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Factors that play a role in determining which preventive agent to choose include:

• Comorbidities of the patient
• Determining if there is a preventive medication that can prevent migraines while at the same time treating the comorbid condition
• Consideration of the drugs being taken by the patient
• Patient preference in terms of adverse effects they are willing to tolerate, (e.g. weight changes, fatigue, etc.)
• Consideration of pregnancy or plans to conceive
• Consideration if a woman is taking contraceptive medication since contraceptives may impact the frequency of migraine headaches and some migraine-preventive medications may reduce the effectiveness of the contraceptives.

In general, preventive medications are given one at a time and are not combined since combinations are associated with more adverse effects and data is limited regarding the efficacy of two or more drugs in migraine prevention.

Complementary Therapies for Migraine Prevention

In 2000, the US Headache Consortium concluded that the following complementary medicine therapies are effective for migraine prevention and may be used as adjunct therapies while receiving other conventional treatments:

• Relaxation training
• Thermal biofeedback combined with relaxation training (stress dilates blood vessels and biofeedback helps to reduce blood vessel dilation by measuring skin temperature)
• Electromyographic biofeedback (reducing muscle tension)
• Cognitive-behavioral therapy

The American Headache Society (AHS) notes that complementary therapies are not as strictly regulated by the FDA as prescription medication and many of these therapies are called "supplements". There is a lack of standardization regarding the purity of content of herbal supplements as well as the consistency of batches that are sold. In addition, many lack rigorous clinical trials and are based on small numbers of patients. The AHS has assigned Grade B to herbal supplements meaning that there is limited evidence from a single randomized control trial or nonrandomized control trial, or several trials with inconsistent results.

Some natural supplements that are under investigation for the treatment of migraine headache include:

• Butterbur
• Magnesium

• Feverfew - adverse effects include:

  • Sore mouth and tongue
  • Oral ulcers
  • Swollen lips
  • Loss of taste
  • Abdominal pain
  • Gastrointestinal disturbance
  • Joint stiffness
  • Increased headaches
• Riboflavin
• Coenzyme Q10

To read more about complementary therapies for prevention of migraine headache, please click on the following link: http://www.ncbi.nlm.nih.gov/sites/entrez?Db=PubMed&Cmd=ShowDetailView&TermToSearch=16732849&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.PubmedResultsPanel.PubmedRVDocSum