A new study looking at several different migraine treatments has found that a first-line medicine commonly prescribed to help prevent the onset of migraine might not be the optimal choice after all.

Of those that were found to be better choices, many of the cheaper options were just as effective as the more expensive pharmaceuticals.

While many preventatives are now available, finding the right one for each person is a challenge. To take a closer look at relative effectiveness, the research team looked at data from Norway's national prescription database, involving 104,072 people in total.

Preventive treatments (to reduce the number and severity of migraines) were judged based on how long people stuck with them, and how often they were used alongside acute treatments (which are designed to help after migraines have started).

"When the withdrawal of acute migraine medicines changed little after starting preventive medicines, or people stopped quickly on the preventive medicines, the preventive medicine was interpreted as having little effect," says neurologist Marte-Helene Bjørk, from the University of Bergen in Norway.

"If the preventive medicine was used on long, uninterrupted periods, and we saw a decrease in the consumption of acute medicines, we interpreted the preventive medicine as having good effect."

The researchers found that all preventive treatments were somewhat effective at lowering migraine frequency, duration, and intensity – but that CGRP inhibitors, amitriptyline, and simvastatin appeared to have the biggest positive effect.

"The latter two medicines are also established medicines used for depression, chronic pain and high cholesterol, respectively," says Bjørk.

All three drugs outperformed beta blockers, which are the usual go-to drug for migraine prevention. The CGRP inhibitors target the calcitonin gene-related peptide, which has been linked to inflammation in the brain, and unlike the other two drugs they've been specifically developed to combat migraines.

However, CGRP inhibitors are significantly more expensive than the other two options, and that's an important consideration when it comes to ongoing efforts to get more migraine sufferers to take preventive medication.

Migraines are more than just severe headaches, and often come with feelings of nausea attached, as well as heightened sensitivity to light and sound. They can be genuinely debilitating, tend to be more common in women, and are thought to affect almost a billion people worldwide.

It's a major problem, but only 3–13 percent of people who experience migraines take any kind of drug to try and reduce them in some way. The researchers are hoping that their comprehensive review helps to make a difference to those figures.

"Our analysis shows that some established and cheaper medicines can have a similar treatment effect as the more expensive ones," says Bjørk.

The research has been published in the European Journal of Neurology.