Migraine prevention medications

Created 06-25-2009

Preventative medications

Not everyone with migraine headaches will require a preventative medication. If you experience only a few headache days a month, and you are not disabled by your headaches, you may be able to treat your headaches successfully with a migraine-specific medication alone.

Research has shown, however, that although about 40% of migraine sufferers are candidates for preventative medication, only one-fifth of those who would benefit from migraine prevention are receiving such medication therapy.

There are many, many medications used for the prevention of migraine, but only a few have been approved by regulatory agencies like the U.S. Food and Drug Administration, Health Canada, or the European Agency for the Evaluation of Medicines (EMEA). Only five of these are approved by the U.S. FDA for the treatment of migraine; one of those five is no longer on the market in the U.S.

Medications that have not yet been approved for a specific condition by a regulatory agency, but are prescribed for you by your doctor anyway are used in what is called "off-label" use. It does not mean that is unsafe to do so; it just means that the drug has not been tested for that condition. This is why you might go pick up your prescription, and be told by the pharmacist that you have been given a blood pressure medication, or a seizure medication, or an antidepressant. Your doctor knows you don't have these conditions, but we have found that some of these medications are useful for the prevention of migraine. Many of them have been tested in a formal fashion for migraine, but simply have not been subjected to the very expensive and rigorous testing necessary to obtain the approval of the appropriate regulatory agency for a secondary condition (migraine), since it is already known that they are safe and effective for their primary use.

By Christina Peterson, MD