But in some 40% of sufferers, the migraines can be prevented. Yet, only a small percentage of those sufferers, about 3 to 13%, actually use preventive therapies.
Today's guidelines are available to all doctors and list what works and what doesn't.
"So, this is an easy way for a doctor or a care provider to look at what is likely to work and on what basis is that drug likely to work," said Dr. Stewart Tepper of the Cleveland Clinic.
The guidelines evaluate several prescription drugs, classifying them anywhere from effective, to probably or possibly effective, to ineffective.
The prescription medications that are said to work include several seizure medications like divalproex sodium and topiramate, and beta blockers like metoprolol , propranolol and timolol. For women with menstrual migraines, the drug frovatriptan is classified as effective.
When it comes to herbal remedies, the one they say works best to prevent migraines is petasites, a spiky plant also known as butterbur. Magnesium and feverfew were considered "probably effective" along with riboflavin and histamines.
So were over the counter pills like ibuprofen, naproxen, ketoprofen and fenoprofen.
Although the evidence is week, coenzyme q-10 and estrogen are "possibly" effective and may be considered for migraine prevention.
As for aspirin, researchers say the evidence is conflicting or inadequate and they can neither support nor refute its use for migraine prevention.
Keep in mind migraines can get better or worse over time.
If relief is hard to come by, then it's worth it to see a specialist.
"My recommendations is that if a person has really tough headaches and is going nowhere that they probably ought to seek out a board certified headache medicine specialist," said Dr. Tepper.
The complete list of guidelines can be found in the medical journal "Neurology."
The researchers say migraines are under recognized and undertreated.
By the way, women sufferers outnumber men by a ratio of 3 to 1.
What causes migraines? It's not totally clear, but genetics are definitely involved.
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