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Choices for preventive therapy are based on patient preferences about side effects and evidence of efficacy. The evidence level and commonly used doses for selected categories of migraine preventive medication are reviewed, including antiepileptic drugs, antihypertensive drugs, and antidepressants. Propranolol, timolol, topiramate, and divalproex sodium are approved for migraine prevention by the US FDA. OnabotulinumtoxinA is approved for prevention of chronic migraine. Several off\u2010label drugs, especially lisinopril, candesartan, and amitriptyline also have good evidence of benefit. The spectrum of response to preventive therapy varies; in general, complete cessation of headaches is uncommon, although there are \u201csuper\u2010responders\u201d to every therapy, as illustrated by patient reports of dramatic responses to treatment. Preventive treatment should be started at a low dose and doses increased slowly until therapeutic benefit is achieved or side effects preclude continued use.<\/jats:p>","DOI":"10.1111\/head.13375","type":"journal-article","created":{"date-parts":[[2018,8,23]],"date-time":"2018-08-23T09:20:04Z","timestamp":1535016004000},"page":"218-229","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":50,"title":["Pharmacologic Prevention of Migraine: A Narrative Review of the State of the Art in 2018"],"prefix":"10.1111","volume":"58","author":[{"given":"Elizabeth","family":"Loder","sequence":"first","affiliation":[{"name":"Division of Headache Brigham and Women\u2019s Hospital  Boston MA USA"},{"name":"Department of Neurology Harvard Medical School  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Rizzoli","sequence":"additional","affiliation":[{"name":"Department of Neurology Harvard Medical 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