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Preventive
migraine therapies such as relaxation training, cognitive behaviour therapy,
thermal and electromyographic biofeedback proved beneficial for episodic
migraine patients.
A clinical report published in the January issue of American Family Physician by Hien Ha et al. highlighted the prophylactic or preventive medications for migraine.
Migraine notably hampers the quality of life of the patients worldwide. About
13% of migraineurs take prophylactic medicines but with the introduction of
preventive therapies about 38%, episodic migraineurs will be potentially
benefited from them. The severity of migraine and its frequency and
headache-related distress are reduced by Preventive medication therapy. It may
also be useful for improving the quality of life and prevent the advancement of
chronic migraines. Preventive treatments can be given to patients experiencing
4 or more headaches or 8 or more headache days a month, headaches due to
medication overuse and debilitating headaches. Migraines can be prevented by
recognising and managing the environmental, dietary, and behavioural triggers.
The first-line medications rendered as effective according to clinical evidence
comprise divalproex, topiramate, metoprolol, propranolol, and timolol. The
medicines for second-line therapy include amitriptyline, venlafaxine, atenolol,
and nadolol.
Limited
evidence is available for carbamazepine, gabapentin, nebivolol, bisoprolol,
pindolol, fluoxetine, nicardipine, verapamil, nimodipine, candesartan,
lisinopril and nifedipine. lamotrigine, acebutolol, oxcarbazepine, and
telmisartan are not sufficient. New CGRP antagonists have recently been
approved by USFDA for the prevention of migraine but to evaluate long term
efficacy and safety more studies are needed. Petasites, feverfew, magnesium,
and riboflavin deemed as complementary treatments are most likely effective. It
has been observed that non-pharmacologic therapies such as relaxation training,
thermal biofeedback combined with relaxation training, electromyographic
feedback, and cognitive behaviour therapy, are helpful in migraine prevention.
American Family Physician
Migraine Headache Prophylaxis
Hien Ha et al.
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