Which medication class is the first-line therapy for the prevention of migraine headaches?

Beta-blockers are considered the first-line therapy for the prevention of migraine headaches due to their effectiveness in reducing the frequency and severity of migraine attacks. They work by influencing the cardiovascular system, particularly by blocking the effects of epinephrine on beta-adrenergic receptors, which in turn may stabilize vascular tone and decrease vasodilation associated with migraine attacks.

Numerous clinical studies have demonstrated that beta-blockers, such as propranolol and metoprolol, significantly lower the number of migraine days experienced by patients. They also have a favorable side effect profile, which contributes to their positioning as a first-line option.

Other medication classes, while they may also be used for migraine prevention, do not have the same level of evidence supporting their first-line status. Antidepressants, such as amitriptyline, are often considered an alternative treatment, particularly for patients who also suffer from concomitant depression or anxiety. Calcium channel blockers have some efficacy, but their use is generally less established than that of beta-blockers. Nonsteroidal anti-inflammatory drugs are primarily utilized for acute management rather than prevention, making them less appropriate for this question.

This evidence-based approach is why beta-blockers are the recommended first-line therapy in clinical guidelines