Migraine Prevention Medications: Brand and Generic Names
The most commonly used migraine preventive medications include both traditional agents and newer CGRP-targeted therapies, with specific brand and generic names outlined below.
First-Line Traditional Preventive Medications
Beta-Blockers
- Propranolol (Inderal) - 80-240 mg/day 1
- Timolol (Blocadren) - 20-30 mg/day 1
- Metoprolol (Lopressor, Toprol-XL) 2
Antidepressants
Anticonvulsants
- Divalproex sodium (Depakote) - 500-1500 mg/day 1
- Sodium valproate (Depakene) - 800-1500 mg/day 1
- Topiramate (Topamax) - evidence-based for both episodic and chronic migraine 3
CGRP-Targeted Therapies (Newer, Migraine-Specific)
Monoclonal Antibodies (Injectable)
- Erenumab (Aimovig) 3, 4, 5
- Fremanezumab (Ajovy) 3, 4, 5
- Galcanezumab (Emgality) 3, 4, 5
- Eptinezumab (Vyepti) - intravenous administration 6, 4, 5
Gepants (Oral CGRP Receptor Antagonists)
- Atogepant (Qulipta) - oral preventive 4, 5, 7
- Rimegepant (Nurtec ODT/Vydura) - dual indication for acute and preventive treatment 8, 4, 5
Additional Preventive Options
For Chronic Migraine Specifically
- OnabotulinumtoxinA (Botox) - proven efficacy in chronic migraine 3
Calcium Channel Blockers
- Flunarizine - 10 mg/day (not available in US, used internationally) 1
- Verapamil (Calan, Verelan) 1, 2
- Nimodipine (Nimotop) 9, 2
Other Agents with Evidence
- Candesartan (Atacand) - ARB with migraine prevention evidence 3
- Pizotifen (not available in US) 1
- Lisuride (not available in US) 1
Important Clinical Considerations
The 2024 American Headache Society position statement establishes that CGRP-targeting therapies should be considered first-line options alongside traditional preventives, without requiring prior failure of other treatments 4. This represents a paradigm shift from older guidelines that positioned these as second or third-line options.
Key Distinctions:
Traditional agents (propranolol, amitriptyline, topiramate, valproate) were developed for other conditions and repurposed for migraine, often with tolerability issues affecting adherence 10, 4.
CGRP-targeted medications are migraine-specific with superior tolerability profiles and adherence rates, though cost and insurance restrictions may limit access 3, 10, 4.
Dosing Considerations:
Start traditional preventives at low doses and titrate slowly over 2-3 months to assess efficacy while monitoring for adverse effects 1. CGRP-targeted therapies typically don't require titration and have fixed dosing schedules.
Common Pitfalls:
- Topiramate and valproate are teratogenic - require effective contraception and folate supplementation in women of childbearing potential 9
- Beta-blockers with intrinsic sympathomimetic activity are ineffective for migraine prevention 2
- Avoid medication overuse (using acute treatments >2 days/week) which can lead to medication-overuse headache 3, 11