From the Guidelines
The most effective medications for preventing migraines are candesartan, telmisartan, erenumab, fremanezumab, and galcanezumab, as recommended by the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline for the management of headache 1.
Medication Options
The following medications are recommended for the prevention of migraines:
- Candesartan or telmisartan, which have strong evidence for preventing episodic migraine 1
- Erenumab, fremanezumab, or galcanezumab, which have strong evidence for preventing episodic or chronic migraine 1
- Other options, such as intravenous eptinezumab, lisinopril, oral magnesium, topiramate, propranolol, valproate, memantine, atogepant, and onabotulinumtoxinA injection, have weaker evidence or are suggested for specific patient populations 1
Key Considerations
When selecting a medication for migraine prevention, it is essential to consider the patient's individual needs, comorbidities, and potential side effects. Lifestyle modifications, such as regular sleep, stress management, and trigger avoidance, should also be encouraged to optimize treatment outcomes.
Preventive Therapy
Migraine sufferers should be evaluated for the use of preventive therapy, especially if they experience two or more attacks per month that produce disability lasting 3 or more days per month, or if they have contraindications to or failure of acute treatments 1.
From the FDA Drug Label
Valproic Acid Oral Solution, USP is prescription medicines used alone or with other medicines, to treat: •complex partial seizures in adults and children 10 years of age and older •simple and complex absence seizures, with or without other seizure types
Women who are pregnant must not take Valproic Acid Oral Solution, USP to prevent migraine headaches.
All women of childbearing age (including girls from the start of puberty) should talk to their healthcare provider about using other possible treatments instead of Valproic Acid Oral Solution, USP.
Medication options to prevent migraines include:
- Propranolol (PO) Valproate (PO) is not recommended for preventing migraine headaches in pregnant women. Propranolol is used for the prophylaxis of migraine headaches, however the provided text does not explicitly state this, it only mentions interactions with migraine drugs. 2 3
From the Research
Medication Options for Migraine Prevention
- Topiramate is a first-line medication for migraine prevention, with studies showing significant reductions in migraine frequency and severity 4, 5, 6, 7.
- The optimal dosage of topiramate for migraine prevention is 100 mg per day, with higher doses not providing additional efficacy but increasing the risk of adverse effects 4, 6.
- Other medications that have shown efficacy in migraine prevention include:
- Propranolol
- Timolol
- Amitriptyline
- Divalproex
- Sodium valproate
- Gabapentin
- Naproxen sodium
- Botulinum toxin 5
- Anti-epileptic drugs, such as topiramate and valproate, are effective for migraine prophylaxis, but may have serious side effects, particularly for women of childbearing potential 8.
- The choice of medication for migraine prevention should be individualized, taking into account the patient's medical history, comorbidities, and potential side effects 5, 8.
Common Adverse Effects
- Topiramate: paresthesia, fatigue, decreased appetite, nausea, diarrhea, weight decrease, and taste perversion 4, 7.
- Other medications: varied adverse effect profiles, with some medications having more serious side effects, such as valproate, which should not be given to women of childbearing potential for migraine prevention 8.