Preventing Migraine Headaches

Content provided by the Faculty of the Harvard Medical School
Excerpted from a Harvard Special Health Report

When migraine headache attacks are particularly severe, do not respond to treatment, or occur more than three or four times a month, it's time to look into preventive strategies. In addition to identifying and avoiding triggers, you may find it worthwhile to consider alternative strategies (especially acupuncture). But often, preventive therapy involves taking a course of medication daily, gradually tapering the dose, and, ideally, eventually discontinuing it altogether.

Beta blockers (used to treat high blood pressure and angina) and tricyclic antidepressants can reduce the frequency of migraine headaches by 50% to 60%. They can also reduce the intensity and duration of the headaches. Calcium-channel blockers, also used to treat high blood pressure and angina, don't have the track record of the beta blockers, but they show promise. Anticonvulsant medications may also help (see Table ).

Table: Medications that help prevent migraine headache

Class

Generic name

(brand name)

Side effects

Cautions

Beta blockers

atenolol (Tenormin)

bisoprolol (Zebeta)

metoprolol (Lopressor)

nadolol (Corgard)

propranolol (Inderal)

timolol (Blocadren)

Fatigue, dizziness, depression, cold hands and feet, exercise intolerance, fatigue, insomnia, and impotence

People with heart failure, asthma, or other lung conditions should be closely monitored by a physician if they take these drugs. People taking thyroid medication should avoid propranolol.

Tricyclic antidepressants

amitriptyline (Elavil, Endep)

doxepin (Adapin, Sinequan)

imipramine (Tofranil)

nortriptyline (Aventyl, Pamelor)

Drowsiness, dry mouth, blurred vision, weight gain, constipation, urinary retention

Do not take these drugs if you have a history of glaucoma, heart disease, or an enlarged prostate, or if you are taking a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate).

Calcium-channel blockers

verapamil (Calan, Isoptin, Verelan)

Fatigue, dizziness, constipation, swollen ankles, and fluid retention

People with heart failure or problems with the electrical pathways in the heart should not take these drugs.

Anticonvulsants

divalproex (Depakote)

Nausea, diarrhea, weakness, tremor, and weight gain

People taking this medication need regular blood tests to monitor their liver function. Don't take this drug if you have any liver problems, including elevated liver enzyme levels.

gabapentin (Neurontin)

Drowsiness, fatigue

Although this drug is not specifically approved for migraine headache treatment, doctors sometimes prescribe it off-label.

topiramate (Topamax)

Drowsiness, cognitive dysfunction, weight loss, word-finding problems, tingling in hands and feet

Avoid this drug if you have a history of kidney stones.

Beta blockers

Doctors have prescribed these medications for years to treat high blood pressure, abnormal heart rhythms, and angina. Beta blockers may relieve migraine headaches by hampering blood vessel expansion.

Six beta blockers have been found effective in preventing migraine headaches (see Table 5). The most effective medication varies from person to person, so if the first one doesn't work, it's worth trying another.

Side effects can include fatigue, dizziness, cold hands and feet, exercise intolerance, insomnia, shortness of breath, depression, and impotence. Some beta blockers can worsen asthma or other chronic lung disorders by narrowing the airways inside the lungs. They also may cause dangerously slow heart rates in unusual circumstances. Beta blockers may on occasion worsen heart failure, although they benefit most heart failure patients. People with heart and lung conditions who are on beta blockers should be closely monitored by a physician.

Reference: Migraine & Headaches section on Better Medicine


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Did You Know?

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Although most people experience headaches only from time to time, an unfortunate but significant minority — about 1 in 20 people — experience them daily or almost every day.

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