From the Guidelines
To prevent migraines, a multi-faceted approach is necessary, including lifestyle modifications, trigger avoidance, and appropriate medications, with the goal of reducing frequency and severity of attacks, as recommended by the American College of Physicians in their 2025 clinical guideline 1.
Key Lifestyle Modifications
- Establish consistent sleep patterns with 7-8 hours nightly
- Maintain regular meals to avoid blood sugar fluctuations
- Stay hydrated with 2-3 liters of water daily
- Exercise moderately for 30 minutes most days
Trigger Avoidance
- Identify and avoid personal triggers such as certain foods (aged cheese, processed meats, alcohol, artificial sweeteners)
- Avoid strong smells, bright lights, and stress
Acute Treatment
- Take medications at the first sign of a migraine
- Options include over-the-counter pain relievers like ibuprofen (400-600mg) or naproxen (500mg)
- Prescription triptans such as sumatriptan (50-100mg) or rizatriptan (5-10mg) may also be effective
Preventive Medications
- For those with frequent migraines (more than 4 monthly), preventive medications may help
- Options include propranolol (80-160mg daily), topiramate (50-100mg daily), amitriptyline (10-50mg nightly), or newer CGRP antagonists like erenumab (70-140mg monthly injection)
Non-Medication Approaches
- Biofeedback, cognitive behavioral therapy, acupuncture, and stress management techniques can complement medical treatment
- These strategies work by addressing the neurological, vascular, and inflammatory processes involved in migraine pathophysiology, helping to reduce both frequency and severity of attacks, as supported by the clinical guideline 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Preventing Migraines
To prevent migraines, several strategies can be employed:
- Lifestyle changes, such as avoiding migraine triggers and maintaining regular sleep, eating, and work habits 2
- Identifying and managing trigger factors, including environmental factors, sleep pattern changes, diet, physical activity, stress and anxiety, some medications, and hormonal changes 3
- Maintaining a regular lifestyle, with regular sleep, meals, exercise, and management of stress 4
- Using non-pharmacological approaches, such as weight control, management of migraine comorbidities, lifestyle modification, behavioural treatment and biofeedback, patient education, and using headache diaries 3
Non-Pharmacological Approaches
Non-pharmacological approaches can be helpful in managing migraines:
- Exercise, such as exercising for 40 minutes three times a week, may be an option for the prophylactic treatment of migraine in patients who do not benefit from or do not want to take daily medication 5
- Relaxation techniques, such as relaxation according to a recorded programme, may also be beneficial 5
- Neuromodulation techniques, dietary supplements such as riboflavin, coenzyme Q10 and magnesium, and acupuncture can be helpful 3
Pharmacological Approaches
Pharmacological approaches can also be used to prevent and manage migraines:
- Beta-blockers, calcium channel blockers, tricyclic antidepressants, and anticonvulsants are among the more common drug classes used for migraine prophylaxis 2
- Triptans, such as sumatriptan, zolmitriptan, naratriptan, and rizatriptan, are effective in ending a migraine attack 2
- Anti-epileptic drugs, such as valproic acid, gabapentin, and topiramate, have been evaluated for the prophylaxis of migraine 6
- Medications to prevent or reduce the frequency of migraine tend to be less specific and effective than medications for the acute treatment of migraine 2