Your doctor is likely to prescribe preventative migraine medication or a prophylactic, if your migraines are frequent and significantly impact your daily life. In early 2008, the FDA approved four migraine medications – topiramate (Topomax), divalproex sodium (Depakote), propranolol (Inderal) and timolol (Blocadren). Classes of drugs that have demonstrated promise as migraine preventative medication include antiepileptics (AEDs), antidepressants, beta-blockers as well as calcium channel antagoists. However, such migraine medication may not totally eliminate your need for acute medications completely.
1) Antiepileptic Drugs (AEDs)
AEDs are antiseizure or anticonvulsant durgs used in the treatment of epilepsy and other brain-based disorders. AEDs are believed to prevent migraines, or reduce the intensity of migraines, by increasing levels of the neurotransmitter GABA, which helps to suppress the spreading cortisol depression which may trigger a migraine attack.
Currently, only divalproex sodium (Depakote) and topiramate (Topomax) have been approved by the FDA for treating migraine. If you and your doctor decide on using AEDs as a medication for your migraine headaches, you will generally be started on a low dose that is gradually increased, to minimise side-effects and find the optimal dosage level. When starting on an AED, maintain your headache diary carefully so that you can gauge how effective the treatment is and document what side effects you may be experiencing.
Side effects of AEDs include nausea and vomitting, weight gain, dizziness and fatigue. Be sure not to take other depressants and alcohol with AEDs. If you already have a health condition, be sure to inform you doctor first. People with liver and kidney problems as well as pregnant women should not take AEDs as they have been linked to birth defects.
Clinical studies have found antidepressants to be useful to migraine prevention by regulating the levels of serotonin, norepinephrine, and other neurotransmitters in the brain. Amitriptyline (Elavil, Endep) is a tricyclic antidepressant and antianxiety medication that has been effective in migraine treatment and is considered a first-line drug in migraine prophylaxis.
Side effects of tricyclic antidepressants include dry mouth, dizziness, nausea, constipation, weight gain, anxiety, photosensitivity and fatigue. Orthostatic hypotension, a sudden drop in blood pressure when changing position, may also occur. More serious side effects include loss of libido, blurred vision, high blood pressure and increased heart rate. If taken in too high a dose, tricyclic antidepressants can cause seizures, stroke or heart attack.
That being said, antidepressants should never be abruptly stopped because doing so can cause dizziness, headache, muscle aches, nausea and anxiety. People taking an MAO inhibitor should never take tricylic antidepressants because of the risk of a life-threatening drug interaction. Any MAO inhibitor must be stopped two weeks prior to starting these antidepressants. People with kidney, liver and heart disease should be allowed to take antidepressants only after being carefully monitored by their doctors.
Beta blockers are drugs that relax blood vessels and block the effects of adrenaline in the body. Traditionally used to treat heart disease, Inderal and Biocadren are now FDA approved for the prevention of migraine.
Potential side effects of beta-blockers include fatigue, sleep problems, depression, decreased physical endurance, and impotence. Inderal and other beta-blockers decrease blood pressure and could cause dizziness and fainting in people with normal to low blood pressure as a result.
Migraineurs who have had lung or breathing problems such as asthma and chronic obstructive pulmonary disease should not take this medication for migraine as these drugs can cause breathing to deteriorate. They are also not recommended for people with slow heart rate or electrical conduction problems with their heart. If you take other over-the- counter and prescription medications, make sure you inform your doctor to prevent dangerous interactions.
4) Calcium Channel Blockers
Like beta-blockers, calcium channel blockers were traditionally used to treat cardiovascular conditions such as hypertension and irregular heart rhythms. They block the absorption of calcium into the heart muscle and vascular system, thereby relaxing the cardiovascular system and increasing blood flow to the heart. They also regulate serotonin levels, which explains their efficicacy in migraine prevention.
Calan and Procardia may be useful in preventing migraine. However, potential side effects include constipation, edema, and low blood pressure causing dizziness and even fainting. Avoid grapefruit juice when you are on a prescription for calcium channel blocker as the juice decreases the efficacy of the drug. Alcohol should also be avoided. People with liver and kidney disease, as well as pregnant women should avoid calcium channel blockers.
5) Botox Treatment For Migraines
Botox is another migraine preventative. Click on botox for migraine for more information.