"Many migraine sufferers could have fewer less severe headaches if they took preventive medicines but few eligible patients do say doctors releasing updated treatment guidelines Monday. Not everyone with migraines needs prevention medicine. Not everyone with migraines needs prevention medicine. The guidelines list seven prescription medicines and one herbal remedy backed by strong evidence and include many other treatments that might work for some patients. Migraine is one of the most disabling conditions known to man but patients need to know that there is hope says Stephen Silberstein a neurologist at Thomas Jefferson University in Philadelphia and lead author of the guidelines from the American Academy of Neurology httpcontent.usatoday.comtopicstopicAmericanAcademyofNeurology and the American Headache Society. They were presented at an academy meeting and published in the journal Neurology.  Medicines backed by the strongest evidence include antiseizure drugs divalproex sodium sodium valproate and topiramate blood pressure drugs metoprolol propranolol and timolol and for menstrualrelated migraines a medicine called frovatriptan the guidelines say. They also cite strong support for the herbal remedy butterbur and include a longer list of prescription and nonprescription therapies patients can consider. More about migraines Migraines are not ordinary headaches. They cause throbbing pain often on one side of the head and can come with nausea vomiting and sensitivity to light and sound. Visual disturbances or other warning signs called auras may precede the headaches. Migraines are three times more common in women than men. In some susceptible people stress bright lights lack of food or sleep hormonal changes or other triggers may play roles.  Source National Institute of Neurological Disorders and Stroke  These preventive treatments usually are used daily. The guidelines do not look at the options patients have once symptoms begin. Not everyone with migraines needs prevention medicine. But nearly  have headaches that are so frequent at least once a week severe or hardtotreat that they qualify Silberstein says. Studies find that just  to  use the treatments. Why so few One reason is that its hard to persuade people to take medicines on days when they feel fine says Elizabeth Loder a neurologist at Brigham and Womens Hospital in Boston. Silberstein adds that some patients have not been properly diagnosed or made aware of their options. Still others try the treatments and decide they dont work or have unacceptable side effects. You have a lot of gunshy patients because of a lot of bad experiences says Michael John Coleman founder of the patient group MAGNUM also known as the National Migraine Association. Many spend months or years taking medicines that dont work and make them miserable he says. Thats what happened to Emily Guzan  a lawyer from Pittsburgh who was diagnosed with migraine in . She was given a prescription for Topamax topiramate and it was a real nightmare she says. She kept having headaches bad enough to land her in an emergency room once a month and suffered nightmares an altered sense of taste an unwanted pound weight loss and memory problems  all of which she attributes to the drug. She tried some other medications but for now shes given up on all of them and says shes getting better results with diet yoga and other lifestyle changes. Finding the right medication for the right patient can take a lot of trial and error and careful dosing Silberstein says. But about  will get relief he says  defined as a headache reduction of at least   after trying three or four drugs alternative remedies and lifestyle changes. Even hardtotreat patients may eventually respond to something Loder says so she urges frustrated patients to keep trying. The life toll that poorly controlled headaches take is really underappreciated she says. You dont get back the time you lost at work or the time you lost with your children. Coleman of Alexandria Va. also urges fellow sufferers to keep working with their doctors His own migraines took  years to control. This is not a cookiecutter disease and there is no magic bullet but there is hope."