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.
“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:
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
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, to find out what information to include in your migraine diary
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
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.
– 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 and mindfulness exercises.
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 on how to get into good sleep habits.
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:
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:
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:
if you find that you get headaches during, or after, exercise, speak to your doctor
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 on tips for losing weight
Conditions such as sleep apnea, insomnia, depression or anxiety can all make migraine worse so try to make sure you are managing and treating that condition
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:
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
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
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)
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:
there are other anti-GCRP therapies that can treat a migraine that’s in progress, which you can read more about in our article.
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 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 and migraine with aura
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
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
There are other herbs and supplements which may help with migraine prevention, but the jury is out on how beneficial they are.
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
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
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 – 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
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
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
If you get menstrual migraines, you may be able to stop them using hormonal or non-hormonal treatments.
non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen – read more about NSAIDs in migraine treatment article
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
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. 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
if your migraine attacks are happening more than once a month, your first step towards prevention is usually making lifestyle changes such as:
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), aren’t safe for ocular migraine prevention because in this type of migraine, they can increase your risk for permanent vision loss
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, propranolol, 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
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
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.
Important: Our website provides useful information but is not a substitute for medical advice. You should always seek the advice of your doctor when making decisions about your health.