migraines can become less frequent or severe even after stopping Botox treatment.
It is usually well tolerated. Common side effects include neck pain, headaches after injections, muscle weakness, and drooping of the eyelids. These side effects are generally mild and temporary.
