For people who have migraine headache more than twice a week, or even milder daily headaches with some migraine features, seeing your doctor for preventative treatment is essential.
Theoretically the commonest problem people develop is analgesia-induced headache, which happens if you take painkillers like ibuprofen or codeine more than 2-3 times a week. The headaches linger on because the brain depends on them. So a preventative is used to change the way your brain cells respond to pain, and reduce the headache days and severity. Your GP or neurologist can prescribe these medications, and they will talk to you about potential side effects as well as benefit. One thing to remember is that these do not work if you are also taking painkillers every day. Also, alcohol makes migraines worse, so while you are trying to improve your headaches, avoid alcohol.All these must start small and gradually increase to a dose which works for you.
B-blockers (propranolol)This is an old blood pressure medication, which has good evidence in migraines. The main side effects are low blood pressure and cold hands/feet.
Anti-epileptic (Topiramate)This is a very good migraine drug, which is also an epilepsy drug. 25% of patients loose weight with this drug due to loss of appetite. 10% have pins and needles and few can have confusion at higher doses.
Anti-depressant (Amitriptyline)This is a very good pain drug overall. The main side effect is drowsiness, and therefore is you have difficulty sleeping with the headaches, it is a good drug for you. It should only be taken at night.
ACE-inhibitors (Candesartan)This is a newer migraine drug, but has been used in the cardiac world for many years safely. It is a blood pressure drug which as shown to be effective in migraines, with minimal side effects. Low blood pressure and dizziness are the main issues.
Anti-histamine (Pizotifen)A very old drug, which is good in younger patients. The main side effect is weight gain, and so we do not prescribe it routinely in over-weight patients.Not every drug works in every patient.
Depending on your genetics, all, one or none of these drugs will work in you! Do not worry, the specialists have more treatments up their sleeves if needed.