How to prevent frequent migraines in my 41-year-old sister?

Question

Hi doctor,

My sister is 41 years old and has been experiencing migraine headaches for many years. The pain usually occurs on one side of the head and is often accompanied by nausea and sensitivity to light. Recently, the frequency has increased to almost 10 to 12 days per month, affecting her work routine. She has tried pain relief medication, but the headaches continue to recur. Stress and lack of sleep seem to trigger attacks more frequently.

Kindly tell me the following:

What preventive treatments are available to reduce migraine frequency?
When should long-term therapy be considered?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com

I have read your query and understand your concern.

It is clear this is significantly affecting her quality of life. Based on what you describe, her migraines have likely progressed to a more frequent or chronic pattern, and this is when preventive (prophylactic) treatment becomes especially important.

In general, preventive therapy is considered when migraines occur more than four to five days per month, are particularly disabling, or do not respond well to acute pain medications. Since she is experiencing headaches 10 to 12 days per month, she would strongly benefit from a preventive approach rather than relying only on pain relief.

Preventive therapy such as a regular sleep schedule, hydration, trigger avoidance, stress reduction, and consistent meals is helpful.

She may require investigations like clinical neurological evaluation, headache diary, MRI (magnetic resonance imaging) brain if red flags present, assessment for medication overuse, sleep evaluation

There are several evidence-based preventive options.

Medications such as beta-blockers (like Propranolol).
Certain antidepressants (such as Amitriptyline).
Anticonvulsants (like Topiramate).

These are commonly used and can significantly reduce frequency and intensity over time. More recently, targeted therapies like CGRP (calcitonin gene-related peptide) monoclonal antibodies have shown very good results in patients with frequent migraines.

In addition, lifestyle regulation is essential; maintaining a consistent sleep schedule, managing stress, staying hydrated, and identifying personal triggers can make a meaningful difference.

Non-pharmacological approaches such as relaxation techniques, cognitive behavioral therapy, and even biofeedback can also support long-term control.

Hope I have addressed all of your queries and concerns.

Let me know if I can assist you further.

Thank you.