Newer Migraine Preventive Medicines Sydney | Dr Ron Granot
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Newer Preventive Medicines for Migraine

The first medicines designed specifically to prevent migraine — three are PBS-listed in Australia. Prescribed by Dr Ron Granot at Sydney Headache Centre, Bondi Junction.

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The First Migraine-Specific Preventative Class

Until 2018, every medicine used to prevent migraine was repurposed from another use — from heart, epilepsy and depression treatment, and even cosmetic injections. These newer medicines are different: they were designed specifically for migraine and act on the actual pain pathway that drives it.

During a migraine, the trigeminal nerve endings release a small protein that widens blood vessels, inflames the surrounding tissue and amplifies pain signals to the brain. These medicines block either that protein or its receptor, preventing the cascade that produces a migraine attack.

The Medicines Available in Australia

Four of these medicines are available in Australia. Three are PBS-subsidised. The fourth is registered but not PBS-listed, which makes it substantially more expensive, so it is used rarely.

  • Pens used at home: three are pen injections you give yourself under the skin each month; one of the PBS-listed pens can also be used every three months.
  • A drip in a clinic: one is given as a drip (about 30 minutes) at an infusion clinic every three months, with no self-injection. It can start working sooner than the pens, sometimes within days.
  • How soon they work: most people who respond notice improvement within 4–8 weeks.

PBS Eligibility — Who Qualifies?

The three PBS-listed medicines have effectively identical PBS criteria. Eligibility focuses on treatment-resistant chronic migraine.

Patient must meet ALL of the following

  • Chronic migraine — ≥8 headache days per month, documented with a headache diary
  • Adequate trials of ≥3 oral preventative medications from different classes — each at adequate dose and duration, discontinued for inefficacy or intolerance
  • Treatment prescribed by a neurologist (Dr Granot meets this requirement)
  • Not concurrently receiving the 12-weekly injection treatment under the PBS for chronic migraine

Continuation — PBS authority is granted in stages. Initial approval covers a treatment trial; continuation requires demonstrated ≥50% reduction in headache days. Reviews continue at regular intervals.

How the Treatment Works in Practice

1

Pre-treatment baseline

Headache diary documenting frequency, intensity and duration of migraine days over at least 1 month (ideally longer). PBS approval is contingent on a documented baseline.

2

Choosing a medicine

The four medicines are broadly similar in benefit. The choice considers whether you prefer a pen at home or a drip in a clinic, how often it is given, side effects (for example, a history of constipation), and pregnancy plans.

3

PBS authority application

Dr Granot submits the PBS authority application on your behalf. Once approved, the prescription is dispensed at your pharmacy (or, for the drip, booked at an infusion centre).

4

First dose & technique training

For the pens, the first dose is often given in the rooms with technique training. Later doses are self-administered at home. The drip takes about 30 minutes at a designated infusion clinic.

5

Response assessment

Response is formally assessed after 3 months (PBS minimum) and again at 6 months. Continuing diary entries are essential. PBS continuation requires ≥50% reduction in migraine days at the assessment point.

These Medicines or the 12-Weekly Injections — Which to Choose?

For chronic migraine patients meeting both sets of PBS criteria, both are reasonable options. Choice depends on individual factors. Read the detailed comparison on our injection treatment page.

FactorNewer preventive medicines12-weekly injection treatment
PBS indicationChronic migraine — ≥8 headache days/monthChronic migraine — ≥15 headache days/month with ≥8 migraine days
FrequencyMonthly or 3-monthlyEvery 12 weeks (3-monthly)
RouteSelf-injection under the skin, or a drip in a clinic31 small injections into the muscles, in the rooms
Time to response4–8 weeksOften by cycle 2 (24 weeks)
Best suited forChronic migraine; one is also approved for high-frequency episodic migraineChronic migraine with medication-overuse component

Frequently Asked Questions

What are these medicines and how do they work? +
A small protein released by nerve endings is a key chemical messenger in migraine pain. These medicines block either the messenger itself or its receptor. They are given by injection (under the skin monthly or every three months, or by a drip every three months) and prevent migraine attacks rather than treating them when they occur.
Which of these medicines are PBS-listed in Australia? +
Three are PBS-listed: two are pens you use at home (one monthly, the other monthly or every three months), and one is a drip given in a clinic every three months. A fourth medicine is registered for use in Australia but is NOT PBS-subsidised, making it considerably more expensive, so it is used rarely in our practice when PBS-listed alternatives exist. PBS subsidy criteria are essentially the same across the three PBS-listed medicines.
Who is eligible for PBS subsidy? +
PBS criteria require: chronic migraine with at least 8 headache days per month; failed adequate trials of at least 3 oral preventatives from different classes; treatment prescribed by a neurologist; not currently receiving the 12-weekly injection treatment under the PBS for chronic migraine; and a headache diary documenting baseline frequency. Authority approval is required and continuation depends on demonstrating ≥50% reduction in headache days.
How quickly do they work? +
Many responders notice improvement within 4–8 weeks of the first dose, which is faster than the 12-weekly injection treatment (where response is typically seen by cycle 2 at week 24). PBS guidelines require 3 months of treatment before formally assessing response.
What are the side effects? +
The most common are injection-site reactions (redness, soreness). Constipation is more common with one of them, so tell us if you are prone to constipation. All four can rarely cause allergic reactions. Unlike oral preventatives, they have few systemic side effects — they don't cause the sedation, weight changes or slowed thinking that some older preventive tablets can.
Can I use them alongside the 12-weekly injection treatment? +
Not concurrently under PBS — patients must choose one, although switching between them is permitted under PBS authority rules. Some private (non-PBS) use of both has been described internationally but is not subsidised in Australia.
What happens if it doesn't work? +
PBS continuation requires documented ≥50% reduction in migraine days. If inadequate, treatment is discontinued and an alternative — including the 12-weekly injection treatment or a different medicine from this group — may be tried. A different one is sometimes effective when the first has failed, particularly when switching between one that blocks the receptor and one that blocks the messenger.
What about pregnancy and breastfeeding? +
These medicines are not recommended in pregnancy. Because they stay in the body for several months, they are stopped well before a planned pregnancy — for most of them, at least 5 months before trying to conceive. Discuss the timeline in advance if you are considering pregnancy, and tell us if you are breastfeeding.

Related: Migraine overview · Injection treatment for chronic migraine · Headache diary tool · For GPs · Migraine aura

Important: This page is general health information for adults living in Australia and is not a substitute for individual medical advice. These medicines have specific PBS eligibility criteria and are prescribed only after a comprehensive consultation. Treatment decisions are made on an individual basis with your treating doctor.

Considering These Medicines for Your Migraines?

Book a consultation with Dr Ron Granot to assess your PBS eligibility and choose the right medicine for you.

Book a Consultation
Call Us02 9388 0615
LocationSuite 301, Bondi Junction
Emailreception@eastneurology.com.au

Last reviewed: 18 October 2026 by Dr Ron Granot, FRACP — Consultant Neurologist, East Neurology, Bondi Junction.

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