How does preventive therapy work?
Some people take daily medications to prevent headaches. In many cases, researchers developed these medications for other medical conditions. But they discovered that the drugs also help headaches. These medications won’t cure headaches. However, they can reduce the frequency, duration and severity of headache attacks.
Preventive medications can be either OTC or prescription. While these drugs are not habit-forming, they may cause unpleasant side effects. Your healthcare provider will work with you to regulate the dosage. The goal is to maximize headache relief and minimize side effects.
Should I consider preventive therapy?
If you use symptomatic relief or abortive therapies more than twice a week, talk to your healthcare provider about daily preventive therapy. In addition, try other forms of headache treatment to decrease your headache attacks, such as:
- Adequate hydration (six to eight glasses of water per day).
- Biofeedback.
- Enough sleep (at least eight hours per night).
- Exercise.
- Dietary changes.
What should I expect when taking preventive headache medications?
You need to take preventive medicines one or more times a day. Stick to your medication regimen, and don’t skip a day. You may find that you need to switch medications and change dosages until you figure out the right solution for you.
While you’re taking the medication, record your headache frequency and severity each day. Doing so will help your provider figure out how the medicines are working. And remember, it may take some time to feel the full effects. Typically, you need about eight weeks before you and your provider can judge how it’s working.
Can I ever stop taking preventive medications?
Once you’ve achieved headache control and maintained it for six months to a year, you may be able to stop the medications. Don’t stop taking them all at once — your provider will help you slowly reduce the dosage. Some people may need to take the medication longer.
Can children take preventive therapies?
The FDA has not approved preventive therapies for use in children. Talk to your child’s healthcare provider to figure out the best treatment plan for any headaches.
What types of preventive therapy medications are available?
Medications to prevent headaches include:
Generic name: Amitriptyline HCI
- Brand name: Elavil®.
- Possible major side effects: Fatigue, dry mouth, weight gain and constipation.
- Instructions when used for headaches: Start at low dosages and slowly increase to a therapeutic level. Usually taken at night. You may need an EKG.
Generic name: Antihistaminescyproheptadine HCI (syrup or tablet)
- Brand name: Periactin®.
- Possible major side effects: May induce sleep. Can cause weight gain and drowsiness.
- Instructions when used for headaches: Start at low dosages and slowly increase. Usually taken at bedtime.
Generic name: Botulinum toxin injection
- Brand name: Botox®, Dysport®, Seomin® and Mybloc®.
- Possible side effects: Side effects from botulinum toxin injections vary depending on the area receiving treatment. Most problems improve in a day or two. They include: pain, swelling or discoloration at the injection site, flu-like symptoms, headache, neck pain, upset stomach, eyelid drooping and eye irritation or redness.
Generic name: Calcitonin gene receptor peptide (CGRP) antagonist, erenumab-aooe
- Brand name: Aimovig®.
- Possible side effects: Injection site reaction, constipation, cramps and muscle spasms.
Generic name: Gepants, rimegepant
- Brand name: NURTEC®.
- Possible side effects: Allergic reactions, including trouble breathing and rash, nausea, stomach pain/indigestion.
Generic name: Beta blockers atenolol, propranolol HCI
- Brand name: Tenormin®, Inderal®.
- Possible major side effects: Fatigue, depression, weight gain, faintness and diarrhea, memory disturbance, decreased performance among athletes.
- Instructions when used for headaches: One to three times a day, depending on the form.
Generic name: Calcium channel blockers, verapamil, flunarizine
- Brand name: Calan®, Isoptin®, Sibelium®.
- Possible major side effects: Constipation, dizziness, hair loss.
- Instructions when used for headaches: Start at low dosages and slowly increase. Taken twice a day. Usually, the first dose is in the morning.
Generic name: Anticonvulsants valproic acid
- Brand name: Depakote®.
- Possible major side effects: Nausea, drowsiness, weight gain, tremors, rare liver failure. May cause birth defects.
- Instructions when used for headaches: Start at low dosages and slowly increase. You may need periodic blood tests.
Generic name: Topiramate
- Brand name: Topamax®.
- Possible major side effects: Rare: glaucoma, kidney stones (when you take a higher dose, usually more than 150 milligrams), weight loss, word-finding difficulties.
- Instructions when used for headaches: Start at low dosages and slowly increase. May be taken two to three times per day.
Generic name: Gabapentin
- Brand name: Neurontin®.
- Possible major side effects: Generally well tolerated.
- Instructions when used for headaches: Start at low dosages and slowly increase. May be taken two to three times per day.
*Other SSRIs include citalopram (Celexa®), escitalopram (Lexapro®), fluvoxamine (Luvox®), paroxetine (Paxil®), sertraline (Zoloft®).