A clinical report published in the January issue of American Family Physician by Hien Ha et al. highlighted the prophylactic or preventive medications for migraine.

Migraine notably hampers the quality of life of the patients worldwide. About 13% of migraineurs take prophylactic medicines but with the introduction of preventive therapies about 38%, episodic migraineurs will be potentially benefited from them. The severity of migraine and its frequency and headache-related distress are reduced by Preventive medication therapy. It may also be useful for improving the quality of life and prevent the advancement of chronic migraines. Preventive treatments can be given to patients experiencing 4 or more headaches or 8 or more headache days a month, headaches due to medication overuse and debilitating headaches. Migraines can be prevented by recognising and managing the environmental, dietary, and behavioural triggers. The first-line medications rendered as effective according to clinical evidence comprise divalproex, topiramate, metoprolol, propranolol, and timolol. The medicines for second-line therapy include amitriptyline, venlafaxine, atenolol, and nadolol.

Limited evidence is available for carbamazepine, gabapentin, nebivolol, bisoprolol, pindolol, fluoxetine, nicardipine, verapamil, nimodipine, candesartan, lisinopril and nifedipine. lamotrigine, acebutolol, oxcarbazepine, and telmisartan are not sufficient. New CGRP antagonists have recently been approved by USFDA for the prevention of migraine but to evaluate long term efficacy and safety more studies are needed. Petasites, feverfew, magnesium, and riboflavin deemed as complementary treatments are most likely effective. It has been observed that non-pharmacologic therapies such as relaxation training, thermal biofeedback combined with relaxation training, electromyographic feedback, and cognitive behaviour therapy, are helpful in migraine prevention.