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Clinician’s Corner: Migraine Prevention

Ben Franklin said: “An ounce of prevention is worth a pound of cure”, and this is so true in migraine headache treatment.  Prevention migraine can be a challenge, and this unit covers the older and less expensive drugs used to prevent migraine headaches.  The newest prevention drugs we covered a few weeks ago are nearly $800.00 a month

MIGRAINE Prevention: COMMONLY USED AGENTS

BEHAVIORIAL MANAGEMENT

Risk Factors

  • Stress
  • Menses

Sensory Stimuli

  • Foods/stimulants
  • Weather fronts
  • Chronobiologic changes
  • Protective Factors
  • Stress management
  • Biofeedback
  • Regular Sleep & meals
  • Regular exercise
  • Adequate Hydration
  • Regular work/ school

When to use Pharmacological prevention

Headache Frequency: greater than 8 days/ month   or  2 days/week

Complications with Migraines

Relief therapies are ineffective

Success:  is defined as working in 50% of the patients to decrease headaches by 50%

Expect at least 6 weeks to see benefit from migraine prophylaxis

Encourage patients to identify and avoid triggers…skipping meals, disrupted sleep, stress, alcohol, wine, cheese, aspartame, etc.  Men are 35% more likely to report overexertion as a migraine trigger.  Men are more sensitive to light. Women are more sensitive to triggers of smell and are more likely to become nauseous.

  1. a) beta blockers (considered first line for prophylaxis)
  • Propranolol (Inderal®)
  • Metoprolol tartrate (Lopressor®) or metoprolol succinate (Toprol-XL)

Best to avoid beta blockers in smokers and patients over age 60

  1. b) general analgesics/NSAIDs (second line)
  • Aspirin 650-1950mg  per day.
  • Naproxen 250mg to 550mg –twice daily

Caution: regular use might lead to chronic headache. See last week’s article on medication overuse headache.

Avoid: CV disease, GI risk, hypertension

  1. c) Antidepressants (second line)
  • Amitriptyline (Elavil®) tablets
  • Venlafaxine (Effexor®) (second line)

d)calcium channel blockers (3rd line)

  • Diltiazem (Cardizem®, Cardizem CD, Cardizem LA)
  • Verapamil (Isoptin® or Calan®) SR

e)anticonvulsants: (usually for seizure disorders)

  • Topiramate (Topamax®) 25, 50mg , 100mg, 200mg
  • Divalproex (Depakote ER®)
  • Gabapentin (Neurontin®)  -NOT effective- no better than placebo

g)Cyproheptadine

(Periactin®) (often used for children)  is an antihistamine, with anti-serotonin properties

As you can see there are lots of drugs with lots of different mechanisms of action.  Look to your Thompson Pharmacist to give you advice needed to help better control your migraines.  Go Ahead and ASK… at Thompson Pharmacy it’s ALL for YOU!