Chronic disease · Conversation prep
Your GP mentioned going on something to stop the migraines? There isn’t one preventer — there are several. This tool builds the question card that lets you walk in able to choose between them, instead of being handed the first one. It does not tell you which to take.
Just to check — is this a sudden, severe or different headache happening right now, or your usual migraines you want to prepare to discuss?
What you’ve written can be a sign of a headache that needs checking now — not at your next appointment.
This tool helps you prepare for a planned conversation — it can’t tell whether a headache is serious. If in doubt, get it checked.
This tool helps you prepare — it can’t tell if a headache is serious. If you’re worried it might be urgent, call 000 or your GP now.
In your words
The one thing to know
The menu you get to choose from
These are options to understand and discuss — not a recommendation, and not in any order of preference. Your GP decides what’s appropriate for you.
| Option (class) | Often also used for | The trade-off people notice | A question to ask |
|---|---|---|---|
| A beta-blocker e.g. propranolol | blood pressure, anxiety | can lower your blood pressure / make you tired; not ideal if you already run low or have asthma | “Is my blood pressure / asthma a reason to skip this one?” |
| An older antidepressant e.g. amitriptyline | nerve pain, sleep | can make you drowsy — a problem for some, a bonus if you don’t sleep well | “If I struggle with sleep, does that make this a better fit?” |
| A blood-pressure tablet candesartan | blood pressure | usually well tolerated; an option when others caused side effects | “Is this a reasonable first choice for me, or a back-up?” |
| Pizotifen — migraine-specific | — | can increase appetite / weight and cause drowsiness | “How likely is the weight change, and is it reversible?” |
| Topiramate epilepsy | epilepsy | can cause tingling, word-finding trouble, mood change; not safe in pregnancy | “Given my pregnancy plans, is this one off the table?” |
| Sodium valproate epilepsy | epilepsy | effective for some, but must be avoided if you could become pregnant | “Should this be ruled out for me because of pregnancy risk?” |
Doing nothing for now is also a real option — ask “what happens if we hold off and review in a few months?”
These medicines are prescription-only. Which (if any) is right for you is a decision for you and your doctor — this tool just helps you ask better questions. Option set and framing from Australian Prescriber — Migraine management and Pain Management Today — Preventive therapies for migraine.
The honest bit
Two honest things no leaflet leads with: (1) None of these works for everyone. With the usual oral preventers, roughly 1 in 2 people get about half their migraine days back — which means about 1 in 2 don’t get that benefit. (2) You won’t know if one is working for 8–12 weeks at the right dose, so ‘it’s not doing anything’ after two weeks isn’t a fair test. Knowing this up front stops you abandoning a fair trial — or staying on one that genuinely isn’t helping.
Class-level figures from Australian Prescriber — Migraine management (“a 50% reduction in attack frequency in every second patient… if taken regularly”; “efficacy… assessed only after 8–12 weeks at a therapeutic dose”), consistent with the European Headache Federation re-appraisal. Not attached to any single medicine.
A clean, printable version with your question card and blank lines to note what your GP says — there at your appointment, on your phone or in your hand.
That doesn’t look like an email — mind checking?
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This is the general version. The full Migraine decisions kit runs the real numbers for each option, walks the pregnancy-safe choices, and tracks whether your preventer is actually working over the 12-week trial — so your next appointment is a review, not a restart. → See the kit
Get the rest of your appointment ready with the Consult Prep Wizard. Want to see what “about half of people respond” looks like across 100 people? Try the migraine-preventer NNT visualiser.