Diet and Health FAQ

Tagged As: Compare Migraine Medication

Question:
If verapamil proved to be ineffective as a migraine prophylactic for a migraine sufferer, would propranolol be any better? Are the medications significantly different enough for migraine control? Would their in/effectiveness depend upon the individual?

Answer:
Maybe, yes, and yes. There are more than a dozen different medications useful for migraine prophylaxis. I usually start with verapamil 240 mg SR at bedtime, then push the dose up to twice a day if the headaches aren't under control on the lower dose in a month. I like it because it has the lowest incidence of side effects of any of the medications for migraine prophylaxis. You can also use the non-sustained release tablets which are a good deal cheaper but have to be taken 3-4 times a day. If that doesn't work, I usually go to propranolol or Depakote next. Amitriptyline works as well as the rest of these, better if there is a significant tension headache component, but has the most side effects of the four. Amitriptyline and propranolol together is a good combination for particularly resistant migraines. The trick is to give each medication for at least a month, because they may take some time to start working, and slowly push the dose up until side effects prevent further increases. Of course, even more important than choice of a medication for migraine prophylaxis is to make sure that you have made any necessary dietary or lifestyle adjustments.