Headache Preventive Medication Treatment

Preventive medications can help decrease the frequency, severity and/or duration of headaches. Preventives are normally prescribed for people

Preventive medication may cause abortive medications to be more effective. Unlike abortive medication, preventive medicine should be taken every day, whether you have a headache or not. You may need to take preventive medications daily for at least four to six weeks before you feel the full effect of the medication. Do not abruptly (suddenly) stop taking a preventive medication. Talk to your health care provider first. Many of these medications must be slowly discontinued over time to avoid disturbing side effects.

Virtually all medications used to treat headaches are also used to treat other conditions. Don’t be confused by terms such as “anti-seizure” or “anti-depressant,” among other names. The main purpose of these medications is to treat your headache.

• Beta-blockers – These medications work by stabilizing blood vessels; thus, minimizing size changes and limiting stimulation of the surrounding nerves. Also, beta-blockers can stop the effects that neurotransmitters can have on blood vessels. Possible side effects include fatigue, light headedness, sleep interruption, decreased heart rate and sexual dysfunction. Some commonly used beta-blockers for headache treatment include propranolol (Inderal, Inderal LA), nadolol (Corgard), bystolic (nebivolol), atenolol (Tenormin) and metroprolol (Lopressor, Toprol XL).

• Botox (botulinum) – Botulinum is a naturally-occurring toxin. When given by subcutaneous injection in small doses, it can provide health benefits that include prevention of chronic headache. Botulinum is given on an outpatient basis, so speak with your health care provider about this therapy. 

• Calcium channel blockers – Similar to beta-blockers, these medications help stabilize blood vessels. Potential side effects include constipation, light headedness (especially when standing up), low blood pressure, facial flushing and upset stomach. Examples include verapamil (Isoptin, Calan, Verelan, Covera) and nimodipine (Nimitop). 

• Dopamine reuptake inhibitors – Medications such as bupropion (Wellbutrin) increase the amount of dopamine available for your body to use. People with a history of seizures should not use this drug. Side effects include agitation, insomnia and upset stomach.

• Selective serotonin reuptake inhibitors (SSRI) – SSRIs increase the amount of serotonin available for your body to use. Potential side effects include drowsiness, constipation, insomnia, upset stomach, tremor and sexual dysfunction. SSRIs used for headache treatment include fluoxetine (Prozac), paroxetine (Paxil),setraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro).

• Serotonin and norepinephrine reuptake inhibitors (SNRI) – SNRIs such as venlafaxine (Effexor XR) and duloxetine (Cymbalta) increase the amount of the serotonin and norepinephrine available for your body to use. In addition to causing the same side effects as SSRIs, these medications can also cause dry eyes or dry mouth. 

• Specific serotonergic/noradrenergic – Medications such as mirtazapine (Remeron) cause your body to release increased amounts of serotonin and norepinephrine and stop the effects of histamine. Possible side effects include excessive sleepiness, constipation, dry mouth and increased appetite. 

• Tricyclic antidepressants – These medications alter the amount of serotonin and norepinephrine available for your body to use. They can also stop the effects of histamine (histamine release can result in swelling of blood vessels and contribute to pain). Side effects may include drowsiness, upset stomach, dry mouth, dry eyes, increased appetite, constipation and sexual dysfunction. Examples include amitriptyline (Elavil), protriptyline (Vivactil), doxepine (Sinequan), desipramine (Norpramine), imipramine (Tofranil), nortriptyline (Pamelor), trimipramine (Surmontil) and amitriptyline/chlordiazepoxid (Limbitrol).