Migraine - Preventing migraine

There are a number of ways you can reduce your chances of experiencing migraines.

Identifying and avoiding triggers

One of the best ways of preventing migraines is recognising the things that trigger an attack and trying to avoid them.

You may find you tend to have a migraine after eating certain foods or when you are stressed and by avoiding this trigger, you can prevent a migraine. Read more about possible migraine triggers.

Keeping a migraine diary can help you identify possible triggers and monitor how well any medication you are taking is working.

In your migraine diary, try to record:

the date of the attack
the time of day the attack began
any warning signs
your symptoms (including the presence or absence of aura)
what medication you took
when the attack ended

You can find a free online migraine diary on the Migraine Trust website.

Medication and supplements

Medication is also available to help prevent migraines. These medicines are usually used if you have tried avoiding possible triggers and you are still experiencing migraines.

You may also be prescribed these medicines if you experience very severe migraine attacks, or if your attacks happen frequently.

Some of the main medications used to prevent migraines are outlined below.

Topiramate

Topiramate is a type of medication usually used to prevent seizures in people with epilepsy, but it has also been shown to help prevent migraines. It is usually taken every day in tablet form.

Topiramate should be used with caution in people with kidney or liver problems. It can also harm an unborn baby if taken during pregnancy and can reduce the effectiveness of hormonal contraceptives, so your GP should discuss alternative methods of contraception with women who are prescribed topiramate.

Side effects of topiramate can include decreased appetite, nausea, vomiting, constipation or diarrhoea, dizziness, drowsiness and problems sleeping.

Propranolol

is a medication traditionally used to treat angina and high blood pressure, but it has also been shown to help prevent migraines. It is usually taken every day in tablet form.

Propranolol is unsuitable for people with asthma, chronic obstructive pulmonary disease (COPD) and some heart problems. It should be used with caution in people with diabetes.

Side effects of propranolol can include cold hands and feet, pins and needles, problems sleeping and tiredness.

Gabapentin

If topiramate or propranolol are unsuitable or ineffective, you may be prescribed a medication called gabapentin. Like topiramate, this is a medication that is normally used to treat people with epilepsy that may also help prevent migraines. It is usually taken every day in tablet form.

Most people can take gabapentin, but it should be used with caution in people with kidney problems and those over 65 years of age.

Side effects of gabapentin can include dizziness, drowsiness, increased appetite, weight gain and suicidal thoughts.

Gabapentin has been recommended as a possible treatment for migraines by the National Institute for Health and Care Excellence (NICE), but recent research has suggested it may not be effective in preventing attacks and concerns have been raised about the quality of earlier research into the medication.

Riboflavin

For some people, taking a 400mg supplement of riboflavin (vitamin B2) every day may help reduce the frequency and severity of migraines.

Riboflavin supplements are available without prescription, but it's a good idea to discuss using them with your GP first as it is not clear what the effects of taking high doses of riboflavin supplements each day might be.

Botulinum toxin type A

In June 2012, NICE recommended the use of a medication called botulinum toxin type A by headache specialists to prevent headaches in some adults with chronic (long-term) migraine.

Botulinum toxin type A is a type of neurotoxin (nerve toxin) that paralyses muscles. It is not exactly clear why this treatment can be effective for migraine.

NICE recommends that this treatment can be considered as an option for people who have chronic migraine (headaches on at least 15 days of every month, at least eight days of which are migraine) that has not responded to at least three previous preventative medical treatments.

Under the NICE guidelines, botulinum toxin type A should be given by injection to between 31 and 39 sites around the head and back of the neck. A new course of treatment can be administered every 12 weeks.

Preventing menstrual-related migraines

Menstrual-related migraines usually occur between two days before the start of your period to three days after. As these migraines are relatively predictable, it may be possible to prevent them using either non-hormonal or hormonal treatments.

Non-hormonal treatments

The non-hormonal treatments that are recommended are:

non-steroidal anti-inflammatory drugs (NSAIDs) – a common type of painkiller
triptans – medicines that reverse the widening (dilation) of blood vessels, which is thought to be a contributory factor in migraines

These medications are taken as tablets two to four times a day from either the start of your period or two days before, until the last day of bleeding.

Hormonal treatments

Hormonal treatments that may be recommended include:

combined hormonal contraceptives, such as the combined contraceptive pill, patch or vaginal ring
progesterone-only contraceptives, such as progesterone-only pills, implants or injections
oestrogen patches or gels, which can be used from three days before the start of your period and continued for seven days

Hormonal contraceptives are not usually used to prevent menstrual-related migraines in women who experience aura symptoms because this can increase your risk of having a stroke. Read about the complications of migraines for more information about this.

Transcranial magnetic stimulation

In January 2014, the NICE approved the use of a treatment called transcranial magnetic stimulation (TMS) for the treatment and prevention of migraines.

Read about treating migraines for more information about TMS.

Acupuncture

If medication is unsuitable, or it doesn't help to prevent migraines, you may want to consider acupuncture.

NICE states that a course of up to 10 sessions over a five to eight week period may be beneficial. Read more about acupuncture.