9. Preventive Treatments for Migraine

  1. Matthew S. Robbins MD,
  2. Brian M. Grosberg MD and
  3. Richard B. Lipton MD
  1. William B. Young

Published Online: 19 JUL 2013

DOI: 10.1002/9781118678961.ch9



How to Cite

Young, W. B. (2013) Preventive Treatments for Migraine, in Headache (eds M. S. Robbins, B. M. Grosberg and R. B. Lipton), John Wiley & Sons, Ltd, Oxford, UK. doi: 10.1002/9781118678961.ch9

Editor Information

  1. Montefi ore Headache Center, Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA

Author Information

  1. Thomas Jefferson University, Philadelphia, PA, USA

Publication History

  1. Published Online: 19 JUL 2013

ISBN Information

Print ISBN: 9780470654729

Online ISBN: 9781118678961



  • Migraine preventive drugs;
  • migraine prophylaxis;
  • medication overuse;
  • propranolol;
  • timolol;
  • amitriptyline;
  • valproic acid;
  • topiramate


Treatment with preventive migraine medication is necessary when migraine causes undue distress or dysfunction or the patient is at risk for clinical deterioration. Migraine preventives are generally not chosen based on demonstrated superior efficacy, since there is no evidence of such therapeutic superiority. Choices are made on the basis of comorbid conditions, to minimize unwanted side effects, or take advantage of potentially beneficial ones. Other considerations include costs, convenience, and previous response to medications. Among the anticonvulsants, the strongest evidence for efficacy is for valproic acid and topiramate. Gabapentin is less effective. Amitriptyline and venlafaxine have been shown to be effective. Propranolol, timolol, and metoprolol are the beta-blockers with the strongest evidence of efficacy. Lisinopril and candesartan appear to be effective, while verapamil works weakly. Botulinum Toxin A is probably not effective for episodic migraine but is effective for chronic migraine. Butterbur extract is effective. Riboflavin, magnesium, coenzyme Q, thioctic acid (alpha lipoic acid), and fevefew may be effective migraine preventives.