Migraine? Updated Guidelines Point to Drugs That Can Prevent the Pain

Antiepileptic drugs, beta blockers, and triptans are among the medications that can help prevent episodic migraines, updated treatment guidelines suggest.

Studies suggest that just a small fraction of migraine patients who could benefit from preventive therapy are taking advantage of it. To help these patients and the health care professionals who treat them select the most effective preventive pharmacologic agents, an expert panel assembled by the American Academy of Neurology in cooperation with the American Headache Society has released updated treatment guidelines in the April 24, 2012, issue of Neurology.

The new guidelines, which build on guidelines published in 2000, report that certain types of antiepileptic drugs, beta blockers, triptans, and other medicines are particularly effective at preventing episodic migraines. Several types of antidepressants, angiotensin receptor blockers (ARBs), angiotensin-converting enzyme (ACE) inhibitors, and calcium channel blockers also exhibited a strong capability of preventing migraine headaches. The updates also single out 7 medications that are ineffective at preventing migraines and 14 medicines for which there was not enough evidence to determine viability. Included among the medications deemed ineffective were certain antidepressants, antiepileptic drugs, beta blockers, triptans, and calcium-channel blockers.

The panel evaluated 284 studies published between May 1999 and June 2009 and selected 29 as suitable for use in developing the guidelines. Based on their review of these studies, the panelists determined that divalproex sodium, sodium valproate, topiramate, metoprolol, timolol, and propranolol were all effective at preventing migraines. They also determined that amitriptyline, venlafaxine, atenolol, and nadolol are probably effective at preventing episodic migraines, while lisinopril, candesartan, clonidine, guanfacine, carbamazepine, nebivolol, and pindolol were possibly effective.

The panel determined that lamotrigine was definitely ineffective, clomipramine was probably ineffective, and acebutolol, clonazepam, nabumetone, oxcarbazepine, and telmisartan were possibly ineffective at preventing migraines. Finally, the panel found inadequate or conflicting data regarding the effectiveness of gabapentin, fluoxetine, fluvoxamine, protriptyline, acenocoumarol, warfarin (Coumadin), picotamide, bisoprolol, nicardipine, nifedipine, nimodipine, verapamil, acetazolamide, and cyclandelate.

The panel also determined that frovatriptan is effective and naratriptan and zolmitriptan are very likely to be effective as preventive treatments for short-term, menstrually associated migraines.

According to a MedPage Today article, the updated guidelines differ from the 2000 guidelines in a number of ways: Topiramate has been elevated based on the evidence of 5 trials, while verapamil and gabapentin have been downgraded.

The panelists note that although the guidelines provide indications of effective preventive treatments for migraines, they do not establish an optimal therapy.

To read the article outlining the guidelines, click here.