What should be considered before administering preventive drugs for migraine headache?

Updated: Oct 21, 2019
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

As with abortive medications, the selection of a preventive medication must take into consideration comorbid conditions and the side-effect profile (see Tables 2 and 3, below). Most preventive medications have modest efficacies and have therapeutic gains of less than 50% when compared with placebo. The latency between initiation of therapy and onset of positive treatment response can be quite prolonged. Furthermore, the scientific basis for using most of these medications is wanting.

Table 2. Preventive Drugs for Migraine (Open Table in a new window)

First line

High efficacy

Beta blockers

Tricyclic antidepressants

Divalproex

Topiramate

Low efficacy

Verapamil

Second line

 

High efficacy

Methysergide

Flunarizine

MAOIs

CGRP inhibitors

Botulinum toxin

 

Unproven efficacy

Cyproheptadine

Gabapentin

MAOIs = monoamine oxidase inhibitors

Table 3. Preventive Medication for Comorbid Conditions (Open Table in a new window)

Comorbid Condition

Medication

Hypertension

Beta blockers

Angina

Beta blockers

Stress

Beta blockers

Depression

Tricyclic antidepressants, SSRIs

Overweight

Topiramate, protriptyline

Underweight

Tricyclic antidepressants (nortriptyline, protriptyline)

Epilepsy

Valproic acid, topiramate

Mania

Valproic acid

SSRIs = selective serotonin reuptake inhibitors


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