There are a number of ways you can reduce your chances of experiencing migraines.
Identifying and avoiding triggers
One of the best ways of preventing migraines is recognising the things that trigger an attack and trying to avoid them.
You may find you tend to have a migraine after eating certain foods or when you're stressed and by avoiding this trigger, you can prevent a migraine. Read more about possible migraine triggers.
Keeping a migraine diary can help you identify possible triggers and monitor how well any medication you're taking is working.
In your migraine diary, try to record:
- the date of the attack
- the time of day the attack began
- any warning signs
- your symptoms (including the presence or absence of aura)
- what medication you took
- when the attack ended
Medication and supplements
Medication is also available to help prevent migraines. These medicines are usually used if you've tried avoiding possible triggers but you're still experiencing migraines.
You may also be prescribed these medicines if you experience very severe migraine attacks, or if your attacks happen frequently.
Some of the main medications used to prevent migraines are outlined below.
Topiramate is a type of medication originally developed to prevent seizures in people with epilepsy, but is now much more commonly used in migraine. It's been shown to help prevent migraines and is usually taken every day in tablet form.
Topiramate should be used with caution in people with kidney or liver problems. It can also harm an unborn baby if taken during pregnancy and can reduce the effectiveness of hormonal contraceptives, so your GP should discuss alternative methods of contraception with women who are prescribed topiramate.
Side effects of topiramate can include:
Propranolol is a medication traditionally used to treat angina and high blood pressure, but it's also been shown to effectively prevent migraines. It's usually taken every day in tablet form.
Propranolol is unsuitable for people with asthma, chronic obstructive pulmonary disease (COPD) and some heart problems. It should be used with caution in people with diabetes.
Side effects of propranolol can include:
Botulinum toxin type A
In June 2012, NICE recommended the use of a medication called botulinum toxin type A by headache specialists to prevent headaches in some adults with chronic (long-term) migraine.
Botulinum toxin type A is a type of neurotoxin (nerve toxin) that paralyses muscles. It's 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 hasn't responded to at least three previous preventative medical treatments.
Under the NICE 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.
Preventing menstrual-related migraines
Menstrual-related migraines usually occur between two days before the start of your period to three days after. As these migraines are relatively predictable, it may be possible to prevent them using either non-hormonal or hormonal treatments.
The non-hormonal treatments that are recommended are:
These medications are taken as tablets two to four times a day from either the start of your period or two days before, until the last day of bleeding.
Hormonal treatments that may be recommended include:
- combined hormonal contraceptives, such as the combined contraceptive pill, patch or vaginal ring
- progesterone-only contraceptives, such as progesterone-only pills, implants or injections
- oestrogen patches or gels, which can be used from three days before the start of your period and continued for seven days
Hormonal contraceptives aren't usually used to prevent menstrual-related migraines in women who experience aura symptoms because this can increase your risk of having a stroke. Read about the complications of migraines for more information about this.
If medication is unsuitable, or it doesn't help to prevent migraines, you may want to consider acupuncture.
NICE states that a course of up to 10 sessions over a five to eight week period may be beneficial. Read more about acupuncture.