Preventive medicines
Also known as prophylactic medication, taken to prevent attacks
Introduction
In the past few years the use of prophylactic or preventive drug treatments has fallen. This could be because some prophylactics have side effects such as weight gain and can take time before they start to show a beneficial effect. Also acute medication has improved for migraine. However, if you are having at least four migraine attacks per month you may wish to discuss prophylactic medication with your GP.
It could take up to three months for the preventive effect of the drug to be felt. Therefore, if the drug did not relieve your migraine attack it does not mean that the drug itself did not work but that you need to give it some time. You must avoid overusing painkillers as this can make the headaches harder to treat.
It is important to note that some preventive drugs prescribed by your GP for your migraine may be licensed for other conditions such as high blood pressure, depression or epilepsy. This could mean that the information sheet is more relevant to those conditions. If you see information in the Patient Information Sheet which you don’t understand you should discuss this further with your GP.
Migraine is a complicated condition which varies widely between individuals. What may work for one person may not for another and your migraine management plan will be individual to you.
Doctors are unable to predict how an individual will respond to a particular treatment so this means you may need to try several different treatments until one is found that is the best at controlling your condition. Migraine is a condition for which, unfortunately, there is currently no cure.
Caution
Drugs and new treatments for migraine are changing all the time. If you are on long term medication you should ensure that your treatment is regularly reviewed by your doctor.
Key
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POM – Prescription only medication
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OTC – over the counter medication
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® – registered
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Enteric coated – tablets can be coated with a substance that enables them to pass through the stomach and into the intestine unchanged.
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IV – intravenous injection
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BNF – British National Formulary is the joint publication published by the British Medical Association and the Royal Pharmaceutical Society which is distributed to NHS doctors by the Department of Health.
For more information about a specific medicine, the electronic Medicines Compendium (eMC) website contains up to date, easily accessible information about medicines licensed for use in the UK.
Angiotensin II blockers
Action
Mode of action in migraine is unclear. They block the hormone angiotensin II. They are used in the treatment of hypertension.
Candesartan (generic name)
Candesartan is the only member of the AII antagonist group that has shown to have an effect in migraine.
| Brand name | Formulation type | Prescription required |
| Amias® | Tablets | Yes |
Anti-convulsants
Action
Mode of action in migraine is unclear. They may reduce the capacity of the nerves to transmit pain signals in the brain.
Special note
The Medicines and Healthcare products Regulatory Agency (MHRA) has a toolkit to ensure female patients are informed about the risks of taking valproate medicines during pregnancy – access ‘Valproate guide for patients‘ on the Gov.uk website >
Sodium valproate (generic name)
| Brand name | Formulation type | Prescription required |
| Generic form | Tablets, solution. | Yes |
| Epilim® | Tablets, syrup, liquid. | Yes |
| Epilim chrono® | Tablets | Yes |
| Episenta® | Capsules | Yes |
Topiramate
| Brand name | Formulation type | Prescription required |
| Generic form | Tablets, capsules. | Yes |
| Topamax® | Tablets | Yes |
Gabapentin
| Brand name | Formulation type | Prescription required |
| Generic form | Capsules | Yes |
| Neurotonin® | Tablets, capsules. | Yes |
Anti-serotonergic (Anti 5-HT) drugs
Action
Serotonin (5-HT) is a chemical occurring in the body, which is thought to play a key role in migraine. These drugs block 5-HT2 receptors to stop the effects of 5-HT.
Pizotifen (generic name)
Pizotifen also has anti-histamine properties and is related to the tricyclic antidepressants.
| Brand name | Formulation type | Prescription required |
| Generic form | Tablets | Yes |
Methysergide
Methysergide, a semi synthetic ergot alkaloid, is currently not available – read more here >
Beta-blockers
Action
These drugs have several actions and are used to treat people with high blood pressure, but are also effective in treating migraine. They should be avoided by people with asthma.
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They reduce activity of the brain cells involved in migraine
- They can also reduce the dilation (widening) of arteries in the body.
| Generic name | Brand name | Formulation type | Prescription required |
| Propranolol | Generic form and several brands available | Tablets, capsules, solutions (modified release available) | Yes |
| Metoprolol | Generic form | Tablets | Yes |
| Lopressor® | Tablets | Yes | |
| Atenolol | Generic form | Tablets | Yes |
| Tenormin® | Tablets | Yes | |
| Nadolol | Corgard® | Tablets | Yes |
| Timolol | Generic form | Tablets | Yes |
| Betim® | Tablets | Yes |
Calcitonin Gene-Related Peptide pathway monoclonal antibodies
New treatment
These are the newest preventive medicines specifically developed and licenced for the treatment of migraine.
Most of the current preventive medicines used to treat migraine have been developed for other conditions. This is therefore an exciting development for migraine sufferers.
Read more about Calcitonin Gene-Related Peptide pathway monoclonal antibodies here.
Calcium channel blockers (calcium channel antagonists)
Action
Reduces calcium entry into neurons making them less ‘excitable’. Blocks dopamine receptors in the brain.
Flunarizine (generic name)
Flunarizine is not widely available in the UK and is usually only prescribed by a specialist.
| Brand name | Formulation type | Prescription required |
| Sibelium® | Tablets | Yes |
Non-steroidal anti-inflammatory drug (NSAID)
Action
NSAIDs reduce inflammation by inhibiting the production of certain chemicals in the body.
They should not be used as long-term preventives.
Naproxen (generic name)
| Brand name | Formulation type | Prescription required |
| Generic form | Tablets, enteric coated tablets. | Yes |
| Naprosyn® | Tablets | Yes |
Tricyclic antidepressants (TCAs)
Action
These drugs were previously used for depression, however, they are also effective at preventing migraine. They can be helpful in people with migraine who also have difficulty sleeping.
Tricyclic antidepressants are thought to:
- Block the re-uptake of 5-HT and norepinephrine
- May block 5-HT2 receptors.
The products shown are most commonly used for the prevention of migraine.
| Generic name | Brand name | Formulation type | Prescription required |
| Amitriptyline | Generic form | Tablets, oral solution. | Yes |
| Dosulepin (Dothiepin) | Generic form | Capsules, tablets. | Yes |
| Nortriptyline | Generic form | Tablets | Yes |
