What medications can help prevent migraine headaches?

Boston Women's Health Book Collective
Administration Specialist

The medication for migraines can be either for acute treatment of headache pain or for prevention (treatment of the underlying causes of the headaches). Medication for prevention is used daily by women who have very frequent headaches (usually more than two or three per month) or have severe headaches. For mild to moderately severe migraines, over-the-counter medication has been found to be effective. These include nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen and naproxen sodium. Caffeine can also be helpful; however, sometimes too much caffeine can make the headache worse.

Medication for acute treatment is more effective when used early. Earlier treatment also leads to less severe headaches and fewer accompanying symptoms. Sometimes, you are reluctant to treat a headache until you are sure it is a migraine; but this allows the headache to become more severe and makes treatment less effective.

The simplest treatment is high-dose NSAIDs, which are effective for many women. Of all the prescription medications that are used to treat acute headaches, the newest and most widely used is a group of medications called triptans. All these drugs fall into two categories: those that take effect more quickly and wear off more quickly, and those that take longer to take effect but are effective longer. The drugs also vary with regard to adverse effects, and so the choice of triptan depends on individual women. Triptans can be administered by different routes: for example, sumatriptan may be taken as a pill, by injection, or in a nasal spray. Rizatriptan can be taken as a disintegrating tablet that dissolves in the mouth.

Our Bodies, Ourselves: Menopause

More About this Book

Our Bodies, Ourselves: Menopause


Many medications can prevent menstrually related migraines, and your overall migraine pattern will influence the choice of which medication to use. If the headaches only occur with your period, then hormone therapy with birth control pills can be useful. Treatment with triptans can be used as well. Other prophylactic medications could be used depending on patient preferences.

There are some drugs that can help prevent migraine, but they have side effects. In this video, Mark Green, MD, director of the Center for Headache and Pain Medicine at the Mount Sinai School of Medicine, discusses these medications.

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 percent. 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.

Migraine attacks can be treated with acute medications or can be prevented. Medications to treat an acute migraine attack include: over the counter medications, such as non-steroidal anti-inflammatory drugs (i.e. Ibuprofen or Naproxen), or prescription medications, such as triptans (i.e. sumatriptan), ergots ( i.e. DHE) and combination drugs (i.e. Butalbital/acetaminophen/caffeine).

Preventative medication can be prescribed by your doctor if the headache frequency is high or if acute medications are not effective. There is a variety of prophylactic medications which include: beta blockers, calcium channel blockers, anti-depressants and anti-seizure medications.

Ergotamine compounds are used to treat moderate migraine pain after analgesics and nonsteroidal inflammatory drugs (NSAIDs) have proved ineffective. The drug ergotamine is an ergot compound that is available in oral, inhalant, under-the-tongue (sublingual) and suppository form. Oral forms of the drug should be used for symptoms with slow onset, whereas suppository forms are favored for rapid-onset migraines. It should be noted that its overuse may provoke the development of chronic daily headaches.

Dr. Dawn Marcus

Effective therapy to prevent migraine aggravation with your menstrual period is called mini-prophylaxis. Prophylaxis is another word for prevention, so mini-prophylaxis means a short course of a prevention therapy. Menstrual migraines may improve by using mini-prophylaxis with hormonal therapy or standard migraine drugs.

Consider mini-prophylaxis only if your headache diary consistently shows a strong link between migraine aggravation and your menstrual periods:

  • Mini-prophylaxis with perimenstrual hormone therapy: 1.5 mg transdermal estrogen patch worn for 7 days, starting 2 to 5 days before your period is expected to begin
  • Mini-prophylaxis with standard headache therapies: All medications should be used at standard migraine treatment doses (unless otherwise specified by your healthcare provider) for 2 to 3 days before the expected menstrual period and during the first 2 to 4 days of menses.

Standard acute headache medications include:

  • Nonsteroidal anti-inflammatory drugs (for example, naproxen sodium550 mg twice daily with food or mefenamic acid (Ponstel) 500 mg three times daily with food)
  • 1 mg naratriptan (Amerge) twice daily
  • 2.5 mg frovatriptan (Frova) once or twice daily
  • Sumatriptan (Imitrex) 25 mg three times daily

Standard headache preventive medications include:

  • Beta-blockers, such as propranolol (Inderal)
  • Antidepressants, such as amitriptyline (Elavil) or imipramine 
  • Calcium-channel blockers, such as verapamil (Calan and Isoptin), and flunarizine (Sibelium; not available in the United States)
  • Neurostabilizing antiepileptics, such as topiramate (Topamax)
The Woman's Migraine Toolkit: Managing Your Headaches from Puberty to Menopause (A DiaMedica Guide to Optimum Wellness)

More About this Book

The Woman's Migraine Toolkit: Managing Your Headaches from Puberty to Menopause (A DiaMedica Guide to Optimum Wellness)

Migraines are a common, controllable type of headache that affects one in every six women, more than 20 million in the United States alone. The Woman’s Migraine Toolkit helps readers take charge of...

Continue Learning about Migraine Headache Prevention

News: FDA Approves New Drug for Migraine Prevention
News: FDA Approves New Drug for Migraine Prevention
Migraines, a type of moderate-to-severe headache, affect 39 million Americans and a whopping 1 billion people around the world, according to the Migra...
Read More
What activities should someone with migraine headaches avoid?
Honor Society of Nursing (STTI)Honor Society of Nursing (STTI)
Migraine headaches can last from four hours up to three days depending on the individual. People wit...
More Answers
Can postdrome phase be prevented?
Honor Society of Nursing (STTI)Honor Society of Nursing (STTI)
If you suffer from a migraine headache, chances are you will also go through the postdrome phase. To...
More Answers
How Long Have You Been Treating Migraine Patients with Botox?
How Long Have You Been Treating Migraine Patients with Botox?

Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.