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Migraines & headaches health centre

Migraine - Preventing migraine

NHS Choices Medical Reference

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Although there is no cure for migraine, it is often possible to manage the condition by using measures to prevent migraine attacks, as well as treatments.

Avoiding triggers

One of the best ways of preventing migraines is recognising the things that trigger an attack.

Keeping a migraine diary is helpful. You may find you tend to have a migraine after eating certain foods or when you are stressed. By avoiding this trigger, you can prevent a migraine.

Learn more about migraine triggers in causes of migraine.

Recognising the signs

Some people who experience migraines begin to feel unwell up to a day or so before a migraine attack.

The strange sensations that are sometimes felt before a migraine are known as the prodrome. They can include:

  • a change in mood
  • tiredness
  • hyperactivity
  • food cravings

As these feelings are not specific to migraine, it can be difficult to identify them as warning signs. Try to be aware of how you feel before a migraine. It can help to ask your relatives or friends if they notice any changes in you before you have a migraine.


Medication is available to prevent a migraine attack. These medicines are usually used if you have tried other preventative measures and you are still experiencing migraines.

You may also be prescribed these medicines if you experience very severe migraine attacks, or if your attacks happen frequently.

Medications used to prevent migraines are outlined below.


Beta-blockers include propranolol, metoprolol and timolol. They are traditionally used to treat angina and high blood pressure. It is not known how beta-blockers prevent migraine attacks.

Beta-blockers are unsuitable for people with:

  • asthma
  • chronic obstructive pulmonary disease (COPD)
  • vascular disease
  • heart failure

Possible side effects of beta-blockers are cold hands and feet, tiredness and hallucinations (seeing or hearing things that are not real).


Amitriptyline is a type of antidepressant, but it has also been shown to prevent migraines.

The medicine is usually started on a low dose, which can be increased if necessary. Amitriptyline can be used in combination with beta-blockers. It is unsuitable for people who:

  • have had a heart attack
  • have heart disease
  • have an irregular heart beat
  • have epilepsy


Topiramate is a type of anticonvulsant. Anticonvulsants are usually used to prevent seizures in people with epilepsy, but can also help prevent migraines. Topiramate is currently the only anticonvulsant licensed for migraine prevention in the UK.

Botulinum toxin type A

In June 2012, the National Institute of Health and Clinical Excellence (NICE) recommended the use of a medication called botulinum toxin type A to prevent headaches in some adults with chronic (long-term) migraine.

Botulinum toxin type A is a type neurotoxin (nerve toxin) that paralyses muscles, although it is not exactly clear why this treatment can be effective for migraine.

NICE recommends that this treatment can be considered as an option for people who have chronic migraine (headaches on at least 15 days of every month, at least eight days of which are migraine) that has not responded to at least three previous preventative medical treatments.

Under the new guidelines, botulinum toxin type A should be given by injection to between 31 and 39 sites around the head and back of the neck. A new course of treatment can be administered every 12 weeks.

Other drugs

A large number of other drugs have been suggested for the prevention of migraine, but there is limited evidence as to how effective most of them are. They include:

These medicines will only be prescribed when other treatments have failed.


If medication is unsuitable, or it doesn't help to prevent migraines, then you may want to consider acupuncture.

The National Institute of Health and Clinical Excellence (NICE) states that a course of up to 10 sessions over a 5-8 week period may be beneficial. Read more about acupuncture.

Medical Review: May 12, 2012
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