How Can I Prevent a Migraine Attack?
If you are having more than 3 migraines per month, you may want to consider Preventive Therapy for your migraine attacks.
Many Migraineurs are not aware that they may be able to prevent their migraine attacks. Preventive Therapy mainly utilizes medications designed for other purposes that physicians accidentally discovered were also helpful in reducing the frequency and severity of migraines in their patients who were taking them. This is called Anecdotal Evidence.
Examples of some of the types of preventive medications include blood pressure medications, antihistamines, alzheimer’s medications, anti-depressants, anti-seizure medications, muscle relaxants, and even simple dietary supplements and diuretics. Below I have posted a fairly comprehensive list of some of the most current preventives available including surgeries and medical appliances and treatments. A trial of a preventive should last no shorter time than 2-4 months for each dosage, and preventives may be more effective for you when combined with other preventives or medications. The number of combinations are nearly endless.
One of the first things to consider trying even before attempting to find a preventive that is effective for you, is to identify and avoid any migraine triggers.
A migraine attack is often triggered by something you may have come into contact with such as a food or allergen, or possibly something that you have done that has stressed your body in some manner. Even fluorescent lights, computer monitors, weather and barometric pressure can trigger migraine in those susceptible to those issues. Different people have different triggers and it is not always as easy as it might seem to begin to identify your triggers. More information on Migraine Triggers can be found HERE
The first thing your doctor may want you to do is begin by keeping a migraine diary. The more complete the diary, the more likely you are to find commonalities that may be triggering an attack. Some things you may want to keep track of in your diary are- onset, duration and pain level of an attack. Any auras you experience and how long they lasted. What you ate and what the weather was. Any physical, mental, or emotional stressors of the day, or anything that you may have done differently from any other day.
Some people may be able to easily identify their triggers, but most cannot and think of these diaries as a failure. Triggers may act alone to trigger an attack, or it may take more than one trigger to begin the cascade of neurological activity that starts your attack.
You might think of each trigger as a building block, like you probably played with as a child. A severe trigger might be worth 3 or 4 building blocks, and a mild trigger only 1.
We know that only *so many* building blocks can be piled upon each other before the tower comes crashing down. This is how I like to illustrate the potential for triggers. Cheese may have seemed to trigger a migraine one day, but it may be because it was combined with other triggers of which you were unaware. The next time you eat cheese it is not combined with the other triggers and a migraine does not result. As you can see, this can make identifying triggers extremely difficult.
Some patients find it more effective to begin straightaway with a special diet to see if it helps the frequency and duration of the attacks. If this is ineffective, adding more restrictions one at a time may be helpful. Likewise, if it is effective, you may want to begin adding things back into your diet one at a time to see if you can tolerate eating those items. Examples of Migraine Diets may be found HERE.
Everything about Migraine Disease/Disorder requires extreme patience. If you were not a patient person before Migraine, you soon will be. If you get too impatient and don’t give yourself enough time to try a method or medication, you may be denying yourself something that eventually would have worked. It is easy to give up looking for the right preventive, but finding one that works can be life changing for many patients. Each failure is another step toward finding an answer for you. Migraine Disease is usually a lifetime issue, so thinking of this time as an investment in your future may be helpful. Having a support system is highly recommended as depression and discouragement is extremely common and may itself trigger migraine attacks.
Many Migraineurs are not aware that they may be able to prevent their migraine attacks. Preventive Therapy mainly utilizes medications designed for other purposes that physicians accidentally discovered were also helpful in reducing the frequency and severity of migraines in their patients who were taking them. This is called Anecdotal Evidence.
Examples of some of the types of preventive medications include blood pressure medications, antihistamines, alzheimer’s medications, anti-depressants, anti-seizure medications, muscle relaxants, and even simple dietary supplements and diuretics. Below I have posted a fairly comprehensive list of some of the most current preventives available including surgeries and medical appliances and treatments. A trial of a preventive should last no shorter time than 2-4 months for each dosage, and preventives may be more effective for you when combined with other preventives or medications. The number of combinations are nearly endless.
One of the first things to consider trying even before attempting to find a preventive that is effective for you, is to identify and avoid any migraine triggers.
A migraine attack is often triggered by something you may have come into contact with such as a food or allergen, or possibly something that you have done that has stressed your body in some manner. Even fluorescent lights, computer monitors, weather and barometric pressure can trigger migraine in those susceptible to those issues. Different people have different triggers and it is not always as easy as it might seem to begin to identify your triggers. More information on Migraine Triggers can be found HERE
The first thing your doctor may want you to do is begin by keeping a migraine diary. The more complete the diary, the more likely you are to find commonalities that may be triggering an attack. Some things you may want to keep track of in your diary are- onset, duration and pain level of an attack. Any auras you experience and how long they lasted. What you ate and what the weather was. Any physical, mental, or emotional stressors of the day, or anything that you may have done differently from any other day.
Some people may be able to easily identify their triggers, but most cannot and think of these diaries as a failure. Triggers may act alone to trigger an attack, or it may take more than one trigger to begin the cascade of neurological activity that starts your attack.
You might think of each trigger as a building block, like you probably played with as a child. A severe trigger might be worth 3 or 4 building blocks, and a mild trigger only 1.
We know that only *so many* building blocks can be piled upon each other before the tower comes crashing down. This is how I like to illustrate the potential for triggers. Cheese may have seemed to trigger a migraine one day, but it may be because it was combined with other triggers of which you were unaware. The next time you eat cheese it is not combined with the other triggers and a migraine does not result. As you can see, this can make identifying triggers extremely difficult.
Some patients find it more effective to begin straightaway with a special diet to see if it helps the frequency and duration of the attacks. If this is ineffective, adding more restrictions one at a time may be helpful. Likewise, if it is effective, you may want to begin adding things back into your diet one at a time to see if you can tolerate eating those items. Examples of Migraine Diets may be found HERE.
Everything about Migraine Disease/Disorder requires extreme patience. If you were not a patient person before Migraine, you soon will be. If you get too impatient and don’t give yourself enough time to try a method or medication, you may be denying yourself something that eventually would have worked. It is easy to give up looking for the right preventive, but finding one that works can be life changing for many patients. Each failure is another step toward finding an answer for you. Migraine Disease is usually a lifetime issue, so thinking of this time as an investment in your future may be helpful. Having a support system is highly recommended as depression and discouragement is extremely common and may itself trigger migraine attacks.
Replies to This Discussion
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Permalink Reply by Ellen S on -
This is a partial list. There are more than mentioned here. These meds and methods can be used in combination with other meds for best effectiveness. Migraine Prevention LInk
As always, do not try anything new without consulting your physician first. Be sure to tell him/her about everything that you currently take, including vitamins and supplements.
Please feel free to let me know if you found something else that is currently being used as a preventive, or if you see that I may have made a mistake or left something out! Because what physicians and researchers know about migraine changes every day, this is is essentially a ‘living document’ , so please join in!
*ANTIHYPERTENSIVES (blood pressure meds)
Alpha-2 agonists
- Clonidine, aka Catapres
- Guanfacine, aka Tenex
*ACE Inhibitors
- Benazepril, aka Lotensin
- Captopril, aka Capoten
- Enalapril, aka Vasotec
- Fosinopril, aka Monopril
- Lisinopril, aka Zestril, Prinivil
- Moexipril, aka Univasc
- Perindopril, aka Aceon
- Quinapril, aka Accupril
- Ramipril, aka Altace
- Trandolapril, aka Mavik
*Angiotensin II Inhibitors
- Candesartan, aka Atacand
- Eprosartan, aka Teveten
- Irbesartan, aka Avapro
- Losartan, aka Cozaar
- Olmesartan, aka Benicar
- Telmisartan, aka Midcardis
- Valsartan, aka Diovan
*Beta Blockers
- Acebutolol, aka Secral
- Atenolol, aka Tenormin
- Betaxolol, aka Kerlone
- Bisoprolol, aka Zebeta, Emconcor
- Cartelol, aka Cartrol
- Labetalol, aka Normodyne, Trandate
- Metoprolol, aka Lopressor
- Nadolol, aka Corgard
- Penbutololm aka Levatol
- Pindolol, aka Visken, Syn-Pindolol
- Propranolol, aka Inderal
- Timolol, aka Blocadren
*Calcium Channel Blockers
- Amlodipine, aka Norvasc
- Bepridil, aka Vascor
- Diltiazem, aka Cardizem, Tiazac
- Felodipine, aka Plendil
- Flunarizine, aka Sibelium (Canada)
- Isradipine, aka DynaCirc
- Nicardipine, aka Cardene
- Nifedipine, aka Adalat, Procardia
- Nimodipine, aka Nimotop
- Nisoldipine, aka Sular
- Verapamil, aka Calan, Verelan, Isoptin
*Other Antihypertensives
- Mirtazapine, aka Remeron
*ANTIHISTAMINES
- Benadryl
- Cyproheptadine, aka Periactin
- Pizotifen, aka Sandomigran (UK)
*ANTIDEPRESSANTS
Tricyclic antidepressants (TCAs)
- Amitriptyline, aka Elavil (discontinued), Endep
- Amoxapine, aka Asendin
- Clomipramine, aka, Anafranil
- Desipramine, aka Norpramin
- Doxepin, aka Sinequan
- Imipramine, aka Norfranil, Tofranil
- Nortriptyline, aka Pamelor, Aventyl
- Protriptyline, aka Vivactil
- Trimipramine, aka Surmontil
*MAOI Antidepressants
- Isocarboxazid, aka Marplan
- Phenelzine, aka Nardil
- Tranylcypromine, aka Parnate
*Selective serotonin reuptake inhibitors (SSRIs):*
- Citalopram, aka Celexa
- Escitalopram oxalate, aka Lexapro
- Fluoxetine, aka Prozac
- Fluvoxamine, aka Luvox
- Paroxetine, aka Paxil
- Protriptyline, aka Vivactil
- Sertraline, aka Zoloft
*Selective serotonin and norepinephrine reuptake inhibitor (SSNRIs)
- Duloxetine hydrochloride, aka Cymbalta
- Venlafaxine, aka Effexor, Effexor XR
*Other antidepressants
- Bupropion, aka Wellbutrin, Zyban
- Mirtazepine, aka Remeron
- Trazodone, aka Desyrel
*ATTENTION DEFICIT HYPERACTIVITY DISORDER MEDS
Selective Norepinephrine Reuptake Inhibitor
- Atomoxetine HCl, aka Strattera
*ARTHRITIS MEDS Cox-2 Enzyme Inhibitors
Celecoxib, aka Celebrex
*ANTI-INFLAMMATORIES
-Steroids such as Prednisone
- NSAIDS such as Indomethacin
*NEURONAL STABILIZING AGENTS (antiseizure meds)
- Carbamazepine, aka Tegretol
- Clonazepam, Klonopin
- Clorazepate, aka Tranxene
- Divalproex, aka Depakote
- Gabapentin, aka Neurontin
- Levetiracetam, Keppra
- Lamotrigine, aka Lamictal
- Oxcarbazepine, Trileptal
- Pregabalin, aka Lyrica
- Tiagabine, aka Gabitril
- Topiramate, aka Topamax
- Valproate Sodium, aka Depacon
- Zonisamide, aka Zonegran
*ERGOT ALKALOID
- Methylergonovine, aka Methergine (the only ergot used as a preventive)
*LEUKOTRIENE BLOCKERS
- Montelukast, aka Singulair
- Zafirlukast, aka Accolate
- Zyleuton, aka Zyflo
*OTHER
- Baclofen, aka Lioresal
- Botulinum Toxin Type A, aka Botox
-Diamox aka Acetazolamide
*MUSCLE RELAXANTS
- Zanaflex
- Carisoprodol (Soma)
- Soma Compound (Soma + Aspirin)
- Soma Compound + Codeine
- Cyclobenzaprine (Flexeril)
- Chlorzoxazone (Parafon forte, Paraflex)
- Metaxolone (Skelaxin)
- Methocarbamol (Robaxin)
- Methocarbamol (Robaxin) + Aspirin
- Orphenadrine (Norflex)
- Orphenadrine (Norgesic) + Aspirin + Caffeine
- Orphenadrine (Norgesic forte) + Aspirin + Caffeine (Higher dosage)
*MEDICATION FOR ALZHEIMER’S TYPE DEMENTIA
- Memantine, aka Namenda
*HORMONE THERAPIES
- Birth Control Pills or Patches
- HRT’s including Estrogens and Progestins
- Anti-Androgen therapy medications such as Goserelin aka Zoladex
- Thyroid preparations aka Cytomel (T3)
*TRIPTANS
- Frovatriptan aka Frova
- Sumatriptan aka Imitrex
- Naratriptan aka Amerge
-Zolmitriptan aka Zomig
- Rizatriptan aka Maxalt
- Almotriptan aka Axert
*DIETARY SUPPLEMENTS
- Coenzyme Q10
- Feverfew
- Butterbur, aka Petadolex
- Magnesium (must be balanced correctly with calcium or bone loss and kidney stones may develop)
- Iron (anemia)
-Vitamin B12
- Vitamin B complex
- Vitamin B2
- 5-HTP (Check carefully with doctor because of interactions with meds including triptans)
-GABA
- Lecithin
- Melatonin
- Combination supplements such as MigraHealth and Migra-Lieve.
- Vitamin D3- Cholecalciferol in oil base
*PROCEDURES
- Nerve Blocks
- Radio Frequency Ablation
- De-nervation
*MEDICAL DEVICES
- The NTI Tension Suppression System (Dental)
- TENS machine
- Alpha-Stim
- Nerve Stimulators
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Permalink Reply by Ellen S on
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*OTHER
- Acupuncture or Acupressure
- Chiropractic Care- Manual, Activator, Pro-Adjustor
- Othogonal Chiropractic
- Cranio-sacral Therapy
- Bio-feedback
- Osteopathic Manipulation
- Massage
- Daily Exercise
- Physical Therapy
- Physio Therapy
This list was garnered from many different personal resources and knowledge gained thru the years with online resources over a period of 25 or so years including About.com . Teri Robert of MyMigraineconnection.com tells me she also has a similar list. I am hoping that she will provide me with a link so that I can post it here as well! If you know of a link to a more comprehensive or inclusive list, or anything that we can add to this list, please post it here. I’m happy to edit in more treatment options! More information only makes us all wiser in making treatment decisions with our doctors.
Remember that medications and therapies work differently for each patient. If you’re interested in hearing another person’s experience with a particular drug or therapy, please ask. There’s likely someone here who has tried it and may be willing to share their experiences.
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Permalink Reply by Ellen S on
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Another thing worthy of mention is that, depending on what may be triggering your migraine, there may be other options for you. Preventing the trigger may help to prevent the migraine attack.
For instance:
Prilosec- My ENT (Ear, Nose and Throat doctor) tells me that he has helped many migraineurs by prescribing Prilosec twice daily. Many people have undiagnosed LPR (Laryngo-pharyngeal Reflux) that causes stimulation of the nerves and pain in the throat, ears, and even sinuses. By eliminating the acid, headaches may be averted. This treatment takes time, but it may be worth a try for those that seem refractory to other preventives.
Valtrex- The cold sore virus and shingles can take up residence anywhere in your body there is a nerve. Some doctors have had success putting their patients on a trial of Valtrex-- an anti-viral medication used to treat shingles and other viruses. This will probably only work on a very select few, but whoever they are, I’m sure they will be grateful to find this is an option.
Chromium, Curcumin or Cinnamon-- If your migraines are being triggered by high insulin levels, using these supplements have been proven to help balance the body’s sensitivity to sugars and carbs, lessening the overproduction of insulin. Adding Magnesium is usually very helpful as well when insulin resistance is an issue, even in the face of normal appearing levels.
Fluconazole- This oral medication is usually used to treat yeast infections. I haven’t done any research on a yeast and migraine connection, but I have been told by a few that their migraine attacks were much better during long-term treatment with this once-a-week medication.
To my knowledge, these are not listed anywhere as migraine preventives, but if you do a search thru the back door ie. LPR can cause migraine, so what treats LPR… more information may be found. I would never have thought to do this, but on learning thru my personal physicians that these were options for me if I should so choose, I wanted to pass along the information in case someone else with refractory headaches might find them of benefit.
As I find more, I will add them.
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Permalink Reply by Ellen S on
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Response by fitnessforever:
Thanks for the great info. My husband seems to get them often. He has a bad neck from years of mountain biking. He can actually hear ginding when he turns his head. When this happens so does the migraine. If you are in a quiet place or in the morning when you wake, turn your head slowely back and forth. If you hear any grinding and you experience a migraine you may want to see a spine or neuro sx.
Carla Haug
Response from Ellen:
Hi Carla!
You might want to check out our WEGO page on Cervicogenic headache.
I too have some fairly major neck issues. It sounds like Rice Krispies when I move my head and I often lock up (courtesy of Dystonia). While there is a distinct difference between cervicogenic headaches that I experience and the migraine and other types of headache I have, one can very easily trigger another. I have had occipital blocks, 6 facet blocks and the results were all not good. I was told that only an implanted nerve stimulator might possibly help. Before I went that route, I did some researching about the care that I had received in the past, and found out that many things had not been checked with me. As a result I became very proactive and found some of my own answers. I recommend that anyone with chronic health issues keep copies of their own test results etc and take a very active part in their care.
As with anything that triggers migraine including cervicogenic headache or other cervical or spinal issues, when you can eliminate those triggers, or even lessen them, the resultant effects on your migraine disease is usually quite good. You may not be able to eliminate migraine headache and attacks from your life, but each little bit is a tremendous help, and most of us welcome any relief that we can find.
Good luck to your husband! I hope that he is soon able to find relief with his neck and with his migraines!
Signature
Ellen Schnakenberg
WEGO Health Community Moderator
Headache and Migraine
Response from Ellen:
Worth adding:
Diamox- This medicine was recently posted in another thread, but I thought it was worth putting here as it is sometimes used to help prevent migraines related to barometric pressure changes and weather issues that trigger migraine in some patients. I have not yet found specific details how it is prescribed for migraine prevention, but I have read of some who have taken the medication when they see that there are weather changes headed their way, so it doesn’t seem to be something that needs to be taken on a daily basis… perhaps. I’ll get back when I have more information.
Here is what Beka Serdans has posted about Diamox on the Dystonia forum
“Diamox controls fluid secretion. It is used in the treatment of glaucoma (excessive pressure in the eyes), epilepsy (for both brief and unlocalized seizures), and fluid retention due to congestive heart failure or drugs. It is also used to prevent or relieve the symptoms of acute mountain sickness in climbers attempting a rapid climb and those who feel sick even though they are making a gradual climb.
Diamox (acetazolamide) is officially designated as a Class-C drug, which means that its safety for use during pregnancy has not been established. Physicians are often reluctant to use Diamox before the 20th week because of this designation and a general lack of data on the subject.
The daily dosage is 8 to 30 milligrams per 2.2 pounds of body weight in 2 or more doses. Typical dosage may range from 375 to 1,000 milligrams per day. Your doctor will adjust the dosage to suit your needs; Diamox can be used with other anticonvulsant medication. “
As always, be sure to check side-effects and contraindications before taking any medication. If you have tried this medication for Migraine prevention, please start a thread so that we may all learn from your experiences!
Signature
Ellen Schnakenberg
WEGO Health Community Moderator
Headache and Migraine
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Permalink Reply by Lesly on -
Excellent list, Ellen. I've been suffering from migraines since I was a teenager, and it didn't occur to me until the last few years that I could try preventative measures. I've found that massage therapy has really helped cut down on my frequency of migraines -- luckily, my insurance plan covers much of the cost!
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Permalink Reply by Ellen S on
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When this thread was transferred from one site to the other, a couple of links were not added to the text. Those links are very important to mention so I'm going to include them here:
About.com medication page
MyMigraineconnection.com- Teri Roberts site
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Permalink Reply by Linz on
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Myofascial tension is something that can cause frequent or even chronic migraines and it is something that few people know much about. Although many massage therapists, physios, osteopaths and even chirpractors do some myofascial release as part of their treatments, it is best to see someone who specialised in myofascial release. This could be anyone from a massage therapist to a physiatrist MD, but the important thing is that they have chosen to do the specialist training in myofascial release and that they keep their knowledge level current.
Devin Starlanyl (a Fibro, Myofascial Pain Doctor-Patient-Expert) has some good info in her Myofascia 101 . Otherwise Travell and Simon literally wrote the book on Myofascial release and myofascial trigger points.
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Permalink Reply by Ellen S on
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Wow! This is terrific info that I neglected to add, so thank you! I have had myofascial release and cranio-sacral therapy from Chiros and Osteopaths, but only the osteopath was a real specialist in that area, and he chose the cranio-sacral therapy as his main form of treatment for me. I think this probably deserves a thread all its own in our Migraine community...
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Permalink Reply by Lisa Bratcher Carley on -
Ellen,
I love this post....such a great one!!!!
liz
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Permalink Reply by MaxJerz on -
Here is the list of preventives from MyMigraineConnection.com:
List of over 100 preventives currently used for Migraine prevention
Be well,
MJ
Rhymes With Migraine
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