Preventive migraine medication guide
Preventive migraine medication is used to reduce how often migraines happen and how severe they feel, rather than stopping a single attack once it starts. For many Canadians, prevention becomes part of care when migraines disrupt work, school, or family life. Understanding options, expected benefits, and safety considerations can help you discuss a plan with a clinician.
Migraines can be unpredictable and disruptive, but prevention can make them more manageable over time. In Canada, preventive medications are typically considered when migraine attacks are frequent, disabling, or difficult to control with acute (“as-needed”) treatments alone. The goal is not to eliminate every headache, but to lower the number of migraine days, reduce intensity, and make attacks easier to treat when they occur.
Who needs preventive migraine treatment?
Preventive treatment is often discussed when you have frequent migraine days, prolonged attacks, or substantial day-to-day impairment. Clinicians may also consider prevention if acute medications are needed often (which can raise the risk of medication-overuse headache), if side effects limit acute options, or if migraine is complicated by conditions such as persistent aura. Importantly, “needs” is individualized: a person with fewer attacks may still benefit if each episode is highly disabling, while someone with more frequent mild episodes may start with non-drug strategies first.
Types of medications used to prevent migraines
Preventive options include several medication classes, and the choice often reflects your migraine pattern, other health conditions, and prior response to treatment. Common categories include blood-pressure medicines (such as beta blockers), anti-seizure medicines, and certain antidepressants that also affect pain pathways. For chronic migraine, injections of onabotulinumtoxinA can be used in specific protocols. Newer migraine-specific preventives target calcitonin gene-related peptide (CGRP) pathways, often delivered as periodic injections and, in some places, as intravenous infusions.
How preventive migraine medications work
Most preventives work by lowering the brain’s tendency to enter a migraine state. Beta blockers can dampen adrenergic “stress” signalling and help stabilize blood-vessel and nerve responses. Anti-seizure medications may reduce neuronal hyperexcitability and abnormal firing that contributes to migraine initiation. Some antidepressants influence serotonin and norepinephrine signalling, which can affect pain modulation and sleep quality—both relevant to migraine thresholds. CGRP-targeting therapies work more directly on a key migraine messenger involved in inflammation-like signalling and pain transmission in trigeminal pathways.
Possible side effects and safety considerations
Side effects vary widely by medication class and by individual. Beta blockers can cause fatigue, dizziness, or lower heart rate and may not be suitable for some people with asthma or certain cardiac conditions. Anti-seizure medications can affect concentration, appetite, mood, or sensation (for example, tingling), and some require extra attention to pregnancy planning because of fetal risk. Antidepressants used for prevention may cause dry mouth, constipation, or sedation, and can interact with other medicines. CGRP therapies are generally not associated with sedation, but can cause injection-site reactions and, for some people, constipation. Any preventive plan should include a review of other health conditions, pregnancy intentions, and possible drug interactions.
How to choose the right preventive treatment
A practical way to compare options is to look at whether the medicine is migraine-specific, how it’s taken, and what safety checks it may require. The examples below are commonly discussed in migraine care; availability, indications, and coverage can vary by province and by individual insurance policies.
| Product/Service Name | Provider | Key Features/Benefits |
|---|---|---|
| Propranolol (generic) | Generic (multiple manufacturers) | Oral beta blocker; may fit when anxiety/tremor or high blood pressure coexist; typically taken daily. |
| Topiramate (generic) | Generic (multiple manufacturers) | Oral anti-seizure medicine; can help some people with frequent migraine; may need gradual dose changes. |
| Amitriptyline (generic) | Generic (multiple manufacturers) | Oral tricyclic antidepressant; sometimes helpful when sleep disruption or certain pain syndromes coexist. |
| OnabotulinumtoxinA (Botox) | AbbVie | Injection protocol used for chronic migraine in appropriate patients; administered on a scheduled cycle. |
| Erenumab (Aimovig) | Amgen/Novartis | CGRP receptor-targeting injection; migraine-specific preventive option with periodic dosing. |
| Fremanezumab (Ajovy) | Teva | CGRP ligand-targeting injection; migraine-specific preventive option with periodic dosing. |
| Galcanezumab (Emgality) | Eli Lilly | CGRP ligand-targeting injection; migraine-specific preventive option with periodic dosing. |
| Eptinezumab (Vyepti) | Lundbeck | CGRP-targeting intravenous infusion given on a scheduled cycle in supervised settings. |
Choosing among these options usually comes down to balancing three factors: expected benefit, tolerability, and fit with your health profile. For example, if you also have high blood pressure, a beta blocker may be appealing; if you struggle with sleep, a sedating option taken at night might be considered; and if daily pills have been hard to tolerate, a scheduled injection may be simpler. Many clinicians also recommend tracking migraine days and triggers for at least 8–12 weeks after starting a preventive, because benefits can take time and dose adjustments are common.
This article is for informational purposes only and should not be considered medical advice. Please consult a qualified healthcare professional for personalized guidance and treatment.
Prevention works best as a long-term strategy: the “right” medication is one you can take safely and consistently, with measurable improvement in migraine frequency or disability. With a clear baseline, realistic goals, and periodic review, preventive therapy can become a stable foundation that supports daily life while leaving room to adapt as your needs change.
