Migraine Prophylaxis
8 medicines
Migraine prophylaxis uses daily medicines to reduce how often and how severely migraines occur.
Inderal La
Propranolol
40mg
Inderal La is a heart blood pressure medication containing Propranolol, available as 40mg tablets.
Key facts
- Migraine prophylaxis means taking medicine every day, not to stop an attack in progress, but to make attacks less frequent, shorter, and milder.
- It's usually considered when migraines occur more than three or four times a month, last a long time, or respond poorly to acute treatment.
- Options include beta-blockers such as propranolol, anticonvulsants such as valproic acid and topiramate, the tricyclic amitriptyline, and the calcium-channel blocker flunarizine; clonidine is a further option in some formularies.
- Success is usually defined as a 50% or greater reduction in monthly attack frequency, not complete freedom from headache, and all of these medicines need several weeks to show their full effect.
How preventive medicines work
Preventive agents act on different biological pathways, so the choice depends on a person's broader health picture. Beta-blockers such as propranolol reduce the excitability of pain pathways and are among the best-studied options. Anticonvulsants including valproic acid and topiramate stabilise neuronal membranes and have good evidence for cutting attack days per month. The tricyclic amitriptyline is often favoured when migraine coexists with poor sleep or low mood. Flunarizine, a calcium-channel blocker, is a further long-standing option, and clonidine is used in some formularies. All preventive medicines need several weeks to show their full effect, and the choice is typically reviewed at three months.
Who benefits and what to expect
Candidates are people whose migraines significantly disrupt work or study, those using acute relief medicines on more than ten days a month (which carries its own risks), and anyone with certain migraine subtypes such as hemiplegic migraine. Success is usually defined as a 50 per cent or greater reduction in monthly attack frequency rather than complete freedom from headache. A neurology referral is worth considering if attacks remain difficult to control, or if cardiovascular factors influence medicine choice, since several of these agents also have a role in heart and blood pressure conditions.
This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.