What does migraine prevention mean?
Migraine prevention refers to measures aimed at preventing migraine attacks in advance or at least significantly reducing their severity. In contrast to acute therapy, which is used during an attack, this is a longer-term treatment. The aim is to improve the quality of life of those affected, reduce the number of headache days and decrease the need for acute medication.
Migraine is one of the most common neurological conditions. According to estimates, around one in ten people in Austria is affected, with women more frequently than men. Those who wish to prevent migraine today have access to a number of well-researched options.
When is preventive treatment appropriate?
Not every case of migraine requires ongoing therapy. Migraine prevention is generally considered when the following criteria are met:
- Frequent attacks: three or more migraine days per month
- Significant impairment: long duration of attacks or pronounced accompanying symptoms such as nausea, dizziness or neurological deficits
- Insufficient effect of acute therapy or intolerance to acute medication
- Risk of medication overuse: taking painkillers or migraine medication on more than ten days per month
- Complicated forms of migraine such as hemiplegic migraine or migraine with prolonged aura
The individual level of suffering also plays an important role. Even with less frequent attacks, prevention can be useful if the attacks significantly affect work, family or leisure activities. The decision should always be made together with a doctor.
Non-pharmacological options for migraine prevention
Before, or in addition to, ongoing medication-based therapy, various non-pharmacological approaches may be considered. These can help to prevent migraine and are recommended in current guidelines.
Lifestyle and behavioural changes
- Regular sleep-wake rhythm: both lack of sleep and excessive sleep can trigger attacks
- Adequate fluid intake and regular meals: low blood sugar and dehydration are considered triggering factors
- Stress management: relaxation techniques such as Jacobson's progressive muscle relaxation or autogenic training
- Headache diary: helps to identify individual triggers and avoid them in a targeted way
Exercise and endurance sports
Regular endurance exercise – such as swimming, cycling or walking – has been shown to contribute to reducing migraine frequency. Two to three training sessions per week of 30 to 45 minutes each at moderate intensity are recommended.
Behavioural therapy approaches
Cognitive behavioural therapy and biofeedback have proven effective in studies. They support those affected in better coping with pain, stress and triggering factors.
Acupuncture
Acupuncture may also play a role in migraine prevention. Studies suggest comparable efficacy to some medication-based approaches – although the evidence is not entirely consistent.
Ongoing medication-based migraine therapy
If lifestyle measures are not sufficient, ongoing medication-based therapy may be considered. The choice depends on concomitant conditions, tolerability and personal circumstances.
Classical preventive medications
The following classes of active substances have been used successfully for many years:
- Beta-blockers (e.g. metoprolol, propranolol): particularly suitable when high blood pressure is also present
- Calcium channel blockers (e.g. flunarizine)
- Anticonvulsants (e.g. topiramate)
- Tricyclic antidepressants (e.g. amitriptyline): especially in cases of additional tension-type headaches or sleep disorders
These medications are taken daily. An effect usually only becomes apparent after two to three months, so patience is required. Treatment should be continued for at least six to twelve months before an attempt is made to discontinue it.
Modern antibody therapies
In recent years, so-called CGRP antibodies have expanded the treatment options. They target the messenger substance CGRP (calcitonin gene-related peptide), which plays a central role in migraine attacks. They are usually administered as a monthly or quarterly injection. Their use is generally considered when several classical preventive medications have not worked sufficiently or have not been tolerated.
Botulinum toxin type A
For chronic migraine – defined as headaches on 15 or more days per month over at least three months, of which at least eight have migraine characteristics – treatment with botulinum toxin type A may be considered. The active substance is injected according to a standardised scheme into specific muscles in the head and neck area and repeated every three months. Studies show that this therapy can reduce the number of headache days in some patients.
What to consider with ongoing therapy
Migraine prevention is always an individual decision. The following aspects should be discussed with the treating doctor:
- Concomitant conditions: some active substances are particularly suitable for certain pre-existing conditions, while others are less so
- Possible side effects: depending on the substance, these include fatigue, weight changes, concentration problems or circulatory complaints
- Pregnancy and breastfeeding: require particularly careful selection
- Follow-up: regular check-ups help to assess effectiveness and tolerability
- Realistic expectations: the aim is a noticeable reduction – usually by around 50 per cent – not necessarily complete freedom from symptoms
Keeping a headache diary is useful in order to assess the course objectively. If no improvement occurs after three months at an adequate dose, a change of active substance may be considered.
Conclusion
Anyone who regularly suffers from distressing migraine attacks does not have to simply accept them. A well-planned migraine prevention strategy – consisting of an individually tailored mix of lifestyle measures, behavioural therapy and, where appropriate, ongoing medication-based therapy – can significantly reduce the frequency and severity of attacks. Careful diagnosis and continuous support from qualified medical care are important.
This article does not replace medical advice.