What are the AAN/AHS guidelines on preventing migraine variants (equivalents)?

Updated: Oct 16, 2019
  • Author: Rima M Dafer, MD, MPH, FAHA; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

Answer

Pharmacologic treatment for episodic migraine prevention in adults

According to guidelines released by the American Academy of Neurology and the American Headache Society, [74]  the following medications are established as effective and should be offered for migraine prevention (level A recommendation):

  • Antiepileptic drugs (AEDs): divalproex sodium, sodium valproate, topiramate
  • β-Blockers: metoprolol, propranolol, timolol
  • Triptans: frovatriptan for short-term MAMs prevention

The following medications are probably effective and should be considered for migraine prevention (level B recommendation):

  • Antidepressants: amitriptyline, venlafaxine
  • β-Blockers: atenolol, nadolol
  • Triptans: naratriptan, zolmitriptan for short-term MAMs prevention

The following medications are possibly effective and may be considered for migraine prevention (level C recommendation):

  • ACE inhibitors: lisinopril
  • Angiotensin receptor blockers: candesartan
  • α-Agonists: clonidine, guanfacine
  • AEDs: carbamazepine
  • β-Blockers: nebivolol, pindolol

NSAIDs and other complementary treatments for episodic migraine prevention in adults

The American Academy of Neurology and the American Headache Society also released guidelines regarding the use of NSAIDs and complementary treatments in preventing episodic migraine. [75]

The following therapy is established as effective and should be offered for migraine prevention (level A recommendation):

  • Petasites (butterbur)

The following therapies are probably effective and should be considered for migraine prevention (level B recommendation):

  • NSAIDS: fenoprofen, ibuprofen, ketoprofen, naproxen, naproxen sodium
  • Herbal therapies, vitamins, and minerals: riboflavin, magnesium, MIG-99 (feverfew)
  • Histamines: histamine SC

The following therapies are possibly effective and may be considered for migraine prevention (level C recommendation):

  • NSAIDs: flurbiprofen, mefenamic acid
  • Herbal therapies, vitamins, and minerals: Co-Q10, estrogen
  • Antihistamines: cyproheptadine

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