Second Line Migraine Prevention Drugs

Timothy C. Hain, M.D. Chicago IL.• Page last modified: September 26, 2020

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The Migraine approach flowchart outlines a general approach to migraine using 3 main groups of medications - -anticonvulsants and other drugs that work as nerve stabilizers,  antidepressants that probably work mainly through neurotransmitters such as serotonin and dopamine, and medications that act on blood vessels such as verapamil and the beta-blocker family.  As a general observation, drugs commonly used for bipolar affective disorder are often useful in migraine as well. This opens up a large universe of interesting drugs, often little studied.

The purpose of this page is to outline secondary agents, that can be used when the first set fails, or if the first set is not tolerated.  We will again organize by mechanism, with the main addition being "mysterious" agents -- usually claimed to work on migraine. Of course, these agents are somewhat suspicious.

In general, in the USA, most of these drugs are FDA approved for other indications than migraine.  Their use is generally "off label".  Some popular migraine drugs are not approved by the FDA (e.g. flunarizine).