7 Signs It’s Time to Consider Preventive Treatment for Migraine

Migraine treatment may be acute or preventive. Your specific needs — including episode frequency, severity, or acute treatment side effects — determine whether preventive treatment makes sense.

Migraine treatment is often split between acute and preventive options.

Acute treatments are taken when you have a migraine episode to try and relieve the pain and symptoms and stop the episode from progressing.

Preventive treatments are used to try and reduce the frequency and severity of your migraine episodes over a period of time. There are several types of preventive treatments, like oral medications, injectables, and neuromodulation devices.

If you’re having occasional episodic migraine attacks, an acute treatment might be sufficient for you. But there are specific signs and changes in your attacks to be aware of that could indicate it’s time to consider a preventive migraine treatment.

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1. Multiple attacks a month

If you’re having 4 or more migraine days per month or 8 or more headache days per month, a migraine preventive medication is usually recommended.

Four days a month might not seem like a lot, but we know that migraine can become chronic quickly if episodes are not managed effectively.

Research from 2019 notes that about 38% of people with episodic migraine would benefit from preventive therapy, but less than 13% take preventive medications.

It’s important to seek help sooner and explore different treatment options to try and prevent your episodes from becoming more frequent or severe.

2. Increase in migraine severity or frequency

If you’ve noticed a change in the frequency or severity of your episodes, it’s crucial to discuss preventive treatment options with your doctor.

Non-medication preventive options include:

• complementary therapies, like acupuncture or chiropractic
• herbs, like feverfew
• vitamins, like riboflavin
• supplements, like magnesium

Preventive medication options include:

• blood pressure medications
• anti-depressants
• anticonvulsants
• serotonin antagonists

Sometimes, a second preventive treatment can be added to your current treatment plan to better control your episodes. This might involve using a neuromodulation device at the same time as taking an oral preventive medication.

3. Presence of migraine subtypes

Preventive treatments are worth exploring with your doctor if you’re experiencing new migraine symptoms or a rarer subtype of migraine.

Subtypes can include:

• hemiplegic migraine
• vestibular migraine
• abdominal migraine
• migraine with aura

Even if you aren’t experiencing episodes frequently, rarer subtypes of migraine often require more specialist treatment and attention.

4. OTC pain relievers aren’t working

Sometimes acute medications just don’t cut it.

Acute medications include over-the-counter (OTC) pain relievers such as paracetamol, ibuprofen, or aspirin or more targeted prescription migraine medication such as triptans.

A 2023 review notes that your healthcare professional should consider a referral to a neurologist or headache specialist if:

• 2 or more oral preventive medications aren’t working
• a secondary condition may be causing your headaches
• you’re concerned about drug interactions
• you have comorbid neurologic disorders such as stroke
• you’re pregnant or may become pregnant
• you may benefit from nerve blockers or onabotulinumtoxin A, a neurotoxin used to treat chronic migraine

If you aren’t finding relief with your acute treatments, you run the risk of your migraine episodes becoming more frequent. Ask your healthcare professional if any of the above apply to you.

5. Frequent use of acute medication

If your acute medication isn’t working effectively, you may end up needing to take increasing amounts of pain relievers more frequently.

Over-relying on medication is a common trap to fall into when it comes to managing migraine. Either we’re not aware that preventive treatments even exist, or we don’t know how to go about accessing them.

We do our best to treat episodes ourselves at home but end up taking increasing amounts of pain relievers in an attempt to get relief.

If you’ve noticed that you need to use acute medication or pain relievers more frequently, it’s time to talk with your doctor about preventive migraine treatment.

Taking acute medication for migraine more than 10 days a month may lead to medication overuse headaches, which can be a difficult and painful cycle to break.

6. Acute medication side effects

Another sign it’s time to consider a migraine preventive treatment is if you’re experiencing debilitating side effects from your acute medications.

We need acute treatments to abort episodes, but the side effects can sometimes leave people just as debilitated as the episode itself.

An example of this might be taking a triptan for an episode, then getting so sleepy you can’t function and need to spend the rest of the day in bed.

If your acute medications are impeding your ability to function, it’s time to think about preventive treatment options.

7. Migraine impacts your quality of life

Regardless of how infrequent your migraine attacks may be, they impact your quality of life. Any amount of migraine episodes warrants preventive attention.

While this doesn’t necessarily mean medication, you may want to consider other factors that contribute to prevention.

These include:

• staying hydrated
• getting regular exercise
• avoiding common food triggers
• monitoring your relationship with caffeine
• getting plenty of sleep each night
• reducing stressors where possible
• complementary treatments, like massage or biofeedback

Takeaway

Your needs for managing migraine may change over time, especially if you find your episodes becoming more frequent or severe.

If you notice changes like more frequent episodes, less effective medication, or unpleasant side effects, you can talk with a healthcare professional about preventive options to make migraine more manageable.