Migraine prophylaxis: evidenced options
Written and reviewed by Dr Ibrahim Imam, Consultant Neurologist. Last reviewed .
Migraine prophylaxis: evidenced options. The starting dose is 40mg daily. It is increased by 40mg weekly. Fully referenced neurology checklist.
Betablockers: Propranolol
- The starting dose is 40mg daily
- It is increased by 40mg weekly
- The maintenance dose is 40-120mg bid
Betablockers: others
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Topiramate
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Candesartan
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Frovatriptan
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Amitriptyline
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Valproate
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Flunarizine
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CGRP monoclonal antibodies
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Dual therapy
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Acronym
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References
- Eigenbrodt AK, Ashina H, Khan S, et al. Diagnosis and management of migraine in ten steps. Nat Rev Neurol 2021; 17:501-514.
- Silberstein SD, 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; 78:1337-1345.
- MacGregor EA, Steiner TJ, Davies PTG. British Association for the Study of Headaches (BASH). Guidelines for all healthcare professionals in the diagnosis and management of migraine, tension-type, cluster and medication-overuse headache. September 2010.
- Sprenger T, Viana M, Tassorelli C. Current prophylactic medications for migraine and their potential mechanisms of action. Neurotherapeutics 2018; 15:313-323.
- Hovaguimian A, Roth J. Management of chronic migraine. BMJ 2022; 379:e067670.
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