Choosing the best PRESCRIPTION preventive migraine treatment for you (if you have episodic migraines)!

The below isn't medical advice, but educational knowledge to go prepared with when meeting with your neurologist. 

Episodic migraines are migraines that occur less than 15 times per month. Anything more is chronic migraines.

Let’s get to the point so you don’t need to read more information than you want.

There are 4 main categories you should expect to be prescribed if you have episodic migraines.

Beta blockers: metoprolol, propranolol, timolol

Antidepressants (there are two of different classes): Amitriptyline (a TCA) and venlafaxine (an SNRI)

Anticonvulsants: Valproate (valproic acid), topiramate (more commonly known as the brand name Topamax)

CGRP antagonists: Rimegepant, atogepant, fremanezumab, galcanezumab, eptinezumab.

Due to high cost and hurdles health insurance will put you through, at least in the states, CGRP antagonists are generally only prescribed when other classes have failed. (Yes, I know, this is terrible since they generally work well- at least for a period of time).

Now, which medication is chosen for you as a patient? This requires individualized patient care and a good understanding of a patient’s medical history.

Depression? An antidepressant like the ones listed above may be of benefit.

Insomnia? Amitriptyline.

Obesity? Topamax

Autoimmune condition with Raynaud’s or Raynaud’s alone? Calcium channel blockers. Why aren’t they listed above with the other classes? Data isn’t so great.

Does the patient have hypertension and is less than 60 years of age and a nonsmoker? Then going for the beta blockers is best barring no contraindications. (For smokers or over the age of 60, beta blockers may increase the rate of cardiovascular events so a calcium channel blocker may be indicated instead).

Treatment failure or side effects? Switch to another class.