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Migraine and Headache Preventives:
It's Impossible to Have Tried Everything!

   
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When discussing preventive medications, it's not at all unusual to hear someone with frequent Migraines or headaches say, "I've tried everything!" In the reality of today's headache and Migraine medicine, that's just not possible. As you can see from the list below, there are over 100 medications and dietary supplements, as well as at least one medical device, being used successfully for headache and Migraine prevention. There are also virtually endless combinations of them. Many people find that it's not a single medication or supplement that ends up being successful for them, but a combination of preventives.

Five medications are FDA approved for the treatment of Migraine. They are:

  1. propranolol (Inderal);
  2. timolol (Blocadren);
  3. divalproex (Depakote);
  4. topiramate (Topamax); and
  5. Onabotulinumtoxin type A (Botox), which is approved for chronic Migraine (Migraine occurring 15 or more days per month) only.

None of those medications were originally developed for Migraine treatment. They were developed for other conditions, then coincidentally found to help prevent Migraines. Before FDA approval, they were prescribed off-label as many medications are today. Off-label prescribing is very common and simply means prescribing medications for conditions other than those for which they’re officially approved.

The following medications are being used successfully by some headache and Migraine patients as preventive medications. They're listed first by their generic names, followed by some of their brand names.

ANTIHYPERTENSIVES (blood pressure meds)

Alpha-2 agonists:

  • Clonidine, aka Catapres
  • Guanfacine, aka Tenex

ACE Inhibitors:

  • Benazepril, aka Lotensin
  • Captopril, aka Capoten
  • Enalapril, aka Vasotec
  • Fosinopril, aka Monopril
  • Lisinopril, aka Zestril, Prinivil
  • Moexipril, aka Univasc
  • Perindopril, aka Aceon
  • Quinapril, aka Accupril
  • Ramipril, aka Altace
  • Trandolapril, aka Mavik

Alzheimer's/Dementia Medicaton:

  • Memantine, aka Namenda
            

Angiotensin II Inhibitors:

  • Candesartan, aka Atacand
  • Eprosartan, aka Teveten
  • Irbesartan, aka Avapro
  • Losartan, aka Cozaar
  • Olmesartan, aka Benicar
  • Telmisartan, aka Midcardis
  • Valsartan, aka Diovan

Beta Blockers:

  • Acebutolol, aka Secral
  • Atenolol, aka Tenormin
  • Betaxolol, aka Kerlone
  • Bisoprolol, aka Zebeta, Emconcor
  • Cartelol, aka Cartrol
  • Labetalol, aka Normodyne, Trandate
  • Metoprolol, aka Lopressor
  • Nadolol, aka Corgard
  • Penbutololm aka Levatol
  • Pindolol, aka Visken, Syn-Pindolol
  • Propranolol, aka Inderal
  • Timolol, aka Blocadren  

Calcium Channel Blockers:

  • Amlodipine, aka Norvasc
  • Bepridil, aka Vascor
  • Diltiazem, aka Cardizem, Tiazac
  • Felodipine, aka Plendil
  • Flunarizine, aka Sibelium (Canada)
  • Isradipine, aka DynaCirc
  • Nicardipine, aka Cardene
  • Nifedipine, aka Adalat, Procardia
  • Nimodipine, aka Nimotop
  • Nisoldipine, aka Sular
  • Verapamil, aka Calan, Verelan, Isoptin

ANTIHISTAMINES:

  • Cyproheptadine, aka Periactin
  • Pizotifen, aka Sandomigran (UK)

ANTIDEPRESSANTS

Tricyclic antidepressants (TCAs):

  • Amitriptyline, aka Elavil (discontinued), Endep
  • Amoxapine, aka Asendin
  • Clomipramine, aka, Anafranil
  • Desipramine, aka Norpramin
  • Doxepin, aka Sinequan
  • Imipramine, aka Norfranil, Tofranil
  • Nortriptyline, aka Pamelor, Aventyl
  • Protriptyline, aka Vivactil
  • Trimipramine, aka Surmontil

MAOI Antidepressants:

  • Isocarboxazid, aka Marplan
  • Phenelzine, aka Nardil
  • Tranylcypromine, aka Parnate

Selective serotonin reuptake inhibitors (SSRIs):

  • Citalopram, aka Celexa
  • Escitalopram oxalate, aka Lexapro
  • Fluoxetine, aka Prozac
  • Fluvoxamine, aka Luvox
  • Paroxetine, aka Paxil
  • Sertraline, aka Zoloft

Selective serotonin and norepinephrine reuptake inhibitors (SSNRIs):

  • Duloxetine hydrochloride, aka Cymbalta
  • Venlafaxine, aka Effexor, Effexor XR

Other Antidepressants:

  • Bupropion, aka Wellbutrin, Zyban
  • Mirtazepine, aka Remeron
  • Trazodone, aka Desyrel

 

 
 

Attention Deficit Hyperactivity Disorder Meds:

  • Dextroamphetamine, aka Adderall
  • Atomoxetine HCl, aka Strattera
  • Methylphenidate HCl, aka Concerta, Ritalin
  • Pemoline, aka Cylert

ARTHRITIS MEDS

Cox-2 Enzyme Inhibitors:

  • Celecoxib, aka Celebrex

MUSCLE RELAXANTS:

  • Carisoprodol, aka Soma
  • Cyclobenzaprine, aka Flexeril
  • Lioresal, aka Baclofen
  • Metaxalone, aka Skelaxin
  • Tizanidine, aka Zanaflex

NEURONAL STABILIZING AGENTS (antiseizure meds)
Many people call this class of medications "antiseizure medications." Actually, these meds are neuronal stabilizing agents. They work to stabilize the neuronal activity in the brain. Considering that Migraineurs have overactive neurons in the brain that, when a trigger is encountered, start firing in a wave and start a chain reaction that produces the symptoms of a Migraine attack, it makes sense to use them for Migraine prevention. These meds are only antiseizure meds when they're being used to prevent seizure activity.

  • Carbamazepine, aka Tegretol
  • Clonazepam, Klonopin
  • Clorazepate, aka Tranxene
  • Divalproex, aka Depakote
  • Gabapentin, aka Neurontin
  • Levetiracetam, Keppra
  • Lamotrigine, aka Lamictal
  • Oxcarbazepine, Trileptal
  • Tiagabine, aka Gabitril
  • Topiramate, aka Topamax
  • Valproate Sodium, aka Depacon
  • Zonisamide, aka Zonegran
  • Pregabalin, aka Lyrica

ERGOT ALKALOID:

  • Methylergonovine, aka Methergine (the only ergot used as a preventive)

LEUKOTRIENE BLOCKERS:

  • Montelukast, aka Singulair
  • Zafirlukast, aka Accolate
  • Zyleuton, aka Zyflo

OTHER:

DIETARY SUPPLEMENTS:

  • Coenzyme Q10
  • Feverfew
  • Butterbur, aka Petadolex
  • Magnesium
  • Vitamin B2
  • 5-HTP (Check carefully with doctor because of interactions with meds including triptans and SSRIs)
  • Lecithin
  • Melatonin

DEVICES:

  • The NTI Tension Suppression System, invented by Dr. Jim Boyd, has proven quite effective for some people who have problems with clenching or grinding their teeth in their sleep.

 

This list will be updated as more medications are successfully used for headache and Migraine prevention. If you're having problems finding an effective preventive regimen, sharing this list with your doctor may be helpful to you.

 

 


References:

FDA News Release. "FDA approves Botox to treat chronic migraine." U.S. Food and Drug Administration. October 15, 2010.

 News Release. "FDA approves Botox for Migraine headaches." Associated Press. October 15, 2010.

Friden, Joyce. "FDA Okays Botox to Prevent Migraines." MedPage Today. October 15, 2010.

Interview: Teri Robert with Dr. Stephen D. Silberstein. October 17, 2010.

Interview: Teri Robert with Dr. Fred Sheftell. October 18, 2010.

Rozen, TD, Oshinsky, ML, Gebeline, CA, Bradley, KC, Young, WB, Shechter, AL & Silberstein, SD. "Open label trial of coenzyme Q10 as a migraine preventive." Cephalalgia 22 (2), 137-141.

Andrew D. Hershey MD, PhD; Scott W. Powers PhD; Anna-Liisa B. Vockell RN, MSN, CPNP; Susan L. LeCates RN, MSN, CFNP; Priscilla L. Ellinor RN, MSN, CPNP; Ann Segers RN, Danny Burdine BA; Paula Manning RN; Marielle A. Kabbouche MD (2007). "Coenzyme Q10 Deficiency and Response to Supplementation in Pediatric and Adolescent Migraine." Headache 47(1), 73–80 doi:10.1111/j.1526-4610.2007.00652.x

Ramadan, Nahib M., MD; Silberstein, Stephen D., MD, FACP; Frietag, Frederick G., DO; Gilbert, Thomas T., MD, MPH; Frishberg, Benjamin M., MD. "Evidence-Based Guidelines for Migraine Headache in the Primary Care Setting: Pharmacological
 

Medical review by John Claude Krusz, PhD, MD

 

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Anyone interested in the concerns or patients with these disorders is welcome to join.

The AHMA exists to EASE the burden of Migraine and other headache disorders through Education, Awareness, Support, and Engagement.

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