Prophylactic therapy should be considered for patients whose migraine episodes have a substantial impact on their lives (i.e., causing them to miss workdays and family activities) despite appropriate use of symptomatic medications, or whose frequency of episodes is such that reliance on acute medications alone puts them at risk for medication overuse headache. 3 According to the criteria of the International Headache Society, 1 medication overuse headache is defined as headache present on more than 15 days per month, which has developed or markedly worsened during medication overuse.
What are the best prophylactic drugs for migraine?
What are the best prophylactic drugs for migraine? EVIDENCE-BASED ANSWER A Beta-blockers without intrinsic sympathomimetic activity, amitriptyline, divalproex sodium/sodium valproate, and topiramate are the most eff ective drugs for preventing episodic migraine (strength of recommendation: A, multiple, well-designed, randomized controlled trials
When to start migraine prophylaxis?
Migraine can have considerable impact on quality of life and daily function. The decision about when to start migraine prophylaxis is best guided by the impact of migraine on each patient (rather than focusing on the absolute number of migraines per month). Overusing acute medicines can limit the effectiveness of prophylaxis
What is the best migraine prevention therapy?
Migraine treatment is aimed at stopping symptoms and preventing future attacks. ... Medications used to relieve migraine pain work best when taken at the first sign of an oncoming migraine — as soon as signs and symptoms of a migraine begin. Medications that can be used to treat it include: ... Cognitive behavioral therapy.
When is prophylactic medication prescribed for migraines?
Prophylaxis is a vital part of migraine management. The FDA-approved medications aren't the only drugs that may be prescribed to prevent headaches or to at least reduce the number of headaches that occur per month, but they are the ones that have been studied the most and found to be effective.
What is prophylaxis of migraine headache?
Migraine prophylaxis is one the most important treatment approaches for reducing the frequency of recurrent migraine headaches. Preventive treatment options for migraine include medications such as antidepressants, anticonvulsants, beta-blockers, and more.
What is the first-line treatment for migraine prevention?
Acetaminophen and nonsteroidal anti-inflammatory drugs are first-line treatments for mild to moderate migraines, whereas triptans are first-line treatments for moderate to severe migraines. Although triptans are effective, they may be expensive.
Is there a preventative medication for migraines?
Preventive medication is aimed at reducing how often you get a migraine, how severe the attacks are and how long they last. Options include: Blood pressure-lowering medications. These include beta blockers such as propranolol (Inderal, InnoPran XL, others) and metoprolol tartrate (Lopressor).
What factors would need to be considered to determine if abortive or preventive therapy is most appropriate?
The appropriate choice depends on one's history of abortive and concurrent medication use, comorbidities, contraindications, associated symptoms (e.g., nausea and vomiting), the severity and frequency of attacks, and cost.
Can sumatriptan be used prophylactically?
Sumatriptan should not be used prophylactically. Sumatriptan is recommended as monotherapy for the acute treatment of a migraine attack and should not be given concomitantly with ergotamine or derivatives of ergotamine (including methysergide) (see section 4.3).
Are triptans preventive or abortive?
Abortive treatments include the triptans and ditans, which specifically target serotonin. They are all very similar in their action and chemical structure. The triptans are used only to treat headache and do not relieve pain from back problems, arthritis, menstruation, or other conditions.
How long does it take for preventative migraine medicine to work?
It may take up to 3 months for preventive medicines to help ease migraines. Keeping a headache diary before and after starting treatment may help you keep track of how well the medicine is working. If you don't notice an improvement, let your healthcare provider know.
When should you go to a neurologist for migraines?
Consider making an appointment with a neurologist if: Your headache is continuous for more than a day or two. Your headaches tend to come on suddenly. Your head pain is worsened by straining.
Effectiveness
In one study, an ARB called candesartan was shown to reduce not only the number of headache days, but also headache hours, migraine days, and migraine hours, compared to placebo. In another study, an ACE inhibitor called lisinopril showed significant reductions in headache hours, headache days, and migraine days in study participants.
Side effects
Common side effects of angiotensin blockers may include cough, dizziness, fatigue, lightheadedness, gastrointestinal symptoms, and more. As migraine prophylaxis, it can take weeks for ACE inhibitors and ARBs to show long-term benefits.
Effectiveness
Divalproex sodium and sodium valproate both showed effectiveness for reducing migraine headache rate in clinical studies. Topiramate was also found to significantly reduce migraine frequency in 11 different studies. Gabapentin, lamotrigine, and oxcarbazepine have shown mixed results in their effectiveness for migraine prophylaxis.
Side effects
Common side effects of AEDs may include rash, fatigue, increased energy, gastrointestinal symptoms, paresthesia, weight gain, and hair loss, among others. Anticonvulsants typically begin working immediately, but for migraine prophylaxis it can take 4 to 8 weeks to see results.
Effectiveness
In an early study, an SSRI called fluoxetine was shown to significantly reduce monthly migraine headache hours. Another study on an SNRI called venlafaxine demonstrated a significant reduction in average headache days for study participants. Amitriptyline, a tricyclic antidepressant, was also found to be effective for migraine prophylaxis.
Side effects
Common side effects of antidepressants may include nausea, vomiting, drowsiness, dry mouth, difficulty concentrating, increased heart rate, and more. As a preventive medication for migraine headaches, antidepressants can take 4 to 6 weeks or more to show benefits.
Effectiveness
Multiple studies have found metoprolol to be effective for reducing migraine frequency by as much as 50 percent. A study on propranolol also found this medication to be effective in reducing migraine frequency, duration, and severity. Other potential beta-blockers for migraine prevention include timolol and atenolol.
What are some treatments for migraines?
Nonpharmacologic therapies such as relaxation training, thermal biofeedback combined with relaxation training, electromyographic feedback, and cognitive behavior therapy also have good evidence to support their use in migraine prevention.
What are the best medications for migraines?
First-line medications established as effective based on clinical evidence include divalproex, topiramate, metoprolol, propranolol, and timolol.
How many people with episodic migraines benefit from preventive therapy?
Migraines impose significant health and financial burdens. Approximately 38% of patients with episodic migraines would benefit from preventive therapy, but less than 13% take prophylactic medications. Preventive medication therapy reduces migraine frequency, severity, and headache-related distress. Preventive therapy may also improve quality ...
Does preventive medicine help with migraines?
Preventive medication therapy reduces migraine frequency, severity, and headache-related distress. …. Migraines impose significant health and financial burdens. Approximately 38% of patients with episodic migraines would benefit from preventive therapy, but less than 13% take prophylactic medications. Preventive medication therapy reduces migraine ...
