Migraine prophylaxis, or prevention treatment, may help reduce or prevent migraine attacks. Prophylaxis may include medication, integrative therapies such as acupuncture and behavioral therapy, or a combination of both.

Migraine prophylaxis may help reduce the frequency of migraine headaches, decrease pain intensity, and improve quality of life. Evidence suggests there are effective methods for migraine prevention.

There are a number of medications available, as well as integrative treatments that may be helpful.

This article looks at types of migraine medications, integrative treatment options, and the outlook for migraine prophylaxis.

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According to a 2019 article in American Family Physician, roughly 38% of people with episodic migraine headaches would benefit from prophylaxis medications, but less than 13% take them.

The article states that prophylaxis may help to:

  • reduce migraine attack frequency and severity
  • reduce related distress
  • improve quality of life
  • prevent conversion to chronic migraine

Prophylaxis may be helpful for people who have:

Effective first-line medications for migraine prophylaxis include:

Beta-blockers

Propranolol is a type of beta-blocker. It is one of the most common and effective medications for migraine prophylaxis.

It can take 12 weeks for people to start experiencing the benefits of propranolol. People may begin by taking 40–160 milligrams (mg) and progress to 320 mg daily.

Common side effects of beta-blockers may include:

If someone has an underlying heart condition, they may consider taking other beta-blockers such as:

Beta-blockers may not be suitable for people with the following conditions:

Anticonvulsants

First-line medications for migraine prevention include the following anticonvulsants:

Common side effects of Depakote and sodium valproate include:

Depakote and sodium valproate may be especially helpful for treating prolonged and atypical migraine headaches. They are not suitable for people with severe liver disease or pancreatitis. Additionally, Topamax and sodium valproate are not suitable during pregnancy.

Topamax is as effective as propranolol for preventing migraine. People can start with 25 mg daily and gradually increase to 100 mg twice a day. It can take 2–3 months before a person knows whether treatment is effective or not.

Common side effects of Topamax include:

Other side effects may include:

Antidepressants

The antidepressant amitriptyline may be more effective than propranolol in treating mixed migraine-tension headaches.

Amitriptyline works quicker than beta-blockers, and people may experience benefits in up to 4 weeks. People can take 20–75 mg each day. Side effects may include:

Venlafaxine may be as effective in preventing migraine as amitriptyline. People can take 150 mg each day. Side effects can include:

Other prophylactic treatments for migraine include:

Acupuncture

Acupuncture may help to reduce the frequency and pain of migraine for some people.

A 2017 study looked at the effects of acupuncture on 249 people who had migraine without aura. Researchers split participants into a true acupuncture group, a sham acupuncture group, and a group on the waiting list to receive acupuncture.

Participants in the true and sham acupuncture group had 20 sessions of acupuncture over 4 weeks.

Researchers found that people in the true acupuncture group experienced significant benefits compared to the sham and waiting list groups.

True acupuncture was effective in migraine prophylaxis for at least 24 weeks and reduced migraine frequency and intensity of pain.

Massage

According to the American Massage Therapy Association, massage may help people manage migraine pain. There is limited research on the benefits of massage for migraine. Still, some studies suggest that massage may help reduce the frequency and intensity of migraine attacks and minimize headache frequency and perceived pain for tension-type headaches.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is a psychological technique that may help people manage migraine pain and related distress.

CBT may also help reduce the intensity and frequency of migraine and tension-type headaches. Research suggests that CBT and relaxation techniques may reduce headache activity between 30–60%.

A 2020 study looked at the effects of CBT on migraine in 18 adolescents. Participants took part in eight weekly CBT sessions. Researchers took MRI scans before and after the study to show any changes in the brain.

After 8 weeks, headache frequency decreased and scans showed changes in brain function and activity that could suggest benefits of CBT for migraine prophylaxis.

Biofeedback techniques

Biofeedback devices monitor certain responses in the body, such as muscle tension or the temperature of the skin.

As people alter their response, such as releasing tension in part of the body, the device will provide feedback to let people know. A device might use a sound or light system to deliver feedback.

By using biofeedback, over time, people will develop an awareness of their responses and will be able to release tension or stress in the body without requiring the device. Learning this skill may help to prevent or reduce migraine headaches.

Transcutaneous electrical nerve stimulation

A transcutaneous electrical nerve stimulation (TENS) machine is a small device with pads that people attach to the skin’s surface. The machine then delivers low voltage electrical current pulses, which stimulate nerves and affect pain signals to the brain.

A 2018 meta-analysis of four studies found that TENS may be an effective and well-tolerated treatment for migraine. It may help reduce headache days and decrease intake of pain relief medication.

However, researchers need further evidence to reach a final conclusion.

Recognizing and avoiding triggers

People may find keeping track of their migraine headaches helps them identify their triggers.

Common migraine triggers include:

People can discuss how best to avoid or manage their triggers with a healthcare professional.

Managing stress, avoiding certain foods, keeping to regular mealtimes, and establishing good sleep habits may help.

Migraine prophylaxis will not cure migraine but may help to:

  • decrease frequency of migraine attacks
  • decrease severity and duration of migraine attacks
  • increase response to migraine therapy
  • improve quality of life

According to research, the first-line medications effective for migraine prophylaxis are:

  • divalproex
  • topiramate
  • metoprolol
  • propranolol
  • timolol

People may use the following medications as second-line treatment. They are probably effective in migraine prophylaxis:

  • amitriptyline
  • venlafaxine
  • atenolol
  • nadolol

Other medications for migraine prophylaxis may have limited evidence for their efficacy, are ineffective treatments, or have not yet undergone enough research.

The research also states that non-pharmacologic treatments for migraine may be helpful, including:

A combination of techniques may be effective for migraine prophylaxis. Acupuncture alongside treatment for symptoms may decrease headache frequency and be as effective as medication.

Migraine prophylaxis may help reduce the frequency of migraine headaches, the intensity of pain, and the duration of migraine attacks.

Medications, relaxation, biofeedback, CBT, and acupuncture may all be effective in migraine prophylaxis.