But all medications, even the natural [ones], potentially cause side effects. The only way to know is to try. Everyone reacts differently.

What prescription medications are available to prevent migraines?
Current preventive medications were all developed for [other medical problems, such as] hypertension, depression, epilepsy, memory loss and other psychiatric conditions.

Targeted therapies for migraine prevention are in clinical trials now.

Tell us more about Botox as a preventive.
Botox is recommended for prevention of chronic migraine, which is defined has having a headache at least 15 days monthly for at least three months, of which at least eight days were migraine days.

It's effective in most people] who receive it, and the benefit tends to improve over time.

Every 12 weeks, 31 small injections are given in the head, upper neck and shoulder muscles.

Most insurance companies require a trial of at least two oral preventives prior to approving Botox treatment.

What about treatments such as exercise, massage or cognitive behavior therapy (CBT)?
Any type of regular exercise is helpful.

Yoga is recommended if patients are anxious.

CBT is helpful especially with coexisting anxiety or depression to help with stress management.

Massage can help as well as physical therapy focusing on the neck.

Since a migraine is so awful, why doesn't everyone take preventives, to stop an attack before it starts?
Preventives are recommended for those who experience migraines once a week or more, but it is an individual decision.

Someone who can't afford the downtime may elect to take a preventive, even if she has less frequent migraines.

The reason why more people aren't on preventives is simple: Their providers never offered preventive medications to them.