Medicines to Prevent Headaches

Preventive medicines are taken every day to reduce the number and severity of headache attacks. These medicines also improve the effect of the acute medications.

When are they prescribed?

You may benefit from a preventive medicine if:

• Bad headaches occur more than once a week, or interfere with school or activities

• Rescue medicines are not working

• Headaches continue, even after making positive lifestyle changes

• Some headache is there all the time

What types of medicines are used to prevent headaches?

There are several medicines used for headache control, including anti-seizure medicines, anti-depressants, antihistamines, beta blockers and calcium channel blockers. While these medicines were originally developed for other purposes, they have been shown to work well to prevent headaches. New migraine-specific medicines targeting CGRP have been approved for use in adults, but they are still being studied in children and teens.

Are there side effects?

When these medicines are used to prevent headaches, you can take a low dose. Since the dose is low, there are few side effects. If you read about a medicine on the internet, you will see many side effects listed. This information is usually for high doses. Most of our patients have very mild or no side effects from these medicines.

How long do the medicines take to work?

These medicines can take 2-3 months to work. Our goal is to reduce your headaches by half in the next 3 months. If the headaches greatly improve after 6 months, we will slowly lower the medicine until none is needed.

What can I do to make sure the preventive medicine has a chance to work?

• Take the medicine as prescribed.

• If you miss a dose, take it as soon as you remember. However, if it is almost time for the next dose, or the medicine will make you too tired to go to school, it is okay to skip one dose.

• Limit the use of acute medications to 2-3 days per week. See “Acute Medicines for Headaches” handout.

• Work hard to stick to SMART lifestyle changes. See “SMART Lifestyle Changes” handout.

Reviewed June 2024 by Christina L. Szperka, MD, MSCE