Prescription Medication

The methods described on these pages largely eliminated my migraines, and as a result I was able to reduce then eliminate prescription migraine medication. Over the years I've tried amitriptyline, topiramate, a beta blocker, nortriptyline, emgality (an expensive CGRP inhibitor injection), and probably others. I no longer use preventive medication, and I rarely use relievers. Medication typically treats the symptoms rather than the root cause.

I'm not against medication for migraines. If I could find a medication that worked well and had a side effect profile that I could live with I would give it a try, particularly if it allowed me to increase foods / activities that were triggers - I'd like to be able to eat more dark chocolate! After a recent surgery I was prescribed ibuprofen three times a day for pain relief, and it almost eliminated my migraines even though I was eating foods that usually triggered my migraines. This isn't a good long term solution as ibuprofen can damage your stomach. Some medication side effects diminish over time.

Reducing migraines as this website describes might mean that a lower dose of any medication is required, which could reduce side effects.

Do not change or stop your medication without consulting with your doctor.

Relievers

Relievers appear to make migraines worse over time. Any painkiller or anti-inflammatory can make migraines worse, ibuprofen, paracetamol, etc. I've not used a triptan in years, and use of other painkillers has dropped by 95%+. Ibuprofen is also meant to be not so good for gut bacteria, which are important for health.

Once migraines are reduced usage should drop naturally. I will use a reliever occasionally but I try to minimise usage.

Preventative Migraine Medication

When my migraines were more controlled I decided to see what would happen if I reduced my prescription migraine medication. This worked out well for me, but it may not be generally true - some people may require medications.

ALWAYS ALWAYS ALWAYS consult your doctor before changing your medication.
DO NOT stop medications suddenly. I'M NOT KIDDING HERE, there can be serious consequences stopping medication suddenly. Years ago I reduced amitriptyline from 50mg to 25mg in one step and ended up feeling very sick for 48 hours until I put the dose back up. After that I reduced the dose slowly, but I had no help from doctors. Some doctors still think it's possible to go straight off medications including anti-depressants suddenly - if a doctor told me to stop taking them rather than weaning down I would get a new doctor.
Many medications, particularly SSRIs and tricyclics, need to be reduced very slowly. The Maudsley Deprescribing Guidelines, written for doctors, can be a useful guide for doctors.
This podcast provides some basic advice on how to reduce SSRIs and such about half way through.
My approach was to reduce my dose of nortriptyline by around 10%, then wait until I felt stable before I reduced them again - basically 5mg at a time until I hit 20mg. It took me a year to get off amitriptyline, and a few months to get off nortriptyline.
As I got down to low doses I reduced the medication even more slowly. I used a pill cutter which I got from a pharmacy. Below 20mg I think I reduced the dose by 2.5mg at a time. Below 5mg I went down by around 1mg at a time. When I was reducing capsules another time I opened them up and divided up the little pellets inside.
The longer I was on a medication the longer I found it took to get off it.
I usually reduced my dose Friday or Saturday so any effects were felt on the weekend.