Proper way to use preventive medications

    *  Doctors familiar with the treatment of migraine headaches should prescribe preventive medications.

    * Decisions about which preventive medication to use are based on the side effects of the medication and the presence of any medical conditions.

    * Propranolol (Inderal) often is used first, provided that the individual does not have asthma, COPD, or heart disease. Amitriptyline (Elavil, Endep) also is used commonly.

    * Preventive medications are begun at low doses and gradually increased to higher doses if needed. This minimizes side effects from the medications. Preventive medications are to be taken daily for months to years. When they are stopped, the dose needs to be gradually reduced rather than abruptly stopped. Abruptly stopping preventive medications can lead to headaches.

    * In some instances, more than one drug may be needed. Non-medication and behavioral therapies also may be needed.