Migraine Preventative Medication: What It Can Do and What It Can’t Fix
If you live with frequent or chronic migraines, medication can become part of daily life very quickly.
A rescue medication for the attack.
A preventative medication to reduce how often the attacks happen.
Maybe another medication to manage side effects.
And before long, the whole conversation becomes:
What do I take next?
That is where I want to slow things down.
Because I’m not anti-medication.
There are absolutely times when a preventative can help someone get through the day, function better or get enough breathing room to begin working on what’s underneath the migraine pattern.
For some women, preventatives help.
For others, the side effects make them feel worse.
But either way, I don’t want the entire plan to become:
Which preventative should I stay on forever?
I want the question to become:
What needs to change in my body so I don’t need to depend on this forever?
A Preventative Can Be a Tool Without Being the Finish Line
This is the distinction I want women to understand.
A migraine preventative may reduce frequency or intensity.
That can be useful.
But it still does not explain why the migraines became frequent enough to need a preventative in the first place.
So while a woman is using medication for support, I also want someone asking:
What is happening with her sleep?
What is happening with blood sugar?
What is happening in the gut?
What is happening hormonally?
What is happening with stress physiology?
What is contributing to chronic inflammation?
What is keeping her migraine threshold so low?
Because if those pieces never change, the medication may simply become the long-term strategy by default.
And that is not the same thing as changing the pattern.
The Questions I’d Want You Asking
If you’re taking a preventative, I’m less interested in obsessing over whether you found the “perfect” medication.
I’m more interested in what is happening around it.
Questions I would want you discussing with your healthcare provider include:
What are we doing at the same time to address what may be driving the migraines?
What needs to improve before we can even have a conversation about whether I still need this level of support?
Are there symptoms or patterns that medication may be quieting without addressing what is underneath them?
What would have to change before my provider and I could eventually discuss reducing or coming off the medication safely?
That last word matters.
Safely.
Do not stop a preventative medication because you read an article or listened to a podcast.
Some medications need to be tapered.
Some have important withdrawal considerations.
Those decisions belong with the clinician prescribing them.
But it is completely reasonable to want a long-term plan that includes more than indefinite symptom suppression.
What If the Preventative Makes You Feel Worse?
This is another part of the conversation women often struggle with.
Maybe migraine frequency improved somewhat, but now you’re dealing with:
Brain fog
Fatigue
Constipation
Word-finding issues
Sleep changes
Weight changes
Mood changes
Dizziness
And now you’re trying to figure out which symptoms are migraines, which are hormones, which are age-related, and which may be medication-related.
That deserves a conversation.
It doesn’t automatically mean the medication is wrong.
It means the tradeoff needs to be visible.
If the goal is quality of life, then we have to look at the whole quality-of-life picture.
Rescue Medication Still Has a Place
Preventative medication is one conversation.
Rescue medication is another.
If you have migraines, I believe you should have a clear rescue plan developed with your healthcare provider.
That means knowing:
What to use when an attack starts
When to use it
What to do if the first treatment doesn’t work
When symptoms warrant another level of care
Using a rescue medication appropriately is not failure.
It is using a tool when you need it.
The issue is when every conversation remains focused on treating the next migraine and nobody asks why there are so many migraines to treat.
Medication Overuse Can Complicate the Picture
When acute migraine and pain medications are used frequently, some people can develop medication-overuse headache.
That can create a frustrating loop.
More headache.
More medication.
More headache.
Sometimes women assume their migraine disease is simply worsening when medication use may also be contributing to the pattern.
This is another reason I want the full medication picture.
Not just the prescription migraine drug.
I want to know about:
Over-the-counter pain relievers
Caffeine-containing headache products
Sleep medications
Medications being used for side effects
Supplements
Anything else the body is being asked to process
Because your body does not experience those as separate categories.
It experiences the total load.
This Is Not About Getting Off Medication as Fast as Possible
This is important.
The goal is not:
Get off everything immediately.
The goal is:
Get your body to a place where you and your healthcare provider can determine what support you still need.
Those are very different things.
Medication can create breathing room.
And sometimes breathing room is exactly what a woman needs.
But while we have that breathing room, I want us using it.
I want us working on the factors underneath the migraine pattern rather than simply waiting for the next refill.
I Don’t Want Medication to Become the Finish Line
This is really where I land.
A preventative can be a bridge.
A rescue medication can be a valuable tool.
Neither has to be the enemy.
But I don’t want a woman believing her only two choices are:
Live with migraines
or
Take medication forever.
There is a much bigger conversation to be had.
What is keeping this nervous system so reactive?
What is keeping the inflammatory load high?
What is lowering the migraine threshold?
What can actually be changed?
Because the goal is not to find the perfect medication to take forever.
The goal is to change the reason you needed so much support in the first place.
Ready to Look Beyond the Medication?
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Resources
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Related Articles
Part 1 - Migraine Supplements: What to Take, What to Skip, and What Most Women Overlook
Part 2 - Migraine Trigger Foods: Why Your Avoid List Keeps Growing
Debbie Waidl is a Migraine Freedom Expert and founder of the Freedom From Migraines Method®. She works with women in perimenopause and menopause to identify and address the root causes of chronic migraines so they can stop managing their pain and start living their lives.
Disclaimer: This article is for educational purposes only and is not medical advice. Always consult with your healthcare provider before making decisions about medical procedures or treatments. Debbie Waidl and In The Balance Health Coaching LLC are not responsible for any decisions made based on information in this article.
