Pharmacological Migraine Prophylaxis Guidelines
PHARMACOLOGICAL MIGRAINE PROPHYLAXIS GUIDELINES | ||
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Selecting a therapy:1−3 Initial selection of agents Frequent or high dosing of these medications can lead to rebound headaches and progression to chronic |
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Generic | Brand | Notes |
LEVEL A – ESTABLISHED EFFICACY* (≥2 CLASS I TRIALS) |
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Anti-Epileptic Drugs (AEDs) | ||
divalproex sodium |
Depakote |
• Routine monitoring required due to risk of pancreatitis and hepatotoxictiy. • Contraindicated in pregnant women for migraine prophylaxis. |
Depakote ER | ||
topiramate | Topamax | |
Beta-Blockers | ||
propranolol | Inderal | |
Inderal LA | ||
timolol | — | |
Selective 5-HT1B/1D Receptor Agonist | ||
frovatriptan | Frova |
• Preferred first line agent in women of child-bearing age for short-term prevention of menstrually associated migraine (MAM) |
LEVEL B – PROBABLY EFFECTIVE (1 CLASS I OR 2 CLASS II STUDIES) |
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Nonsteroidal Antiinflammatory Drugs (NSAIDs)* | ||
fenoprofen | Nalfon |
• OTC and prescription formulations can |
ibuprofen | Advil | |
Motrin IB | ||
ketoprofen | ketoprofen ext-rel | |
naproxen | Aleve | |
Anaprox DS | ||
Naprelan | ||
Naprosyn | ||
Selective 5-HT1B/1D Receptor Agonist | ||
naratriptan | Amerge |
• Second line alternative for MAM |
zolmitriptan | Zomig | |
Zomig-ZMT | ||
Zomig Nasal Spray |
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LEVEL C – POSSIBLY EFFECTIVE (1 CLASS II STUDY) | ||
NSAIDs | ||
flurbiprofen | — | |
mefenamic acid | Ponstel | |
NOTES | ||
Not an inclusive list. Contains only those medications FDA-approved for use in the treatment of migraine, headache, and pain. *All equally preferred |
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REFERENCES | ||
Adapted from: 1. 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. 2012; 78(17):1337–1345 2. Silberstein, SD. Preventative Migraine Treatment. Continuum (Minneap Minn) 2015 Aug; 21(4 Headache): 973-989. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4640499. Accessed November 28, 2017. 3. Silberstein SD, Holland S, Freitag F, et al. Evidence-Based guideline update: Pharmacologic treatment for episodic migraine prevention in adults: Data Supplement. Neurology. 2012; 78(17). Available at http://www.neurology.org/content/78/17/1337/suppl/DC1. Accessed May 30, 2012. (Rev. 10/2019) |