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Which preventive medications effective for episodic migraine
How are preventive medications used and which are effective for episodic migraine?
A preventive medication is slowly titrated to the target dose and taken for a minimum of 8 weeks to see if effective.
Contraception should be discussed with women of childbearing potential and the potential risk of medication with pregnancy. A paper or electronic headache diary should be kept to monitor progress.
Here is the table which provides the American Headache Society/American Academy of Neurology Migraine Prevention Guidelines.
Choose a medication based upon efficacy, the patient’s preferences, the medication side effects, and the presence or absence of coexisting or comorbid conditions.
One medication may be used for migraine and another disorder, a “two for” (such as depression, epilepsy, or hypertension). The most effective medications reduce the frequency of headaches by about 50% in about 50% of migraineurs.
AHS/AAN Migraine Prevention Guidelines 2012
| Drugs Recommended for Use | |
|---|---|
| Drug | Examples of Studied Doses |
| Level A: Established as Effective | |
| Should be offered to patients requiring migraine prophylaxis | |
| Divalproex/sodium valproate | 400-1000 mg/day |
| Metoprolol | 47.5-200 mg/day |
| Petasites (butterbur) ∗ | 50-75 mg bid |
| Propranolol | 120-240 mg/day |
| Timolol | 10-15 mg bid |
| Topiramate | 25-200 mg/day |
| Level B: Probably Effective | |
| Should be considered for patients requiring migraine prophylaxis | |
| Amitriptyline | 25-150 mg/day |
| Fenoprofen | 200-600 mg tid |
| Feverfew | 50-300 mg bid; 2.08-18.75 mg tid for MIG-99 preparation |
| Histamine | 1-10 ng subcutaneously twice a week |
| Ibuprofen | 200 mg bid |
| Ketoprofen | 50 mg tid |
| Magnesium | 600 mg trigmagnesium dicitrate qd |
| Naproxen/naproxen sodium | 500-1100 mg/day for naproxen |
| 550 mg bid for naproxen sodium | |
| Riboflavin | 400 mg/day |
| Venlafaxine | 150 mg extended release/day |
| Atenolol | 100 mg/day |
| Level C: Possibly Effective | |
| May be considered for patients requiring migraine prophylaxis | |
| Candesartan | 16 mg/day |
| Carbamazepine | 600 mg/day |
| Clonidine | 0.75-0.15 mg/day; patch formulations also studied |
| Guanfacine | 0.5-1 mg/day |
| Lisinopril | 10-20 mg/day |
| Nebivolol | 5 mg/day |
| Pindolol | 10 mg/day |
| Flurbiprofen | 200 mg/day |
| Mefenamic acid | 500 mg tid |
| Coenzyme Q10 | 100 mg tid |
| Cyproheptadine | 4 mg/day |
Data from Silberstein SD, Holland S, Freitag F, et al.; Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology 78(17):1337, 2012.
