A Plethora of Migraine Prevention Options
For those of us with three or more Migraines a month and those of us whose Migraines are especially severe and debilitating, it's generally recommended that we work with our doctors to find effective Migraine preventive treatments.
At this time, there are no medications on the market that were originally developed for Migraine prevention. The medications in use were developed for other diseases and conditions, and Migraineurs using them for those conditions found that they also helped with Migraine prevention. A few of these went on to get FDA approval for Migraine prevention, but the vast majority of them a prescribed off-label. Off-label prescribing is a very common practice, not only for Migraine, but for other diseases as well.
The medications that have received FDA approval for Migraine prevention are:
In recent years, devices for Migraine prevention have been researched. One of them, the Cefaly, has received FDA approval for Migraine prevention. The second, the Spring TMS (transcranial magnetic stimulation) device, has received FDA approval for the acute treatment of Migraine with aura and is currently in clinical trials in the United States for Migraine prevention. It has received approval for Migraine prevention in Europe.
There has also been quite a bit of research and clinical trials of neurostimulators for Migraine prevention. HOWEVER, none of them are FDA approved at this time. Despite several clinical trials of implantable occipital nerve stimulators for Migraine, they are not FDA approved. This doesn't mean that patients shouldn't investigate and consider them, but anyone considering them should know that they actually failed to meet their endpoints in clinical trials.
Unfortunately, it's difficult — if not impossible — to predict which prevention therapies will work best for any individual patient. That leaves us with having to try them to see if they work or not, and to give a preventive treatment a fair try, we need to try it for about three months. This takes time and patience, but it well worth it when we find what works for us. Something we need to know and keep in mind when trying preventive medications is that trying one medication from a family of medications doesn't tell us anything about how our bodies would respond to another medication in that family. For example — if one calcium channel blocker does nothing for us, that doesn't meant that a different one has no chance of working for us.
The hopeful and positive side of this is that we now have so many options that it's nearly impossible to have tried everything. To give each of the medications now in use for Migraine prevention a fair three-month trial would take in excess of 25 years, and that doesn't even count the devices.
To help you prepare for your next doctor's appointment, satisfy your curiosity, and give you hope, I've put together a list of medications and devices currently in use for Migraine prevention. I'm listing the medications by their drug category.
ANTIHYPERTENSIVES (blood pressure meds)
Angiotensin II Inhibitors:
Calcium Channel Blockers:
Tricyclic antidepressants (TCAs):
Selective serotonin reuptake inhibitors (SSRIs):
Selective serotonin and norepinephrine reuptake inhibitors (SNRIs):
ATTENTION DEFICIT HYPERACTIVITY DISORDER MEDS:
Selective Norepinephrine Reuptake Inhibitor:
Cox-2 Enzyme Inhibitors:
NEURONAL STABILIZING AGENTS (antiseizure medications):
ATYPICAL ANTIPSYCHOTIC MEDICATIONS:
DEVICES AND APPLIANCES:
Loder, Elizabeth, MD, MPH; Burch, Rebecca, MD; Rizzoli, Paul, MD. "The 2012 AHS/AAN Guidelines for the Prevention of Episodic Migraine: Summary and Comparison with other Recent Clinical Practice Guidelines." Headache. Accepted manuscript online: April 26, 2012.
Silberstein, S.D.; Holland, S.; Freitag, F.; et. al. "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;1337.
Holland, S.; Silberstein, S.D.; Freitag, F.; et al. "Evidence-based guideline update: NSAIDS and other complementary treatments 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;1346.
Kotz, Deborah. "How to get better treatment for migraines." The Boston Globe. April 30, 2012.
Gardner, Amanda. "Migraine Guidelines: What Works, What Doesn't." Philly.com. April 24, 2012.
Email interview with Dr. Elizabeth Loder. April 23, 2012.
Ramadan, Nahib M., MD; Silberstein, Stephen D., Md, FACP; Frietag, Frederick G., DO; Gilbert, Thomas T., MD, MPH; Frishberg, Benjamin M., MD. "Evidence-Based Guidelines for Migraine Headache in the Primary Care Setting: Pharmacological Management for Prevention of Migraine." American Academy of Neurology Practice Guidelines. September, 2000.
Reviewed by David B. Watson, MD.
© Teri Robert, 2016. All rights reserved.
last updated July 29, 2016.
All content © Teri Robert, 2004 - Present, unless otherwise noted. All rights reserved.
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