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 preventative 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 preventative 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

  • POM – Prescription only medication
  • OTC – over the counter medication
  • ® – registered
  • Enteric coated – tablets can be coated with a substance that enables them to pass through the stomach and into the intestine unchanged.
  • IV – intramuscular injection
  • 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.

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.

  • 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

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 >

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

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

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 preventatives.

Naproxen (generic name)

Brand name Formulation type Prescription required
Generic form Tablets, enteric coated tablets. Yes
Naprosyn® Tablets Yes

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

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