What migraine prevention medication has the fewest side effects?

From the Guidelines

Candesartan or telmisartan are recommended for the prevention of episodic migraine with the fewest side effects, based on the most recent and highest quality evidence. When considering migraine prevention medications, it's essential to weigh the potential benefits against the risk of side effects. The 2024 clinical practice guideline for the management of headache by the U.S. Department of Veterans Affairs and U.S. Department of Defense [ 1 ] provides strong recommendations for candesartan or telmisartan for the prevention of episodic migraine. Some key points to consider when prescribing these medications include:

• Candesartan and telmisartan are angiotensin II receptor blockers (ARBs) that have been shown to be effective in preventing migraines with a relatively favorable side effect profile [ 1 ].
• Other options like erenumab, fremanezumab, or galcanezumab are also recommended for the prevention of episodic or chronic migraine, but may have different side effect profiles [ 1 ].
• It's crucial to individualize treatment based on patient-specific factors, such as medical history, potential drug interactions, and personal preferences.
• Starting with a low dose and gradually increasing as needed can help minimize side effects.
• Regular follow-up and monitoring are necessary to assess the effectiveness of the medication and adjust the treatment plan accordingly.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Migraine Prevention Medication with the Fewest Side Effects

The choice of migraine prevention medication depends on various factors, including patient preferences, comorbidities, and the presence of side effects.

• Several medications have been established as effective for migraine prevention, including:
  • Beta-blockers (e.g., propranolol, timolol, metoprolol) 2, 3, 4, 5
  • Antiepileptic drugs (e.g., topiramate, divalproex sodium) 2, 3, 4, 5
  • Antidepressants (e.g., amitriptyline) 2, 3, 4, 5
• Some medications have been reported to have a more favorable side effect profile, including:
  • Topiramate, which has been recommended as a first-line treatment for migraine prevention due to its efficacy and relatively low risk of side effects 4, 5, 6
  • Beta-blockers, which are generally well-tolerated and have a low risk of side effects 2, 3, 4, 5
  • Amitriptyline, which has been shown to be effective for migraine prevention and has a relatively low risk of side effects 3, 4, 5, 6
• It is essential to note that the efficacy and side effect profile of each medication can vary depending on the individual patient, and the choice of medication should be based on a thorough evaluation of the patient's medical history, preferences, and lifestyle 2, 3, 4, 5, 6