Preventive medications (eg, topiramate, onabotulinumtoxinA, erenumab, epitinezumab, fremanezumab, galcanezumab) are usually started first, and the overused medication is later stopped, often abruptly; the exception is patients who are taking high doses of opioids, barbiturates, or benzodiazepines; for these patients, the medication may need to be tapered more gradually (over 2 to 4 weeks).