- This is a post taken from excerpts from comments I shared between another migraine patient and I in regards to preventive migraine treatment. I wanted to share it in a blog post, as I didn’t want the information to be overlooked in the comments section. With that said, here is my non-medical, non-authoritative, non-expert, simpleton opinion. If you haven’t tried preventatives to decrease the frequency of the migraines or other headache conditions, I absolutely think you should.
The American Academy of Neurology (AAN) just issued new guidelines on preventive medications for migraines, and listed them according to “proven to be helpful” and “probably helpful.” Drugs that were “proven” to be helpful were given a “Level A” rating. Among the A rating drugs “proven” to be helpful, one triptan made the list, and it was Frovatriptan (Frova). The other medications receiving a Level A rating were the following: 
Divalproex sodium (Depakote)
Sodium valproate (Depacon)
Metoprolol (Lopressor, Toprol-XL)
Timolol (Blocadren, but no longer sold under that name in the U.S.) 
Personally, I have not had any luck with the anticonvulsants reducing the frequency of migraine attacks, and I can’t tolerate the side effects either. Some patients, including myself, refer to Topamax colloquially as “Dopamax”, as it can make some patients feel like their mind has turned into mashed potatoes. My mind felt slower, my wit duller, and I couldn’t ever find my car keys. I still can’t find my cars keys most mornings, so the latter example may only apply to me. Matter of fact, do a search for the slang word “Dopamax” (a completely made up word by patients on the medication) on Google and you will see over 14,000 results. However, this drug has received a Level A rating as proven effective from the AAN, and it is widely reported as helpful in a great deal of patients in reducing the frequency of migraine attacks. All of our bodies are different, and this might just be the medication you need for relief. I know of migraine patients that swear by it, and you couldn’t take it out of their medicine cabinet with a SWAT team, so this may be a medication you want to talk to your doctor about adding to your arsenal.
Next, I would try an herbal supplement (I know, I know, don’t give me that look) called Butterbur, that is used as a headache preventive as well. It is widely reported that Native Americans used the root of Butterbur to treat headaches and some types of inflammation. There are also a variety of double-blind studies that show that Butterbur is effective for reducing the frequency of migraines, and may even relieve a migraine in progress. One of the better known and recommended forms of this herb is a patented drug called Petadolex. I take this medication and I do believe that it has helped in reducing the frequency of migraine attacks, but I have not had any success with it relieving the pain of the attack once it has started. I like Petadolex, as they have a patented process for removing all of the unnecessary alkaloids from the Butterbur that can be toxic to the liver and may cause some cancers, leaving only the good stuff to prevent migraines. I order my Petadolex online and I am signed up for monthly delivery. I order from here: https://www.petadolex.com/
I have also had some success with a beta-blocker called Metoprolol (Lopressor, Toprol-XL) and take this medication daily. Propranolol (Inderal) and Toprol-XL are recommended by the American Headache Society as a preventative for migraine headaches.  Both of these medications received a Level A rating by the AAN as well and are stated by the AAN as a proven effective medication for the prevention of migraine attacks. 
Another factor you may want to consider is your diet, and the amount of essential vitamins you are fueling your body with, such as vitamin D, magnesium, vitamin B6 and vitamin B 12. Studies have shown that a lack of these essential vitamins can lead to a host of health problems, including migraines.   Unfortunately, none of these essential vitamins are included in sufficient amounts in the junk food most of us put into our bodies, so you might need to talk to your doctor about taking supplements. I have done extensive research with Oreos and chocolate cake, but I have no solid evidence that they are increasing my vitamin levels sufficiently, the rigorous research continues . You might also need to have your vitamin D levels checked, as many people, not just migraine patients, have a low level of vitamin D, which can cause all sorts of problems, including headaches.
Other over the counter medications that were rated as “probable efficacy” in the prevention of migraines were: magnesium, riboflavin, histamine SC, and the herbal supplement feverfew.  Feverfew has been used for centuries in Europe, and many people find relief from acute pain from migraine, and well as a reduction in frequency of attacks.  I have had some luck with feverfew in combination with magnesium, vitamin B2, vitamin D, and certainly think you should give it a try if your doctor approves. Feverfew can increase a bleeding risk, much like aspirin, so be certain you have talked to your doctor before taking this supplement
Some antidepressants can work as a preventive for migraines as well, and may help with the depression and anxiety often associated with migraine patients. Talk to your doctor about which medications might be right for you.
Other things I would suggest are getting some exercise. Slow, moderate, exercise (e.g. walking, Pilates, Yoga, Tai Chi, etc.) are good ways for migraine patients to get some physical activity, without the overexertion that can trigger a migraine in some patients. So grab the leash and take the dog for a stroll or find a local facility to try some of the suggested activities. Even using videos at home can be effective, and can be bought cheaply over the internet. I have also found that getting a massage can help reduce the tension and anxiety that can trigger my migraines, and can be a wonderfully needed break from the hustle and bustle of daily life. I actually have a prescription for one massage a week (Thank you Dr. Robbins!) and these work wonders for relaxation and releasing tension in muscles that trigger my migraines.
You may also want to try aromatherapy. I have had success with peppermint oil and rub it on my temples and forehead, as this can give that tingling feeling that can sometimes help reduce pain and the smell of peppermint can help with the nausea. I also rub this on my pillow when I have a migraine so I can smell the peppermint, as my sense of smell gets so strong during an attack that I can smell my dogs like they are in my lap. I also like the product CryoDerm, which is a topical roll-on ointment that contains Menthol as the active ingredient. I rub this on my neck, shoulders, temples, and forehead when I feel tension or a headache starting to occur and it can help ease muscle tension and sometimes keep the headache from progressing as quickly.
As you probably are aware, you are going to have to try combinations of these medications and supplements, play with the dosages, and give them time to work. Don’t expect to see any change until at least a month or so of taking them per your doctor’s orders. Basically, I have to take a shotgun approach to treating my migraines, as there is just nothing in existence I have found that stops the migraine in its tracks. Even when I have to go to the ER (maybe once a year) for strong opiate and nausea medication injections, when everything else has failed, it doesn’t stop all the pain, but it does reduce the pain and nausea allowing me to finally go to sleep, which allows my brain to “reboot” as I call it.
Finally, read and learn as much as you can about your specific headache condition, as knowledge is power, especially in the world of a migraine patient. Many doctors are not aware or as educated as they should be in the treatment of headache disorders and medications, and in the end, your body and input to your doctor is going to determine what works best for you.
If you are suffering from headaches of any type, and your current method of treating them isn’t working, talk to your doctor about adding preventatives to your treatment plan to decrease the frequency of attacks. If your book shelf doesn’t look like mine, and your medicine cabinet does not contain the copious amounts of preventatives and supplements that mine does, perhaps it should.
As always talk to your doctor about these medications and supplements before you begin taking them, and get their educated opinion on what they think you should try or what could be contraindicated for you based on current medications you are taking. Remember, I am just a migraine patient, and all I am sharing is my opinion based on my personal experience of living with chronic migraines for over 30 years. You should always talk to your doctor before beginning any exercise, medication, or herbal supplement program.
Please feel free to share your experiences and what you have found that works best for you. I hope my comments are of some use to those of you suffering. Take care of yourself, give yourself a break, remember you are not alone, and as always, try your best to “Keep Calm and Carry On.”
Wishing you all the best in life and your treatment,
Chronic Migraine Patient
1. Silberstein S, et al “Evidence-based guideline update — pharmacologic treatment for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society” Neurology 2012; 78: 1337-45.
2. Holland S, et al “Evidence-based guideline update — NSAIDs and other complementary treatments for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society” Neurology 2012; 78:1346-53.
3. Lipton RB, Göbel H, Einhäupl KM, Wilks K, Mauskop A (December 2004). “Petasites hybridus root (butterbur) is an effective preventive treatment for migraine”. Neurology 63 (12): 2240–4. PMID 15623680.
4. European Journal of Neurology (2004;11:475-7), Genomics Research Centre (GRC) at Griffith University in Brisbane.
5. “Journal of Headache and Pain”; The prevalence of headache may be related with the latitude: a possible role of Vitamin D insufficiency?; S Prakash, NC Mehta, AS Dabhi, O Lakhani, M Khilari, ND Shah; 2010
*Additional Sources and article review: By John Gever, Senior Editor, MedPage Today
Published: April 23, 2012; Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania. Full Article may be read at: https://www.medpagetoday.com/MeetingCoverage/AANMeeting/32304?utm_source=share&utm_medium=mobile&utm_campaign=medpage%2Biphone%20app
DISCLAIMER: I am not a healthcare provider, and I do not provide any medical advice, diagnosis or treatment. The information presented here is designed for general informational purposes and discussion only, and is not intended to replace a physician’s judgment about the appropriateness or risks of a procedure, medication, product or diagnosis. Always consult your doctor about any medical questions or conditions you may have.