Unfortunately, knowing if and when is not so clear-cut. There are no telltale signs you should take a prescription med to treat migraine, says Noah Rosen, MD, assistant neurology professor at Great Neck, NY’s Cushing Neuroscience Institute, who directs its Headache Center. The most common reason migraineurs decide on treatment by prescription medication is frequent migraine, typically meaning having more than one migraine weekly. Other reasons include: migraine significantly interfering with daily routines, uncommon symptoms such as speech or motor disturbances accompanying migraines, and/or over-the-counter (OTC) medications not working or being contraindicated.

There are two main types of drug therapy for migraineurs. Abortive medications, the more common type, treat migraine pain and related symptoms after an attack has started. Less often, these meds might play a role in preventing anticipated headaches, such as menstrual migraines. Prophylactic, or preventive, medications are taken to keep migraines from striking. Their effectiveness is measured by assessing the drug’s effect on number of monthly headaches.

According to new April 2012 guidelines issued by the American Academy of Neurology and co-developed with the American Headache Society, which were based on a review of all available evidence on migraine prevention, the following preventive prescription drugs were found to be effective at reducing migraine frequency and severity:

Seizure drugs:

  • Divalproex Sodium, also known as Sodium Valproate (brand names including Depakote, Depakene, Stavzor)
  • Topiramate (Topamax, Topiragen)


  • Metoprolol (Lopressor, Toprol)
  • Propranolol (Inderal, InnoPran XL, Pronol)
  • Timolol (Blocadren)

Generally, a trial is considered positive if at least half of participants note headache frequency reduction of at least 50 percent. Many other studies have shown efficacy for other preventive medications and herbal supplements, but the quality of evidence is not as solid for those as it is for those above.

Consider trying natural strategies to curb migraine before taking a prescription. That’s because starting a new migraine medication requires a testing stage which, for some, can be long and frustrating. You may have to try several prescriptions before pinpointing the best fit.

Before deciding whether to start any prescription migraine medication, always discuss all potential side effects and drug interactions with your doctor. Some migraine meds come saddled with particularly offensive potential side effects (from weight gain to hair loss or liver damage) while other side effects may be beneficial (such as nighttime sedation). When making your decision, you want to be armed with all pertinent information and know exactly what to expect.

Are You taking a prescription acute or preventive med for your migraines?