Prevention of migraine attacks, also called Migraine prophylaxis, is indicated in the following group of patients:

• Frequent Migraine Attacks ( Usually greater than four migraine attacks per month)
• Severe episode lasting more than twelve hours per attack
• Migraine with weakness or infarction (stroke-like symptoms), also called hemiplegic migraine and basilar migraine.

Different medications are used for the prophylaxis of migraines. Here are some guidelines that can help you choose for yourself the best prophylactic medicine for migraine:

• If you are younger than 60 years of age and have palpitations or hypertension, use a beta-blocker
  • Metoprolol 50 mg once or twice daily
  • Propranolol or Inderal 20 to 40 mg twice or thrice daily
  • Timolol 5 mg once daily
  • Atenolol 25 to 50 mg once daily
• If you are older than 60 years of age or have a chronic lung disease like asthma or COPD, use Flunarizine or verapamil
• If you have insomnia, you can start amitriptyline
• If there is concomitant depression, it is best to start venlafaxine (or amitriptyline)
• If you have a seizure disorder, you can start topiramate or valproic acid

Other newer drugs that are not yet freely available inhibit the calcitonin gene-related peptide. These include:

• Erenumab,
• Fremanezumab,
• Galcanezumab,
• Eptinezumab, and
• Rimegepant.

What should you do?

If you fall in any of the groups mentioned above, you may choose a prophylactic medicine based on your comorbid condition. For young people, propranolol and amitriptyline are usually preferred. However, Sibelium (Flunarizine), verapamil, and topiramate are other alternative medicines you can use. It is best to keep valproic acid down the list unless advised by your physician.