How to prevent migraines

Get the lowdown on migraine prevention medication, plus how to stop a migraine with non-drug treatments and lifestyle tips

Is migraine prevention right for you? 

Ways to prevent migraine 

Migraine prevention medication

How your pharmacist can help with migraine prevention 

Watch this space 

How do you prevent menstrual migraine?

How do you prevent ocular migraine?

How do you prevent vestibular migraine?

How do you prevent abdominal migraine?

Your question answered: Can Butterbur prevent migraine?	

Consider this – migraine is the 2nd leading cause of disability worldwide and the biggest cause of disability for women under 50, according to the Global Burden of Diseases 2019. They’re sobering statistics but if you get migraines, it may be possible to reduce how often you get them, how severe they are and how long they last.

## Is migraine prevention right for you? 

“Women often delay getting help for migraines, thinking it’s normal to have headaches. But if they’re affecting your daily life, if they’re stopping you from socialising or going to work or enjoying family life, then it’s time to get help,” says Dr. Ann Nainan, family doctor and Healthily expert. 

“Unfortunately there’s a lot of stigma around migraines and they may get dismissed as ‘just a headache’ when they can actually be debilitating. Thankfully, there are ways to prevent them, which include avoiding your triggers and taking preventive medications.” 

You and your doctor can come up with a preventative treatment plan if: 

- you want to take medication to stop migraines happening
- they’re happening on 4 or more days in a month
- your attacks are very severe or debilitating, even if they’re not very frequent
- acute treatment (medication you take for a migraine that’s in progress) isn’t working or you’re having to use medication very frequently. This could put you at risk of something called medication overuse headache (MOH). This is where you get headaches from frequently using medications to treat a migraine attack as it’s happening. Our article, [How to get rid of a migraine](/health-library/treatments/how-to-get-rid-of-a-migraine), explains more.


## Ways to prevent migraine 

### Identify your triggers

- a trigger is something that happens to you, or something that you do, which seems to bring on a migraine

- common triggers for migraines include stress, certain foods and skipping meals. Find out more about triggers in our article, [Get control of migraine](/health-library/conditions/migraine)

- keeping a migraine diary can help you work out what your triggers are so that you can learn to avoid or limit them. It can also help you notice any patterns to help stop a migraine taking hold. Read our article, [Get control of migraine](/health-library/conditions/migraine), to find out what information to include in your migraine diary 

### Avoid your triggers

- once you’ve worked out what your triggers are, think of your migraines as having a threshold. It might be that you can tolerate some of your triggers without having an attack. For example, missing a meal or drinking a glass of red wine on their own might not bring on a migraine. But if you combine those with a period of feeling stressed, that might trigger an attack

- divide your triggers into 2 groups – those you can do something about (such as drinking red wine) and those you can’t change (like your period) 

- try dealing with the triggers you can control. Cut out 1 trigger at a time 

– if you say goodbye to too many triggers at once you can’t be sure which is your migraine-inducing culprit. Keep notes to look back on and share with your doctor. [Or you could use the trackers in the Healthily app](https://www.livehealthily.com/app)

### Lifestyle changes to help prevent migraines 

As well as knowing and avoiding your migraine triggers, there are other lifestyle tweaks you can make which may affect how often you get migraines.

### Get a handle on stress 

- OK, there’s no magic pill for banishing stress but there are ways to learn to deal with it. Try figuring out what causes you to feel stressed regularly 

– you might be able to cut out some of those stressors

- maybe it’s hurried mornings when you’re having to get yourself and your kids out of the door in time for work and school. Think about what you could do to make mornings easier? If you have a partner, could you share the responsibility more? Could you get coats and shoes ready by the door the night before?

- if you know you’re going to be having a particularly stressful time at work – and you know that stress is a trigger for you – try to control other things during that time like your diet and how active you are, to see if it helps prevent a migraine

- make time for regular relaxation techniques to keep your stress levels on an even keel. Techniques include [deep breathing](/mind/5-breathing-exercises-for-instant-calm) and [mindfulness exercises](/mind/mindfulness).

### Sort your sleep 

- it’s all about trying to keep to a regular sleep pattern to reduce your chances of being stuck with a migraine. That means trying to get up and go to bed at around the same time each day, and making your bedroom as restful and device-free as possible

- read [more](/sleep/how-we-sleep-and-how-to-sleep-better) on how to get into good sleep habits. 

### Stay hydrated 

- when you don’t drink enough water you can get mildly dehydrated and that can be a migraine trigger

- why? The balance of water and other substances in your brain allows proper electrical function – and 1 theory is that if this balance is out of kilter, some receptors can be activated which may cause a migraine

- keep hydrated by:
  - drinking water before and after exercising
  - carrying a reusable water bottle around with you
  - sipping water regularly through the day to avoid getting thirsty

### Eat regularly 

- skipping meals can mean that your blood sugar levels dip and if you get migraines you might find this makes you more likely to have an attack or the symptoms more painful

- reduce your risk by:
  - keeping your blood sugar levels stable by eating a healthy, balanced diet that includes lots of fruit and vegetables
  - having small, regular, low-sugar meals
  - trying not to miss breakfast or skip meals

### Keep on moving 

- research shows that exercise could help ease how often you get migraines and how severe they are 

- this could be because exercise stimulates the release of certain chemicals in your body – endorphins which are your body’s ‘natural’ painkillers, plus enkephalins which are your body’s ‘natural’ anti-depressants

- there’s evidence that mild aerobic exercise is most beneficial if you get migraines – so you might find it helpful to choose jogging, swimming, dancing or cycling

- on the flipside, some people find that exercise is actually a trigger for migraine. That could be for reasons such as:
  - not eating properly before working out so your blood sugar levels are low
  - not being hydrated enough before and during exercise
  - starting a strenuous new exercise plan at the same time as a new diet – together these factors could act as a trigger

- if you find that you get headaches during, or after, exercise, speak to your doctor

### Find your healthy weight

- there’s a link between migraines and being overweight or obese

- it’s thought that when you’re obese this keeps your body in a mild but constant state of inflammation. As part of that inflammation process, your body releases pain-generating hormones from fat cells – and there is a similar release of these hormones during a migraine attack

- so if you’re obese, there may be an extra factor which adds to pain and how often you get migraines

- read our [article](/self-care/tips-for-losing-weight) on tips for losing weight

### Address any other health conditions

Conditions such as [sleep apnea](/health-library/conditions/sleep-apnoea), [insomnia](/health-library/conditions/insomnia), [depression](/health-library/conditions/depression) or [anxiety](/health-library/conditions/anxiety) can all make migraine worse so try to make sure you are managing and treating that condition 


Get help with this

## Migraine prevention medication

There are several different medications that are used to prevent migraines, from older, tried and tested drugs to newer options. 

Your doctor will discuss risks and benefits and take into consideration any other medical problems you have or if you’re considering getting pregnant. They will usually first recommend medications with the best evidence that they work. 

Types of migraine prevention medication include:

### Blood pressure medications

- a traditional type of prevention usually used as a 1st option for migraine prevention, beta blockers work by lowering your heart rate. Examples include propranolol and timolol 

- you usually take these medications as an oral tablet every day

- the most common side effects include feeling dizzy when you stand up and fatigue 

- candesartan is another type of blood pressure that can prevent migraine. The most common side effects are dizziness and low blood pressure 

### Anti-seizure medications

- some medicines which are used to treat epilepsy can also be used to prevent migraines

- Topiramate is 1 of the first line treatments – it reduces bursts of electrical activity in your brain and restores the normal balance of your brain’s nerve activity. Side effects may include tingling sensations (1-11% of people), weight loss (4-9% of people), dizziness (4-29% of people), memory problems (2–12% of people) and fatigue (9-16% of people)

- Sodium valproate is another anti-seizure medication that’s occasionally used. Side effects include lack of energy (16-20% of people) and weight gain (4% of people). It isn’t suitable if you have liver disease or you’re thinking about getting pregnant

### Antidepressant medications

- amitriptyline was originally used to treat depression, but it can also prevent migraine – it can be particularly useful if you have migraine and you have trouble sleeping. Side effects include drowsiness (in 1% of people to more than 10% of people)

- venlafaxine is a newer antidepressant which has some evidence that it can help prevent migraines. It’s a selective serotonin and noradrenaline reuptake inhibitor (SSNRI) which means that it increases mood-enhancing chemicals in your brain. Side effects may include nausea (21-58% of people) and insomnia (15–24% of people)

### Anti-calcitonin gene-related peptide (CGRP) therapies 

- CGRP is a protein in your body which plays a role in the pain you feel during migraine 

- anti-GGRP therapies are newer treatments for prevention and they include erenumab which blocks the CGRP docking station (AKA the receptor). Others such as galcanezumab and fremanezumab block CGRP protein itself

- the benefit of these treatments is that they’re suitable for people with heart disease, stroke and vascular diseases – older types of triptan medications aren’t safe for people with these conditions. Anti-CGRP therapies also have fewer side effects than other preventative medication

- these treatments are delivered through injection or IV infusion

- side effects can include:
  - getting pain and/or a reaction on the site where you’ve had the injection. This can happen in 5-6% of people being administered erenumab, 18% of people being given galcanezumab 18% and 5% of people taking fremanezumab
  - constipation in 1-3% of people taking erenumab

- there are other anti-GCRP therapies that can treat a migraine that’s in progress, which you can read more about in our [article](/health-library/treatments/how-to-get-rid-of-a-migraine). 

## How your pharmacist can help with migraine prevention 

There are several herbs and supplements that are believed to help prevent migraine. We run through the evidence for some of the most commonly used. 

### Magnesium 

- magnesium is one of the most studied supplements for preventing migraine

- research has found that people who get migraines may be lacking magnesium and that magnesium levels in your brain can be low before an attack. So taking a magnesium supplement may help prevent attacks 

- 600mg of magnesium citrate per day has been found to be the most beneficial for migraine prevention in research studies. But there is a risk of diarrhea with magnesium supplements so you might want to start on a lower dose and build up to 600mg per day or however much you can take without getting diarrhea

- the evidence for magnesium is limited but it is potentially most helpful with [menstrual migraine](/health-library/conditions/migraine) and [migraine with aura](/health-library/conditions/migraine)

- you can buy magnesium supplements from pharmacies and health food stores. You can also find magnesium in foods such as spinach, nuts and wholewheat bread

### Riboflavin (vitamin B2)

- In 1 study looking at riboflavin and migraine, just over half of people taking a 400mg supplement every day for 3 months, saw a 50% or greater reduction in their migraines – both in terms of how often they got migraines and their number of headache days

- side effects are minimal but it can make your urine look more yellow 


## Watch this space 

There are other herbs and supplements which may help with migraine prevention, but the jury is out on how beneficial they are. 

### Coenzyme Q10 (CoQ10)

- as with magnesium and riboflavin, it’s thought that a lack of CoQ10 – a vitamin-like compound – in your body may be a cause of migraine

- in 1 review of research studies which involved 371 participants, CoQ10 supplements reduced how long migraines lasted by 0.19 hours, and also reduced how often people got migraine attacks by 1.52 times per month 

- no evidence of serious side effects have been reported but it can interact with medication such as blood thinners and insulin. More evidence is needed to know more about the benefit of taking a CoQ10 supplement to prevent migraine  

### Feverfew

- some studies suggest that taking dried leaf capsules of feverfew – a plant that’s closely related to chrysanthemums – may reduce how often you get migraines for those with chronic migraine 

- again, the evidence is limited and not all studies have shown it works. Reported side effects include nausea and bloating

### Other alternative treatments for migraine prevention 

#### Acupuncture

- a treatment that comes from ancient Chinese medicine where fine needles are inserted at various areas around your body for therapeutic or preventative purposes

- there’s some evidence that acupuncture can help prevent migraine –  up to 10 acupuncture sessions over 5–8 weeks may be beneficial

- in a 2016 review of research studies involving almost 5,000 people, the frequency of migraine dropped by 50% or more in up to 59% of people who received acupuncture – and this could last for more than 6 months

- it’s not exactly clear how acupuncture might help prevent or ease migraine – 1 theory is that it may activate pathways in your brain responsible for switching off pain

#### Botox injections for migraine

- Botox – yes, the same kind that’s used to combat wrinkles – is a neurotoxin that’s approved for migraine prevention

- it’s a poison that acts on your nervous system and it potentially works for migraine by blocking the pain signals in your head, neck and shoulders

- research has found that Botox treatment can reduce the number of headache days per month by about 50%

- you’d usually have injections every 12 weeks or your doctor may recommend different intervals

- side effects include neck pain (in around 8–9% of people), usually in the week after you’ve had the procedure. You may also get a headache on the day of, or the day after, the injection 

#### Greater occipital nerve (GON) blocks

- your greater occipital nerve feeds into your trigeminal nucleus – which is an area in your brain where there’s an increase in pain and other sensory messages when you get a migraine

- with this treatment, you’re given an injection of local anaesthetic and steroid around your GON, at the back of your head and top of your neck. The injection reduces traffic to your GON and so reduces migraine symptoms

- about 2 thirds of people with migraine find relief with GON blocks

- around 1 in 30 people find that their head pain gets temporarily worse

- you may find benefits last for up to 3 months, though for others the effect of the injection can lessen after a few weeks

#### Medical devices

- neuromodulation devices are a drug-free option for migraine prevention. The idea is that they work by changing the activity of the nerve pathways in your brain, through electrical currents or magnets

- __Transcranial Magnetic Stimulation (TMS)__ – is approved by the US Food & Drug Administration (FDA) for migraine prevention. You place the device at the back of your head for less than a minute and it generates magnetic impulses which affect the electric signaling in your brain. It’s painless and has no major side effects 

- __Transcutaneous Supraorbital Neurostimulator__ – also FDA approved for preventing migraine, this device uses electrical stimulation to stimulate the nerves in your head. You wear the device across your forehead, a bit like a headband. Research has found a 30% reduction in the number of migraine days experienced in a month when using the device, and a 37% decrease in the amount of as-needed migraine medications taken in a month


## How do you prevent menstrual migraine?

If you get menstrual migraines, you may be able to stop them using hormonal or non-hormonal treatments. 

### Non-hormonal treatments 

- __non-steroidal anti-inflammatory drugs (NSAIDs)__ such as ibuprofen – read more about NSAIDs in [migraine treatment article](/health-library/treatments/how-to-get-rid-of-a-migraine)

- __triptans__ – a type of painkiller specifically for migraines and usually used for acute treatment. Frovaptriptan is licensed for preventing menstrual migraines and you can take it 2 days before, to 3 days after, your period. Tripans work by reversing the widening of your blood vessels around your brain, which is thought to be part of why migraine happens. Read more about triptans in our [migraine treatment article](/health-library/treatments/how-to-get-rid-of-a-migraine)

### Hormonal treatments

- if you need contraception or your periods are irregular – making it harder to take prevention only around the time of your periods – you might find that regular contraceptives help your menstrual migraine. These may be:

  - __combined hormonal contraceptives__ – for example, combined [contraceptive pill, patch or vaginal ring](/sexual-health/15-different-types-of-contraception). If you take the combined pill and you get migraine during your pill-free week, you may be able to take the pill without a break to manage your migraines. The combined pill isn’t suitable if you get migraine with aura – that’s because the combined pill comes with a very small increased risk for stroke. That risk increases when the pill is taken by women who get migraine with aura. In that case, progesterone-only contraception (below) is often used, but it’s worth noting that some women experience irregular bleeding which can bring a migraine with it

  - __progesterone-only contraceptives__ – such as the pill, implant or injection

- you might find that topping up your estrogen levels before and during your period helps with menstrual migraines. You can do this with skin patches or gels and it’s most effective if you have regular periods. You can top up for 7 days, from 3 days before your period 


## How do you prevent ocular migraine?

- if your migraine attacks are happening more than once a month, your first step towards prevention is usually making lifestyle changes such as: 
  - avoiding triggers in your diet such as caffeine and alcohol
  - controlling high blood pressure
  - quitting smoking

- if lifestyle changes don’t help, you may need preventative medication, such as calcium channel blockers (for example, nifedipine or verapamil)

- triptans and ergots (which are commonly used for treating a [migraine that’s in progress)](/health-library/treatments/how-to-get-rid-of-a-migraine), aren’t safe for ocular migraine prevention because in this type of migraine, they can increase your risk for permanent vision loss

## How do you prevent vestibular migraine?

- as with other types of migraine, your first line of prevention is working out your triggers with the help of a migraine diary and then limiting/avoiding those triggers if you can

- prevention medications suitable for vestibular migraine include [amitriptyline](/self-care/how-to-prevent-migraines/#antidepressant-medications), [propranolol](/self-care/how-to-prevent-migraines/#blood-pressure-medications), beta blockers, candesartan and flunarizine which is a calcium channel blocker

- [GON blocks](/self-care/how-to-prevent-migraines/#greater- occipital-nerve-gon-blocks) are also used to prevent vestibular migraine 


## How do you prevent abdominal migraine?

- lifestyle changes are important here, particularly when it comes to eating and sleeping

- it can help to eat slow-release energy foods such as multigrain breads, sweet potato and porridge, and avoid too many carbohydrates. Having a bedtime snack can also be beneficial 

- you or your child might be prescribed preventative medication such as pizotifen which is suitable for children

## Your question answered: Can Butterbur prevent migraine?	

Some studies have found that this shrub can help reduce the frequency of migraine attacks in adults and children. It used to be recommended by the American Academy of Neurology for preventing migraines but this recommendation was withdrawn in 2015 because there are serious safety concerns about its effects on the liver.

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References

 Christina Quaine

Colette Harris

Dr Ann Nainan

Dr Adiele Hoffman

Article information

All of Healthily's articles undergo medical safety checks to verify that the information is medically safe. View more details in our <a href="/safety" target="_blank" rel="noopener noreferrer">safety page</a>, or read our <a href="/legal/editorial-policy-principles" target="_blank" rel="noopener noreferrer">editorial policy</a>.

Get the lowdown on migraine prevention medication, plus how to stop a migraine with non-drug treatments and lifestyle tips.