Are You Good About Taking Your Migraine Preventive Medication?

Adherence to Migraine Preventive Medications

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The purpose of oral migraine preventive medications (OMPMs) is to reduce the number, severity, and duration of migraine attacks. In addition, OMPMs can improve a person's responsiveness to an acute medication (for example, a triptan) when a migraine attack does rear its evil head.

While this all sounds promising, the problem is that many patients are not adherent to their prescribed OMPM. This means that they are not good about taking their migraine preventive drug as advised by their doctor.

Let's take a closer look at this adherence problem, the possible "why" behind it, and potential solutions to combating it.

What Are Some Common OMPMs?

There are numerous types of OMPMs—the most commonly prescribed ones fall into these categories:

  • Beta-blockers, such as Inderal XL (propranolol) and Toprol XL (metoprolol)
  • Antidepressants, such as Elavil (amitriptyline) and Effexor (venlafaxine)
  • Anticonvulsants, such as Topamax (topiramate) and Neurontin (gabapentin)
  • Calcium channel blockers, such as Calan (verapamil) or Nimotop (nimodipine)

The choice of OMPM is based on a patient's unique needs, like what underlying medical conditions they have, and/or if they are taking other potentially interacting medications. Doctors also consider the OMPM's potential side effects, dosing schedule, and patient preference.

New Migraine Preventive Drugs

There is a new class of migraine preventive drugs called calcitonin gene-related peptide (CGRP) inhibitors. These breakthrough drugs are given as injections (not taken by mouth). While exciting, these drugs are costly, and insurance usually only approves them once a person has failed OMPMs.

What the Research Says About OMPM Adherence

Research consistently reveals poor adherence to OMPMs.

For example, according to pooled data from a large review study, adherence rates at 16 to 24 weeks were as followed for these three migraine preventive drugs:

  • Inderal XL (propranolol): 77%
  • Elavil (amitriptyline): 55%
  • Topamax (topiramate): 57%

Another study of over 75,000 participants with chronic migraines found adherence rates to range between 26 to 29% at six months and 17 to 20% at 12 months.

Is Poor Adherence Due to Side Effects?

Many OMPMs can cause unpleasant side effects, making them difficult to take as prescribed.

For instance, the beta-blocker propranolol (a type of high blood pressure medication) can cause fatigue, nausea, drowsiness, and sleep disturbances. Likewise, the tricyclic antidepressant Elavil (amitriptyline) can cause weight gain, sleepiness, and dry mouth.

How to Overcome the Side Effects

The good news is that there are a couple of strategies to minimize the occurrence of and/or negative impact of adverse effects associated with OMPMs.

One key strategy is to start off with a low dose and increase the dose slowly over time until the therapeutic dose is reached, or until side effects become intolerable.

Education is also important when it comes to adhering to a migraine preventive drug. Be sure to learn about the potential side effects before starting the drug—this way you can be mentally prepared for them if one or more occur.

Lastly, it's important to know that most side effects will ease or go away with time, or be fixed with dose adjustments (under the guidance of your doctor).

Other Tips to Consider When Taking an OMPM

Here are a couple more tips to help you navigate your OMPM journey more smoothly.

Understand the Frequency

It can be confusing sorting out your acute migraine medication from your daily preventive migraine medication. Be sure to clarify with your doctor before you leave your appointment the purpose of your medication, and how often you are supposed to take it.

Understand the Timing

Many people, understandably, become disgruntled and stop taking their OMPM because they feel like the medication isn't working. But the truth of the matter is that an OMPM may take two to six months before the maximum response is evident.

Set Realistic Goals

An OMPM is considered successful if it reduces your number of migraine attacks by 50 percent, significantly decreases your attack duration, or improves your response to acute migraine medications.

With that, be sure to set the expectation that your migraine preventive drug will improve your migraine attacks but not cure them.

A Word From Verywell

If you suffer from disabling migraine attacks or frequent attacks (more than once per week), or if you do not seem to get any relief from acute migraine medications, it's a good idea to talk with your doctor about considering a migraine preventive drug. At this time, it's also sensible to see a headache specialist, as you will need close monitoring if you do begin an OMPM or are a candidate for a CGRP inhibitor.

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Article Sources

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  2. Hepp Z, Bloudek LM, Varon SF. Systematic review of migraine prophylaxis adherence and persistence. J Manag Care Pharm. 2014 Jan;20(1):22-33. doi:10.18553/jmcp.2014.20.1.22

  3. Hepp Z, Dodick DW, Varon SF, Gillard P, Hansen RN, Devine EB. Adherence to oral migraine-preventive medications among patients with chronic migraine. Cephalalgia. 2015 May;35(6):478-88. doi:10.1177/0333102414547138.

  4. Silberstein SD et al. Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012 Apr 24;78(17):1337-45. doi: 10.1212/WNL.0b013e3182535d20

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