Preventive Migraine Medications

What Are Preventive Migraine Medications?

Preventive migraine medications are also known as prophylactics. As the name suggests, preventive migraine medications are used to prevent migraine attack symptoms. Used more frequently than abortive medications, preventive migraine medications reduces the frequency and severity of migraine attacks over a longer period of time before the on-set of an actual migraine attack. These medications are generally taken monthly, and can be taken either in pill-form or via injections. 

List Of Common Preventive Migraine Medications

Some common preventive medications you can use for migraine attacks include:

• beta blockers  and Calcium channel blockers 
• antidepressants
• anti-seizure / anticonvulsant medications
• anti-CGRP (injections or oral)

Beta-Blockers and calcium channels blockers

Initially used for the treatment of high blood pressure, beta-blockers, such as Propranolol have been found to be effective in migraine treatment as well. They work by reducing blood vessel dilation, which can be key in helping tame a migraine attack before it happens. Common side effects of beta-blockers include:

• tiredness
• diarrhoea
• blurred vision

Important tip: You should never use beta-blockers if you have asthma.

Antidepressants

Depression and anxiety are often comorbidities to migraine attacks. Thankfully, antidepressants help prevent migraine attacks by introducing more serotonin to the brain, which helps boost mood and blood flow in patients. This function is similar to how triptans prevent migraine attacks. Common tricyclic antidepressants used to prevent migraine attacks include amitriptyline. 

However, it is unclear if other classes of antidepressants, like selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), can help prevent migraine attacks. This is because SSRIs, which look to increase serotonin, may help migraine, but according to Andrew Charles, M.D., director of Headache Research and Treatment and a professor of neurology at the David Geffen School of Medicine at the University of California Los Angeles, the assumption that an increase in serotonin prevents migraine attacks is too simplistic. Depending on each patient’s reaction towards the medication, SSRI may backfire and cause migraine attacks instead.

Common side effects of antidepressants like amitriptyline include weight gain, constipation, dry mouth, fatigue etc.

Anticonvulsants / Anti-seizure drugs

These medications are typically used to treat seizure patients, and can be beneficial to migraine patients as well. Anticonvulsants and anti-seizure drugs help prevent migraine attacks by calming down over-stimulated nerves and parts of the brain that can lead to seizures and migraine attacks. Common anticonvulsants include, topiramate (Qudexy XR, Topamax) or valproic acid (Depakene, Depakote).

Anti-seizure drugs side effects include sleepiness and brain fog etc.

Anti-CGRPs: a new class of migraine preventives

If you visit a migraine doctor or neurologist, they may use injectable migraine medications are utilized by to treat migraine symptoms. Some of these injection migraine medications can be taken on a regular basis to prevent or diminish the intensity of migraine episodes. Additionally, individuals can opt for other treatments as required in order to alleviate the symptoms of a sudden migraine occurrence.

Anti-CGRP migraine medications was launched in the market in 2018, making it one of the newer entrants of migraine medications.  Calcitonin-gene-related peptide (CGRP) is a molecule that is synthesized in our nervous system throughout the brain and other parts of the body to act as a chemical messenger between different cells. Since its discovery in 1982, CGRP has been demonstrated to play an integral role in migraine pathophysiology. The current theory explaining the cause of migraines is the dysfunction of the brain stem, which regulates pain sensations and blood vessel tone. Anti-CGRP drugs include:

• Eptinezumab (Vyepti)
• Erenumab (Aimovig)
• Fremanezumab (Ajovy)
• Galcanezumab (Emgality)
• Nurtec
• Qulipta

CGRP is known by headache experts to affect migraine attacks. According to Dr. Ailani, Erenumab “sits where CGRP is supposed to go.” However, when it comes to effectiveness in preventing migraines, all four injectable CGRP preventive medications are more similar than different. They have data supporting their ability to significantly reduce the number of migraine days compared to a placebo in both migraine and chronic migraine in adults.

How Do Ajovy Injections Treat Migraine?

Ajovy is a pharmaceutical drug specifically designed for the treatment of migraines. It is classified as a calcitonin gene-related peptide (CGRP) inhibitor. Ajovy works by targeting and blocking the CGRP protein, which is involved in the transmission of pain signals associated with migraines. By inhibiting the activity of CGRP, Ajovy helps to reduce the frequency and severity of migraines.

How Are Ajovy Injections Administered?

Ajovy is administered through a subcutaneous injection, typically once a month. The medication is available in pre-filled syringes or autoinjectors, making it convenient for self-administration at home. By regularly taking Ajovy as prescribed, individuals may experience a decrease in the number of migraine attacks they have and may also find that the migraine symptoms they experience are less intense and shorter in duration.

It’s important to note that Ajovy is primarily used as a migraine preventive treatment rather than an acute or abortive migraine medication. It is intended for individuals who experience frequent migraines and want to reduce their occurrence. Ajovy has shown effectiveness in clinical trials and has been approved by regulatory authorities for the treatment of migraines in many countries.

What Are The Side Effects Of Ajovy?

Like any medication, Ajovy may have potential side effects, and it is essential to discuss its use with a healthcare professional to determine if it is a suitable option based on an individual’s medical history and specific needs. According to the Ajovy website, some side effects of Ajovy include allergic reactions, including itching, rash, and hives that can happen within hours and up to 1 month after receiving Ajovy. Constipation if often observed by patients who take anti-CGRP drugs

How Do Emgality Injections Treat Migraine?

Emgality is a medication specifically developed to address migraines. It falls under the class of calcitonin gene-related peptide (CGRP) inhibitors, which work by targeting the CGRP protein responsible for transmitting pain signals associated with migraines. By binding to CGRP and blocking its activity, Emgality helps to reduce the frequency and severity of migraines.

Emgality is administered via subcutaneous injections once a month or as directed by a healthcare professional. The medication comes in prefilled syringes or autoinjectors, enabling convenient self-administration at home. By consistently taking Emgality as prescribed, individuals may experience a decrease in the number of migraine episodes they encounter, as well as a reduction in the intensity and duration of the migraines they do experience.

What Are The Side Effects Of Emgality?

Some common side effects of Emgality include difficulty breathing, fast heartbeat, hives, itching, skin rash etc. Other side effects of Emgality include: hoarseness, redness of the skin, irritation, joint pain, stiffness, or swelling, swelling of the eyelids, face, lips, hands, or feet. Constipation if often observed by patients who take anti-CGRP drugs

Tips for Using Preventive Migraine Medications

When using preventive medications, note that it may take several weeks for results to be noticeable. Preventives are often prescribed in small doses at first, until higher tolerances can be prescribed. Don’t despair if it seems nothing is working—give it a month before trying another medication and seeing how it goes.

Migraine Prevention Treatment And Therapy

Migraine prevention can involve a combination of the following:

1. Prescription and non-prescription medications.
2. Natural supplements, vitamins, or minerals.
3. Lifestyle changes.

Determining the most suitable approach for your specific situation often requires a process of trial and error, taking into account any other medical conditions you may have. While it may be frustrating to engage in this trial and error method to discover the most effective preventive migraine plan for you, it’s important to remember that not all individuals living with migraines are alike.

Ideally, developing a preventive migraine strategy should involve a collaborative discussion between you and your healthcare provider. By working together, you can identify the most appropriate strategy based on your migraine symptoms, any coexisting health conditions, previous medication attempts, and any encountered side effects.

Never taken any preventive migraine medications before? Read on for some helpful information! You can record your abortive migraine medications and preventive migraine medications on Migraine Buddy. You can download Migraine Buddy on iOS and Android!

The above article was written by Stephanie Morley, one of our amazing #MBvolunteers.