Medications Used for Migraine Prevention

Medications for Preventing Migraine Attacks

The Food and Drug Administration has approved five drugs for prevention of migraine:

• Propanolol (Inderal)
• Timolol (Blacadrene)
• Divalproex sodium (Depakote)
• Topiramate (Topamax)
• OnabotulinumtoxinA (Botox)

Propanolol and timolol are beta-blocker drugs. Divalproex and topiramate are anti-seizure drugs. Many other drugs are also being used or investigated for preventing migraines.

Beta-Blockers

Beta-blockers are usually prescribed to reduce high blood pressure. Some beta-blockers, however, are also useful in reducing the frequency of migraine attacks and their severity when they occur. Propranolol (Inderal) and timolol (Blocadren) have been approved specifically for prevention of migraine. Metoprolol (Toprol), atenolol (Tenormin), and nadolol (Corgard) are also being studied for migraine prevention.

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Side Effects. Side effects may include:

• Fatigue and lethargy are common.
• Some people experience vivid dreams and nightmares, depression, and memory loss.
• Dizziness and lightheadedness may occur upon standing.
• Exercise capacity may be reduced.
• Other side effects may include cold extremities (legs, arms, feet, hands), asthma, decreased heart function, gastrointestinal problems, and sexual dysfunction.

If side effects occur, the patient should call a doctor, but it is extremely important not to stop the drug abruptly. Some evidence suggests that people with migraines who have had a stroke should avoid beta-blockers.

Anti-Seizure Drugs

Anti-seizure drugs, also called anticonvulsant drugs, are commonly used for treating epilepsy and bipolar disorder. Divalproex sodium (Depakote) and topiramate (Topamax) are the only anti-seizure drugs that are approved for migraine prevention. However, if patients do not respond to either of these drugs, doctors may try other types of anti-seizure medications.

Divalproex Sodium (Depakote). Divalproex sodium (Depakote) was first approved in 1996 for migraine prevention. A once-a-day formulation of divalproex (Depakote ER) was approved in 2000. Doctors sometimes prescribe a similar drug, valproate (Depakene). Pregnant patients should not use these drugs, as they may cause birth defects.