A migraine is the most common cause of severe, recurring headache. With the recent advances in our understanding of migraine, it can be effectively treated and even prevented. Prophylactic treatment of migraines is indicated when patients have three or more severe migraine attacks a month that interfere with quality of life or when attacks are prolonged and symptomatic medication used alone is not satisfactory. The major objective of migraine prophylactic therapy is optimizing the patient's ability to function normally by reducing the frequency, duration, and intensity of attacks. The major migraine preventive therapies include β-blockers, calcium-channel blockers, and tricyclic medications. Preventive treatment should be tailored to individual patient needs. This requires that patient and healthcare professionals understand the rationale and participate actively in decisions regarding therapeutic intervention.