Migraine - Prevention 

Preventing migraine 

Advice and support

To find out more about migraines and their management, contact The Migraine Trust.

You can call the information and enquiries line on 020 7631 6975 or email on info@migrainetrust.org

You can also join The Migraine Trust's online community through Facebook.

Although there is no cure for migraine, it is often possible to manage the condition by using measures to prevent migraine attacks, as well as treatments.

Avoiding triggers

One of the best ways of preventing migraines is recognising the things that trigger an attack.

Keeping a migraine diary is helpful. You may find you tend to have a migraine after eating certain foods or when you are stressed. By avoiding this trigger, you can prevent a migraine.

Learn more about migraine triggers in causes of migraine.

Recognising the signs

Some people who experience migraines begin to feel unwell up to a day or so before a migraine attack.

The strange sensations that are sometimes felt before a migraine are known as the prodrome. They can include:

  • a change in mood
  • tiredness
  • hyperactivity
  • food cravings

As these feelings are not specific to migraine, it can be difficult to identify them as warning signs. Try to be aware of how you feel before a migraine. It can help to ask your relatives or friends if they notice any changes in you before you have a migraine.

Medication

Medication is available to prevent a migraine attack. These medicines are usually used if you have tried other preventative measures and you are still experiencing migraines.

You may also be prescribed these medicines if you experience very severe migraine attacks, or if your attacks happen frequently.

Medications used to prevent migraines are outlined below.

Beta-blockers

Beta-blockers include propranolol, metoprolol and timolol. They are traditionally used to treat angina and high blood pressure. It is not known how beta-blockers prevent migraine attacks.

Beta-blockers are unsuitable for people with:

  • asthma
  • chronic obstructive pulmonary disease (COPD)
  • vascular disease
  • heart failure

Possible side effects of beta-blockers are cold hands and feet, tiredness and hallucinations (seeing or hearing things that are not real).

Amitriptyline

Amitriptyline is a type of antidepressant, but it has also been shown to prevent migraines.

The medicine is usually started on a low dose, which can be increased if necessary. Amitriptyline can be used in combination with beta-blockers. It is unsuitable for people who:

  • have had a heart attack
  • have heart disease
  • have an irregular heart beat
  • have epilepsy

Anticonvulsants

Topiramate is a type of anticonvulsant. Anticonvulsants are usually used to prevent seizures in people with epilepsy, but can also help prevent migraines. Topiramate is currently the only anticonvulsant licensed for migraine prevention in the UK.

Botulinum toxin type A

In June 2012, the National Institute for Health and Care Excellence (NICE) recommended the use of a medication called botulinum toxin type A to prevent headaches in some adults with chronic (long-term) migraine.

Botulinum toxin type A is a type neurotoxin (nerve toxin) that paralyses muscles, although it is not exactly clear why this treatment can be effective for migraine.

NICE recommends that this treatment can be considered as an option for people who have chronic migraine (headaches on at least 15 days of every month, at least eight days of which are migraine) that has not responded to at least three previous preventative medical treatments.

Under the new guidelines, botulinum toxin type A should be given by injection to between 31 and 39 sites around the head and back of the neck. A new course of treatment can be administered every 12 weeks.

Other drugs

A large number of other drugs have been suggested for the prevention of migraine, but there is limited evidence as to how effective most of them are. They include:

  • the antimigraine medicines pizotifen and methysergide
  • the anticonvulsants gabapentin, lamotrigine and levetiracetam
  • selective serotonin reuptake inhibitors (a type of antidepressant)
  • verapamil (used to treat high blood pressure)

These medicines will only be prescribed when other treatments have failed.

Transcranial magnetic stimulation

In January 2014, NICE approved the use of a treatment called transcranial magnetic stimulation (TMS) for the treatment and prevention of migraines.

TMS involves holding a small electrical device to your head that then delivers magnetic pulses through your skin. It is not clear exactly how TMS works in preventing migraines, but studies have shown that using it regularly can reduce their frequency. It can also be used in combination with the medications mentioned above without interfering with them.

However, TMS is not a cure for migraines and it doesn’t work for everyone. There is also little evidence about the potential long-term effects of the treatment, although studies into the treatment have so far only reported minor and temporary side effects, including:

NICE recommends that TMS should only be provided by headache specialists, because of the uncertainty about the potential long-term side effects. The specialist will keep a record of your experiences using the treatment.

For more information, see 'NICE approves migraine magnet therapy'.

Acupuncture

If medication is unsuitable, or it doesn't help to prevent migraines, then you may want to consider acupuncture.

The National Institute of Health and Clinical Excellence (NICE) states that a course of up to 10 sessions over a 5-8 week period may be beneficial. Read more about acupuncture.

Page last reviewed: 14/05/2012

Next review due: 14/05/2014

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Comments

The 1 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Kevslady said on 20 June 2013

I'm 52 years old, and don't have any hormonal problems, and despite being overweight my health has always been good.
I've had a few small migraines in the past, and learned that my trigger is coffee, so now I drink decaf. They are usually very short lived but very painful, but yesterdays one was excrutiating and long lived.
I had the 'kaleidascope' vision, but didn't have any quick acting painkillers on me. I managed to drive home, with my partner in the car with me, but I was having a very weird episode with imagined conversations - it was almost like I was psychic, and trying to hear very soft voices in my head.
I took a couple of paracetamols, but was too late. The pain in my head was tremendous. I just wanted to lie down, close my eyes, put pressure on the top of my head and sleep, and I had a very painful neck. I cried with the pain trying to ease it, but nothing worked. Eventually I managed to go to sleep properly about 8.30 last night, and eventually woke up at 4.30 this morning. Thankfully my headache had at last gone after 12 hours, but I felt very 'hung over'.
I'm now going to make sure in future that I ALWAYS carry quick acting gel painkillers.

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Keep a migraine diary

Medicines may not stop your migraine attacks completely. Keeping a migraine diary will help you and your GP monitor how well the medicine is working, and any other patterns in your migraine attacks.

Try to record:

  • the date of the attack
  • the time of day the attack began
  • any warning signs
  • your symptoms (including the presence or absence of aura)
  • what medication you took 
  • when the attack ended

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