When prevention enters the conversation
Preventive treatment is often discussed when attacks are frequent, disabling, prolonged, poorly controlled with acute treatment or when acute medicines are being used too often.
Main preventive categories
- Blood-pressure medicines such as propranolol, metoprolol or candesartan
- Antiepileptic medicines such as topiramate
- Tricyclic antidepressants such as amitriptyline
- CGRP monoclonal antibodies
- Gepants such as atogepant or rimegepant
- OnabotulinumtoxinA (Botox) for selected chronic migraine
- Neuromodulation and selected complementary strategies
Where preventive migraine treatment fits
This Clea guide places preventive migraine treatment in the broader migraine treatment landscape. The important distinction is whether it is used for an attack, prevention, symptom support, rehabilitation or another specific care goal.
Treatment choice is individual. The role of a therapy depends on the migraine pattern, other health conditions, pregnancy or breastfeeding, interactions, previous treatment experience, access and a clinician's assessment.
Evidence and limitations
Clea separates evidence from popularity. Randomised trials, systematic reviews, guidelines, observational studies and patient experiences do not carry the same weight. Where evidence is limited or indirect, we say so rather than presenting uncertainty as a recommendation.
Australian access
Australian availability can involve TGA registration, prescription requirements, PBS restrictions, private access, specialist criteria or device availability. Those details can change, so Clea links to current official sources and keeps access separate from whether a treatment is clinically suitable for you.
Safety and suitability
Do not start, stop, combine or change a medicine because of a Clea page or a community experience. Side effects, contraindications and interactions need to be considered with a GP, neurologist or pharmacist who knows your medical history.
What to track in Clea
Record headache or migraine days, severity, associated symptoms, medicines used and the context around the episode. Several weeks of consistent observations are usually more useful than trying to prove a cause from one attack.
- Headache and migraine-like days
- Severity and function
- Associated symptoms
- Acute medicine days
- Anything that changed around the pattern
Go to the original sources.
Clea checks source material, but PBS listings, medicine information and treatment access can change. Confirm current details with the TGA, PBS, your pharmacist or treating clinician.
How Clea sources and reviews migraine information →