The old saying ‘an ounce of prevention is worth a pound of cure’ is well understood by those who suffer from severe headaches. It’s preferable not to get one in the first place. That’s particularly true of migraine sufferers. The pulsating, intense pain can produce unpleasant effects that actually outlast the migraine episode.

To attack that problem, so-called prophylactic drugs are often recommended as part of a spectrum of treatments. The term may be familiar to those who have used condoms. The meaning is similar. They’re used to prevent a certain result, in this case headache pain, before it occurs rather than treating it afterwards. The latter type are termed ‘abortive’, and have a similar meaning to the common one - they eliminate or counteract an effect after it has happened.

In some cases that prevention may take the form of lifestyle adjustments. Alcohol, particularly red wine, can be a trigger for some migraine sufferers. Excessive activity, even something as mild as walking up steps, does it for others. Lack of sleep, stress, missing meals… the list is long. Adjusting behavior, even though requiring willpower, is often the easiest and safest way to prevent a headache before it strikes.

But for many, drugs are the best answer.

Preventive medicines come in a variety of classes, such as beta-blockers, channel-blockers and others. Sometimes they’re combined with or used for drugs to treat other conditions, but have the ’side-effect’ of treating headaches or migraines.

Beta-blockers, for example, are used to treat heart conditions, but they are also often effective in preventing migraines. They prevent blood vessels from dilating, thought to be one factor in migraines. Since they also help treat cardiac or chest pain (angina) and high blood pressure, in some cases they will work to relieve triggers for migraine.

Channel-blockers are another kind of heart pill that is also used as migraine prevention. Typically in the form of so-called CCBs (Calcium Channel Blockers), they work by reducing or blocking calcium from entering heart muscle cells. Calcium is essential in the biochemistry that allows the heart to function, but too much can be a problem. Since they reduce heart action, they sometimes have the side-effect of reducing the odds of migraine.

Some anti-depressant medications can be useful in treating headaches and migraine, since depression is one of the possible triggers of an attack. Prevent one cause, and the odds of the effect are reduced. Amitriptyline and doxepin are two common drugs of this type, and they have a painkilling effect as well at low doses.

Anti-seizure medications are sometimes used as part of a preventive strategy. Migraines and seizures have some similar neurological features. One such is a condition afflicting about 20% of migraine sufferers - auras or prodromes. These are a set of symptoms, such as flashes of light or loss of vision, that are precursors to a migraine episode.

Anti-serotonin medications are another possible treatment. Contemporary research suggests that serotonin (a neurotransmitter in the brain) plays an important role in migraines. Using a compound that can substitute in nerve cell receptors for serotonin, while having a slightly different structure, can prevent an attack.

No drug is considered the all-out favorite, and many are touted as a success if they reduce the frequency of attacks to 50% of normal. As with any drug, consult a physician for diagnosis and ask probing questions to investigate your treatment options.

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