Migraine - Prevention

Prevention-Migraine




There are a number of ways you can reduce your chances of experiencing migraines.

Identifying and avoiding triggers

One of the best ways of preventing migraines is recognising the things that trigger an attack and trying to avoid them. 
You may find you tend to have a migraine after eating certain foods or when you're stressed, and by avoiding this trigger you can prevent a migraine.
Keeping a migraine diary can help you identify possible triggers and monitor how well any medicine you're taking is working.
In your migraine diary, try to record:
  • the date of the attack
  • the time of day the attack began
  • any warning signs
  • your symptoms (including the presence or absence of aura)
  • what medicine you took
  • when the attack ended

Medicines and supplements

Medicines are also available to help prevent migraines. These medicines are usually used if you have tried avoiding possible triggers but you're still experiencing migraines.
You may also be prescribed these medicines if you experience very severe migraine attacks, or if your attacks happen frequently.
Some of the main medicines used to prevent migraines are outlined below.

Topiramate

Topiramate is a type of medicines originally developed to prevent seizures in people with epilepsy, but is now much more commonly used in migraine.
It's been shown to help prevent migraines, and is usually taken every day in tablet form.
Topiramate should be used with caution in people with kidney or liver problems.
It can also harm an unborn baby if taken during pregnancy and can reduce the effectiveness of hormonal contraceptives.
GPs should discuss alternative methods of contraception for women who are prescribed topiramate.
Side effects of topiramate can include:

Propranolol

Propranolol is a medicine traditionally used to treat anginaand high blood pressure, but it's also been shown to effectively prevent migraines.
It's usually taken every day in tablet form.
Propranolol is not suitable for people with asthma, chronic obstructive pulmonary disease (COPD) and some heart problems.
It should be used with caution in people who have diabetes.
Side effects of propranolol can include:

Amitriptyline

Amitriptyline is a medicine originally designed to treat depression, but has also proved useful in helping prevent migraines.
It's usually taken every day in tablet form.
Amitriptyline can make you feel sleepy, so it's best to take it in the evening or before you go to bed.
Other side effects include:
  • constipation
  • dizziness
  • a dry mouth
  • difficulty peeing
  • a headache
It may take up to 6 weeks before you begin to feel the full benefit of the medicine.

Botulinum toxin type A

In June 2012, NICE recommended the use of a medicine called botulinum toxin type A by headache specialists to prevent headaches in some adults with long-term migraine.
Botulinum toxin type A is a type of nerve toxin that paralyses muscles.
It's not exactly clear why this treatment can be effective for migraine.
NICE recommends that this treatment can be considered as an option for people who have chronic migraine (headaches on at least 15 days of every month, at least 8 days of which are migraine) that's not responded to at least 3 previous preventative medical treatments.
Under the NICE guidelines, botulinum toxin type A should be given by injection to between 31 and 39 sites around the head and back of the neck.
A new course of treatment can be given every 12 weeks.

Acupuncture

If medicines are unsuitable or do not help prevent migraines, you may want to consider acupuncture.
NICE states that a course of up to 10 sessions over a 5- to 8-week period may be beneficial.

Preventing menstrual-related migraines

Menstrual-related migraines usually occur from 2 days before the start of your period to 3 days after.
As these migraines are relatively predictable, it may be possible to prevent them using either non-hormonal or hormonal treatments.

Non-hormonal treatments

The non-hormonal treatments that are recommended are:
These medicines are taken as tablets 2 to 4 times a day from either the start of your period or 2 days before, until the last day of bleeding.

Hormonal treatments

Hormonal treatments that may be recommended include:
  • combined hormonal contraceptives, such as the combined contraceptive pill, patch or vaginal ring
  • progesterone-only contraceptives, such as progesterone-only pills, implants or injections
  • oestrogen patches or gels, which can be used from 3 days before the start of your period and continued for 7 days
Hormonal contraceptives are not usually used to prevent menstrual-related migraines in women who experience aura symptoms because this can increase your risk of having a stroke.
Read about the complications of migraines for more information about this.

Advice and support

There are a number of organisations that offer advice and support for people with migraines, including The Migraine Trust.
The Migraine Trust can be contacted on 020 7631 6970 or by emailing info@migrainetrust.org.
You can also join The Migraine Trust's online community through Facebook.

Migraine
Migraines affect 6 million people in the UK. Find out how identifying and avoiding the things that trigger migraines is an important part of managing them.
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