You feel the next migraine coming the way you always do, and you are tired of reorganizing your life around it. If you are missing work, canceling plans, or lying in a dark room more often than you would like, you may be a good candidate for migraine prevention, treatment aimed at stopping attacks before they start rather than just chasing them after they hit.
Migraine is far more common than most people realize. About 14.2% of US adults, roughly 1 in 7, report migraine or severe headache, and the burden is real: more than half of those affected report substantial activity impairment or needing bed rest. The good news is that prevention has changed dramatically, and there are more effective, better-tolerated options than ever before.
What is migraine prevention?
Migraine prevention (also called prophylaxis) means using a medication, supplement, or treatment on an ongoing basis to reduce how often migraines happen, how severe they are, and how long they last. This is different from acute or 'rescue' treatment, which you take during an attack to stop pain that has already begun.
Doctors generally consider preventive treatment when headaches are frequent, long-lasting, or severe enough to interfere with daily life. You do not have to have daily migraines to qualify, if attacks are disrupting work, school, sleep, or relationships, prevention is worth discussing with a clinician.
What medications prevent migraines?
Several well-established prescription medication classes are used for migraine prevention. Many were originally developed for other conditions and were later found to reduce migraine frequency. The right choice depends on your other health conditions, side-effect tolerance, and how often you get attacks.
Common preventive medication categories include:
- Beta blockers such as propranolol and metoprolol. In a large meta-analysis, propranolol reduced episodic migraine by about 1.5 headaches per month versus placebo at 8 weeks and was 1.4 times more likely to achieve a 50% reduction in headaches.
- Calcium channel blockers such as verapamil.
- The tricyclic antidepressant amitriptyline.
- Anti-seizure medications such as topiramate and valproate.
- CGRP-targeting therapies, a newer migraine-specific class (more on these below).
CGRP therapies: the newer first-line option
CGRP (calcitonin gene-related peptide) therapies were designed specifically for migraine, which makes them different from older preventives borrowed from other conditions. They include four FDA-approved monoclonal antibodies, eptinezumab (Vyepti), erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality), along with small-molecule options like rimegepant and atogepant. The first monoclonal antibody was approved in 2018, marking a shift toward migraine-specific prevention.
This category has moved to the front of the line. As of March 11, 2024, the American Headache Society formally recommends CGRP-targeting therapies as a first-line option for prevention, eliminating the prior requirement that patients first try and fail two older preventive medications such as topiramate or a beta blocker. The society noted that the cumulative evidence for the efficacy, safety, and tolerability of CGRP therapies exceeds that of any established preventive therapy.
What about Botox and supplements?
For people with chronic migraine, onabotulinumtoxinA (Botox) injections given about every 12 weeks are FDA-approved to help prevent attacks in some adults. It is delivered as a series of small injections around the head and neck and is typically reserved for chronic, not occasional, migraine.
Some people also use nutraceuticals, supplements with evidence behind them, alongside or instead of prescription medication. The most commonly recommended are magnesium, riboflavin (vitamin B2), and Coenzyme Q10. The American Migraine Foundation recommends 400 to 500 mg per day of magnesium for prevention, and a 2021 study found that 400 mg per day of riboflavin for three months reduced migraine attack frequency, duration, and severity. Supplements still interact with other conditions and medications, so check with a clinician before starting one.
Lifestyle habits that support prevention
Medication is only part of the picture. Many people reduce attacks by stabilizing the everyday factors that tend to trigger migraine. These habits will not replace medical treatment for frequent or severe migraine, but they reinforce whatever preventive plan you choose.
Helpful daily habits often include:
- Keeping a consistent sleep schedule, including on weekends.
- Eating regularly and staying well hydrated.
- Identifying and limiting your personal triggers (a headache diary helps).
- Managing stress with regular movement and downtime.
- Using rescue medication early and not overusing it, since frequent acute medication use can make headaches worse over time.
When should you see a doctor?
See a clinician if migraines are frequent, getting worse, not responding to over-the-counter treatment, or interrupting your work, school, or sleep. A clinician can confirm the diagnosis and tailor a preventive plan to your health history, since the best option varies from person to person.
Some headaches are red flags and need urgent or emergency care. Seek immediate medical attention for a sudden, severe 'thunderclap' headache, a headache with fever, stiff neck, confusion, fainting, weakness, numbness, trouble speaking, or vision loss, or a headache after a head injury. These can signal something more serious than migraine and should not wait.
Medical Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider before starting any new skincare treatment, especially if you have underlying health conditions, are pregnant, or are taking medications.
