I was compensated by Med-IQ through an educational grant from Lundbeck to write about realities of migraine as a chronic disease. All opinions are my own. I decided to work with Med-IQ to help generate awareness around migraine prevention and treatment. Med-IQ is an accredited medical education company that provides an exceptional educational experience for physicians, nurses, pharmacists, and other healthcare professionals.
Migraine is a neurological disease that affects 39 million people in the U.S. 3.3 million people in the United States live with chronic migraine. If these people made up a city, it would be the 3rd largest city in the U.S.
Migraine disorder is often undiagnosed and untreated. If a patient’s episodic migraine is left untreated, it often morphs into chronic migraine. Chronic migraine is defined as having a migraine attack on 15 or more days a month. If untreated for a significant period, migraine can lead to other conditions such as anxiety, depression, stroke, and other cardiovascular diseases.
Another reason to seek migraine prevention is to avoid developing rebound headaches. The frequent and recurring use of any pain relievers can cause what is known as medication overuse headache (also known as rebound headaches). People with migraine are at higher risk of developing this condition. Sharing your medication intake with your provider can help you avoid rebound headaches. So is having an effective preventive migraine treatment.
GOAL OF MIGRAINE PREVENTION
Unfortunately, there is no migraine cure. Nor is there a one-size-fits-all migraine treatment. However, your physician can help you develop an individualized migraine prevention treatment to decrease the frequency and severity of your migraine attacks. Most doctors hope to improve a patient’s migraine frequency by 50%.
WHEN TO SEEK MIGRAINE TREATMENT
According to the American Headache Society guidelines, if a patient experiences migraine attacks four or more days per month, they should initiate some preventive treatment. Approximately 38% of patients with episodic migraine would benefit from preventive therapy, yet less than 13% take prophylactic medications. [1]
People with migraine should receive preventive migraine treatments if they experience the following:
– Disabling attacks despite the acute medications;
– Frequent attacks (at least 1 per week);
– Insufficient response to acute medications;
– Poor tolerance of acute medications;
– A history of long-term and frequent use of pain medications that make symptoms worse. [2]
If you are experiencing any of these factors, you should consider seeking a consultation with a primary care physician, a neurologist, or a headache specialist. Although there are 44 million Americans with migraine, there are only 700 board-certified headache specialists in the United States. Dr. Amaal Starling, a neurologist and a headache specialist at Mayo Clinic, recommends patients have an initial conversation with their primary care provider about their symptoms and medications before seeing a specialist.
MIGRAINE PREVENTIVE MEDICATIONS AND DEVICES
Migraine prevention is also essential for people who suffer from infrequent attacks. These preventive strategies may include lifestyle changes. However, people who suffer from frequent migraine attacks may need more aggressive prevention strategies that sometimes include medication.
Preventive medications are medications that patients take daily to prevent migraine attacks from occurring. Many medications used to prevent migraine attacks were initially created to control other conditions, such as seizures, depression, high blood pressure, or an irregular heartbeat. Often patients find relief with just one medication. However, some require two medications, typically from different drug classes, to complement each other and reduce the risk of side effects.
Other migraine preventive treatments include Botox, nerve block injections, and neuromodulation devices. CEFALY, Spring TMS or ENeura sTM, and GammaCore are the devices that have been FDA cleared to prevent migraine.
Here is a list of available FDA-approved medications for migraine prevention:
| Medication class | Medication name | Date tried |
| Beta-Blocker | Propranolol (Inderal) | |
| Timolol maleate (Blocadren) | ||
| Anticonvulsant | Topiramate (Topamax, Trokendi XR, Quidexy XR) | |
| Depakote, Depakote ER (Divalproex) | ||
| CGRP inhibitor | Aimovig (Erenumab-aooe) | |
| Ajovy (Fremanezumab-vfrm) | ||
| Emgality (Galcanezumab-gnlm) | ||
| Vyepti (Eptinezumab-jjmr) | ||
| Nurtec (Rimegepant) |
There are also evidence-based off-label medications that doctors often prescribe for preventive migraine treatment.
| Medication class | Medication name | Date tried |
| Angiotensin Receptor Blockers/ACE inhibitors | Candesartan | |
| Lisinopril | ||
| Beta-Blockers | Atenolol | |
| Metoprolol | ||
| Nadolol | ||
| Calcium Channel Blockers | Verapamil | |
| Diltiazem | ||
| Nimodipine | ||
| Tricyclic Antidepressants | Amitriptyline | |
| Nortriptyline | ||
| Imipramine |
Here is a list of available FDA-cleared devices for migraine prevention:
| Device | Date Tried |
| CEFALY | |
| Spring TMS or ENeura sTM | |
| GammaCore |
I hope these charts help you keep track of the preventive medications and devices you have tried so far to manage your migraine.
References:
1 – Migraine Headache Prophylaxis – American Family Physician (aafp.org)
2 – American Migraine Foundation
