Published April 24, 2012
Nearly 40 percent of people who have migraines could benefit from taking a daily medication to help prevent them, studies show. Yet only a small percentage of migraine patients take preventive therapy.
Most rely on painkillers that treat the migraines once they hit (called acute treatment), but this approach doesn’t always provide relief from the debilitating pain and nausea of migraines.
The American Academy of Neurology and the American Headache Society want to change that. Together, they published new guidelines in the journal Neurology, recommending a number of effective preventive therapies, including prescriptions, over-the-counter drugs and natural remedies.
After reviewing hundreds of studies, they found that a variety of therapies can reduce the number of migraine attacks by more than half.
The message: “If your migraines are severe, there’s hope for you, and the medicines work,” said Dr. Stephen D. Silberstein of the Jefferson Headache Center at Thomas Jefferson University in Philadelphia.
Those who are candidates for preventive therapy fall into one of four categories:
1. They average more than one migraine attack per week;
2. Their medications to treat the migraines don’t work well;
3. They take these medications so often that they get rebound headaches;
4. The migraine is accompanied by serious severe symptoms like seizures.
For those who have tried a preventive therapy and gave up on it, consider these points: Your dose may have been too high (causing side effects), too low (making it ineffective), or you may need a different treatment. Not all drugs are effective for all people, so it may take some trial and error with different doses and different medications before finding one that works for you. Some headache experts combine two preventive therapies, starting with one, and then adding another on top of it for greater reduction in headaches.
It’s important to work with a doctor who treats headaches and can guide you to a treatment that works. Some of these medications treat other problems or have known side effects, such as lowering blood pressure, weight loss or weight gain, so a doctor needs to treat you as a “whole” person, considering your overall health when deciding on a medication.
The treatments mentioned below fall into two categories, both considered effective. Level A medications have established effectiveness and Level B have probable effectiveness.
“The difference between Level A and B has to do with how much a drug has been studied, not how effective the drug is,” Silberman said.
Anti-seizure dugs: Divalproex sodium or sodium valproate (Depakote, Depacon, etc) and topiramate (Topamax).
Beta-blockers: Metroprolol (Lopressor), propranolol (Inderal), timolol (Blocadren), atenolol (Tenormin) and nadolol (Corgard).
Triptans: Frovatriptan (Frova), Naratriptan (Amerge) and Zolmitriptan (Zomig).
Antidepressants: Amitriptyline (Vanatrip, Elavil, Endep) and Venlafaxine (Effexor)
Herbal and supplements: Butterbur, magnesium, feverfew and riboflavin.
Nonsteroidal anti-inflammatory drugs (NSAIDs): Fenoprofen (Nalfon), ibuprofen (Advil, Motrin, etc.), ketoprofen (Actron), naproxen and naproxen sodium (Aleve, Anaprox, etc.)