Migraines: Do You Need a Preventive Medication?

Migraines affect nearly 40 million people in the United States, making it one of the most common and disabling neurological conditions. Majority of people living with frequent migraines are still only treating the headache after it starts. However, taking a preventive medication regularly to reduce the frequency and severity of attacks can be a very effective strategy.

What Is Preventive Treatment for Migraine?

There are two ways to manage migraines with medication. Acute treatment means taking something when a headache begins to relieve the pain. Preventive treatment is different — it is taken on a regular basis, even when you feel fine, with the goal of reducing how often migraines occur and making them less severe when they do.

What Is the Difference Between Episodic and Chronic Migraine?

Migraines are classified by frequency of occurrence:

• Episodic migraine means having fewer than 15 headache days per month.
• Chronic migraine means having 15 or more headache days per month, with at least 8 of those being migraines, for three months or longer.

Chronic migraine is associated with significantly more disability and is often harder to treat. Fortunately, effective preventive options now exist for both.

Who Should Consider Preventive Treatment?

Not everyone with migraines needs a daily preventive medication. However, prevention should be discussed with your doctor if any of the following apply:

• You are having migraines 4 or more days per month.
• Your migraines significantly interfere with work, school, or daily life.
• Your acute medications (the ones you take when a headache starts) are not working well enough.
• You are taking acute medications so frequently that you risk medication-overuse headache.

The goal of preventive treatment is to reduce how often migraines occur, make them less severe when they do happen, and improve your overall quality of life.

What Are the Traditional Preventive Medications?

Medications that were originally developed for other conditions but were later found to also reduce migraine frequency. Common medications include:

• Beta-blockers such as propranolol and metoprolol, originally used for blood pressure and heart conditions.
• Antidepressants at a low dose such as amitriptyline and venlafaxine, which have evidence for migraine prevention.
• Anti-seizure medications such as topiramate and valproate.

These medications can be effective but require a slow dose build-up over weeks and months before you know if they are working. Studies show that only about 1 in 4 patients is still taking their initial preventive medication after six months, most often due to side effects or insufficient relief.

Botox injections performed by trained medical professionals administered typically in 31 injections across specific head and neck areas every three months can be very effective in treatment of chronic migraines.

What Changed with the Discovery of CGRP?

A chemical messenger in the brain called CGRP (calcitonin gene-related peptide) plays a central role in triggering migraines. These CGRP-targeted medications have transformed migraine care.

What Are the New CGRP Preventive Medications?

There are two types. The first type is injectable medications called monoclonal antibodies — these include erenumab, fremanezumab, galcanezumab, and eptinezumab. Three of these are self-injected once a month using a small autoinjector pen. One is given as an IV infusion every three months at a clinic or infusion center. The second type is oral medications called gepants. Atogepant is taken once a day and rimegepant is taken every other day. Both types have been proven in large clinical trials to reduce migraine frequency in people with both episodic and chronic migraine.

Are These Newer Medications Better Tolerated?

Yes, and that is one of their most important advantages. Unlike the older preventive medications, CGRP-targeted treatments do not require gradually increasing the dose over weeks or months — patients start at the full therapeutic dose and many notice benefits quickly, sometimes within the first week. In a head-to-head study comparing erenumab to topiramate, patients taking erenumab were nearly four times less likely to stop treatment because of side effects.

Clinical Trials

Migraine research is advancing rapidly and new treatments are being studied. At Chase Medical Research, we are preparing to enroll patients in upcoming clinical trials focused on migraine prevention. If you suffer from frequent migraines and feel your current treatment is not providing enough relief, participating in a clinical trial may give you access to the latest medications at no cost while helping advance research for millions of people. Call us today at (203) 419-4404 to learn more and find out if you may be eligible.