Understanding preventive treatment
Migraine medications generally fall into two categories: acute treatments and preventive treatments. Acute treatment medications are taken during a migraine attack to stop symptoms or reduce their severity. Preventive medications are taken regularly—often daily, monthly, or every few months—to reduce the number of migraine attacks a person has.
Preventive treatment may reduce how often migraine attacks occur and how severe they are. For many people, fewer migraine days can mean fewer missed activities, improved productivity, and a better quality of life.
According to the guideline, doctors should offer preventive treatment to people who have four or more migraine days per month, four or more moderate-to-severe headache days per month, or migraine that significantly interferes with work or daily activities.
More options for migraine prevention
One of the most encouraging messages from the updated guideline is that people with migraine now have more options for prevention. Researchers have learned more about migraine in recent years, which has led to new preventive treatments.
The guideline notes that preventive medications work in different ways. Some medications were originally developed to treat other conditions such as depression or high blood pressure and were found to help prevent migraine, too. Other medications were created specifically for migraine prevention. Medication options also vary in how they are taken. Some are pills taken daily while others are injections given monthly or every three months.
This variety gives people more flexibility. Someone who already takes medication daily may prefer a pill, while another person may find a monthly injection easier to manage. The best choice often depends on personal preferences, medical history, cost, insurance coverage, and lifestyle.
Finding the right medication for you
There is no single preventive medication that works for everyone. The updated guideline encourages doctors and patients to decide together. That means discussing the evidence behind each treatment, possible side effects, costs, convenience, and personal health goals before making a decision.
Other health conditions could be a factor in your decision. For example, a medication that helps both migraine and another condition could be a useful choice for some people. People who are pregnant, breastfeeding, or considering pregnancy should discuss treatment options carefully with their doctor because some medications may affect a developing baby.
The guideline reviewed evidence for many medications effective to treat migraine, including older ones and newer ones. Among those with the strongest evidence are several newer migraine-specific therapies including erenumab (Aimovig), galcanezumab (Emgality), fremanezumab (AJOVY), and onabotulinumtoxinA (BOTOX). Other medications show moderate or weaker evidence but may still help some people.
Preventive treatment may take time to work
One challenge of preventive treatment is that results are not immediate. Unlike acute medications, which are taken during an attack, preventive medications often require weeks or months before you notice a difference.
Schedule an appointment with your doctor about two to three months after starting a new preventive medication. Some treatments, such as onabotulinumtoxinA (BOTOX), may take up to six months before you notice a change.
If side effects occur or the medication is not helping, your doctor may recommend adjusting the dose or trying a different medication. The guideline says that if one type of preventive treatment does not work well, another type may still be effective.
Ways to work with your doctor to help prevent migraine
One of the most useful things you can do when living with migraine is track your symptoms. A headache diary or smartphone app can help you monitor how often migraine occurs, how severe attacks are, possible triggers, and whether treatments are helping. Bringing this information to appointments can help your doctor make informed decisions about your care.
It is also important to bring a list of current medications and treatments you have tried in the past. Consider asking questions about side effects, costs, expected benefits, and when you should follow up.
Living with migraine can be frustrating and unpredictable. Advances in treatment mean there are new opportunities to find an approach that works for you. If migraine is affecting your quality of life, talk with your doctor about whether preventive treatment may be right for you. The updated AAN guideline emphasizes that people living with migraine have options for care and finding the right one can make a big difference.
