If you live with chronic migraine, you’ve probably heard the phrase, “Have you tried…?” more times than you can count. The truth is, there’s no one-size-fits-all solution—what works for one person might do nothing for another.
So if you’re still searching for the right preventive treatment, this post is for you. I’ve put together a comprehensive list of migraine preventives, from prescription medications to supplements, lifestyle strategies, and alternative therapies. Whether you’re new to preventives or looking to optimize your treatment plan, this guide will help you explore your options.
Table of Contents
📌 What Are Migraine Preventives?
Migraine preventives are treatments designed to reduce attack frequency, severity, or duration. Unlike acute treatments (which stop an attack in progress), preventives are taken regularly to lower your overall migraine burden.
Most preventives take 4-12 weeks to show full effects, so if you start a new one, give it time before deciding whether it’s working.
1. Prescription Preventive Medications
Many of the most effective migraine preventives were originally designed for other conditions, like high blood pressure, epilepsy, or depression. More recently, migraine-specific preventives have been developed.
🧠 CGRP Inhibitors (Migraine-Specific Preventives)
These target calcitonin gene-related peptide (CGRP), a key player in migraine attacks.
- Injectables (Monthly or Quarterly)
- Aimovig (erenumab)
- Emgality (galcanezumab)
- Ajovy (fremanezumab)
- Vyepti (eptinezumab) – IV infusion
- Oral CGRP Blockers (Gepants)
- Qulipta (atogepant)
- Nurtec ODT (rimegepant) – also used as an acute treatment
CGRP inhibitors have fewer systemic side effects than many older preventives, making them a good option for people who can’t tolerate traditional medications.
💊 Anti-Seizure Medications
Originally designed for epilepsy, these stabilize nerve activity and reduce migraine frequency.
- Topiramate (Topamax)
- Valproate (Depakote)
- Zonisamide (Zonegran)
⚠️ Considerations: Topiramate is commonly prescribed but has cognitive side effects (“Dopamax”), while valproate is not recommended for people who may become pregnant.
❤️ Blood Pressure Medications
These work by stabilizing blood flow and reducing overactivity in the nervous system.
- Beta-Blockers: Propranolol, Metoprolol, Atenolol
- Calcium Channel Blockers: Verapamil, Flunarizine
Propranolol is one of the most common first-line migraine preventives, but it’s not ideal for people with low blood pressure or slow heart rates.
🌱 Antidepressants & Anti-Anxiety Medications
Some medications used for depression and anxiety also help regulate migraine pathways.
- Tricyclic Antidepressants: Amitriptyline, Nortriptyline
- SNRIs: Venlafaxine (Effexor), Duloxetine (Cymbalta)
Amitriptyline can be highly effective for migraine prevention, and is often the first-line of treatment, but it can cause drowsiness and weight gain. If you’re struggling with brain fog, be sure to mention this to your doctor.
💉 Botox (Botulinum Toxin)
- Works by calming overactive nerve signaling
- FDA-approved for chronic migraine (15+ headache days/month)
- Given every 12 weeks via injections in the forehead, scalp, and neck
2. Supplements & Vitamins
Some people prefer natural approaches or add supplements to their medication regimen.
🔑 Clinically Studied Migraine Supplements
- Magnesium (especially magnesium glycinate, citrate, or threonate)
- Riboflavin (Vitamin B2) – High doses may reduce frequency
- Coenzyme Q10 (CoQ10) – Can help with mitochondrial function
- Feverfew & Butterbur – Herbal supplements with mixed evidence
- Omega-3 Fatty Acids – May reduce inflammation and help with brain function
💡 Blood Sugar & Metabolism Support
- Alpha-Lipoic Acid (ALA) – May improve mitochondrial function
- Chromium & Berberine – Help stabilize blood sugar
- L-Carnitine – Supports energy metabolism
3. Lifestyle & Non-Medication Approaches
Preventing migraine isn’t just about medication—lifestyle changes can play a huge role.
🕰️ Sleep & Routine
- Aim for consistent sleep & wake times (even on weekends!)
- Avoid excessive screen time before bed
- Use blue light blockers or migraine-friendly glasses
🍏 Diet & Blood Sugar Stability
- Eat regular, balanced meals (avoid long fasting periods)
- Reduce processed foods, artificial sweeteners, MSG, and alcohol
- Stay hydrated – dehydration is a major trigger for many
🏋️♀️ Exercise & Movement
- Low-impact exercise like walking, yoga, or swimming
- Avoid high-intensity workouts if they trigger attacks
- Strength training can improve overall resilience
🧘 Stress Reduction & Nervous System Regulation
- Cognitive Behavioral Therapy (CBT) for stress & pain management
- Pain Reprocessing Therapy (PRT) – Helps retrain the brain’s pain pathways
- Mindfulness, Meditation & Breathwork – Can help regulate the nervous system
4. Alternative & Neuromodulation Treatments
Some people find relief through devices, acupuncture, or other alternative therapies.
⚡ Neuromodulation Devices
These FDA-cleared devices stimulate nerves to prevent or stop migraine attacks.
- Cefaly – Worn on the forehead to stimulate the trigeminal nerve
- Nerivio – Worn on the upper arm, controlled via a smartphone app
- gammaCore – A vagus nerve stimulator used on the neck
- Relivion – A brainstem neuromodulation headset
🩸 Acupuncture & Physical Therapy
- Some find relief with acupuncture or trigger point injections
- Physical therapy & posture correction can help if neck tension triggers attacks
💬 Final Thoughts
Finding the right migraine preventive can feel like an endless game of trial and error. What works for one person may not work for another, and it can take time to find the best combination of treatments.
If you’re struggling with chronic migraine, know that you’re not alone. There are many options out there, and sometimes the key is stacking multiple strategies together to get the best results.
💡 What’s helped you the most in preventing migraine attacks? Drop your thoughts in the comments—I’d love to hear your experiences!