Materiały źródłowe

• #1 Migraine Headache Prophylaxis | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0101/p17.html

  Migraines impose significant health and financial burdens. Approximately 38% of patients with episodic migraines would benefit from preventive therapy, but less than 13% take prophylactic medications. Preventive medication therapy reduces migraine frequency, severity, and headache-related distress. Preventive therapy may also improve quality of life and prevent the progression to chronic migraines. Some indications for preventive therapy include four or more headaches a month, eight or more headache days a month, debilitating headaches, and medication-overuse headaches. […] Identifying and managing environmental, dietary, and behavioral triggers are useful strategies for preventing migraines. […] First-line medications established as effective based on clinical evidence include divalproex, topiramate, metoprolol, propranolol, and timolol.

• #2 Migraine Headache Prophylaxis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/30600979/

  Migraines impose significant health and financial burdens. Approximately 38% of patients with episodic migraines would benefit from preventive therapy, but less than 13% take prophylactic medications. Preventive medication therapy reduces migraine frequency, severity, and headache-related distress. Preventive therapy may also improve quality of life and prevent the progression to chronic migraines. Some indications for preventive therapy include four or more headaches a month, eight or more headache days a month, debilitating headaches, and medication-overuse headaches. Identifying and managing environmental, dietary, and behavioral triggers are useful strategies for preventing migraines. First-line medications established as effective based on clinical evidence include divalproex, topiramate, metoprolol, propranolol, and timolol. Medications such as amitriptyline, venlafaxine, atenolol, and nadolol are probably effective but should be second-line therapy. There is limited evidence for nebivolol, bisoprolol, pindolol, carbamazepine, gabapentin, fluoxetine, nicardipine, verapamil, nimodipine, nifedipine, lisinopril, and candesartan. Acebutolol, oxcarbazepine, lamotrigine, and telmisartan are ineffective. Newer agents target calcitonin gene-related peptide pain transmission in the migraine pain pathway and have recently received approval from the U.S. Food and Drug Administration; however, more studies of long-term effectiveness and adverse effects are needed. The complementary treatments petasites, feverfew, magnesium, and riboflavin are probably effective. Nonpharmacologic therapies such as relaxation training, thermal biofeedback combined with relaxation training, electromyographic feedback, and cognitive behavior therapy also have good evidence to support their use in migraine prevention.

• #3 Migraine Prophylaxis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK507873/

  Successful therapy is defined as a reduction of migraine attacks by at least 50%. […] Prophylactic therapy may decrease the frequency, severity, and duration of migraine attacks, increase responsiveness to acute migraine therapy and improve quality of life. […] Prophylaxis for episodic migraine may reduce headache severity and frequency and prevent progression to chronic migraine. […] Once the need for prophylaxis is established, the following consensus-based principles of care should be adhered to improve the success of prophylactic treatment: Start medications with the highest evidence-based effectiveness.

• #4 Migraine Headache Prophylaxis | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0101/p17.html

  Preventive therapy should be considered in patients having four or more headaches a month or at least eight headache days a month, significantly debilitating attacks despite appropriate acute management, difficulty tolerating or having a contraindication to acute therapy, medication overuse headache, patient preference, or the presence of certain migraine subtypes (i.e., hemiplegic migraine; migraine with brainstem aura; migrainous infarction; or frequent, persistent, or uncomfortable aura symptoms). […] Divalproex (Depakote), topiramate (Topamax), metoprolol, propranolol, and timolol are effective for migraine prevention and should be offered as first-line treatment. […] Behavioral treatments, such as relaxation training, thermal biofeedback combined with relaxation training, electromyographic biofeedback, and cognitive behavior therapy, are effective options for migraine prevention.

• #5 Migraine Headache Treatment & Management: Approach Considerations, Emergency Department Considerations, Reduction of Migraine Triggers

  https://emedicine.medscape.com/article/1142556-treatment

  Migraine treatment involves acute (abortive) and preventive (prophylactic) therapy. Patients with frequent attacks usually require both. Measures directed toward reducing migraine triggers are also generally advisable. […] Preventive treatment, which is given even in the absence of a headache, aims to reduce the frequency and severity of the migraine attack, make acute attacks more responsive to abortive therapy, and perhaps also improve the patient’s quality of life. […] The following may be considered indications for prophylactic migraine therapy: Frequency of migraine attacks is greater than 2 per month, Duration of individual attacks is longer than 24 hours, The headaches cause major disruptions in the patients lifestyle, with significant disability that lasts 3 or more days, Abortive therapy fails or is overused, Symptomatic medications are contraindicated or ineffective, Use of abortive medications more than twice a week, Migraine variants such as hemiplegic migraine or rare headache attacks producing profound disruption or risk of permanent neurologic injury.

• #6 Migraine Prophylaxis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK507873/

  Recurrent migraines can be functionally disabling and can impair quality of life. After treating acute migraines, all migraine patients should be evaluated for preventive therapy. Preventive therapy aims to decrease the frequency, severity, and duration of migraine attacks. Furthermore, preventative therapy can increase responsiveness to acute migraine therapy and improve the quality of life. […] Prophylactic treatment is not curative, and most patients will still need abortive medications for acute migraine. Before starting prophylactic medications, it is imperative to evaluate if patients are using proper and adequate abortive therapies. Overuse of abortive medications can cause rebound headaches. […] Prophylactic migraine treatment should be considered in patients with more than three monthly episodes or at least eight headache days in one month. Patients with severe debilitating headaches despite appropriate acute treatment or those who are intolerant or have contraindications to acute therapy. Prophylaxis should also be considered in patients with medication overuse headaches, certain migraine subtypes like hemiplegic migraine, basilar migraine, migraine with prolonged aura, or if the patient prefers.

• #7 Preventive medicines for migraine – The Migraine TrustVisualV1 – SearchVisualV1 – CrossVisualV1 – Home VisualV1 – CrossVisualV1 – DownloadVisualV1 – Arrow

  https://migrainetrust.org/live-with-migraine/healthcare/treatments/preventive-medicines/

  Preventive medicines for migraine are medicines you take to prevent migraine attacks. There are several different types. […] Preventive medicines are also known as prophylactics. You take them on a regular basis (sometimes every day) to help stop migraine attacks developing. […] Preventive medicines aim to reduce how many migraine attacks you get and how severe they are. […] Not everyone needs to take preventive migraine medicines. Many people can manage their symptoms through self-help measures or by taking acute medicines during an attack. But preventive medicines may help if: you are having frequent migraine attacks (often considered to be four or more days with migraine a month) […] Talk to your GP to discuss whether preventive medicines would be a good option for you. […] There are several different types of medicine that can be used to prevent migraine attacks. The most common ones are listed below.

• #8 Migraine Headache Treatment & Management: Approach Considerations, Emergency Department Considerations, Reduction of Migraine Triggers

  https://emedicine.medscape.com/article/1142556-treatment

  The goals of preventive therapy are as follows: Reduce attack frequency, severity, and/or duration, Improve responsiveness to acute attacks, Reduce disability. […] Currently, the major prophylactic medications for migraine work via one of the following mechanisms: 5-HT2 antagonism – Methysergide, Regulation of voltage-gated ion channels – Calcium channel blockers, Modulation of central neurotransmitters – Beta blockers, tricyclic antidepressants, Enhancing gamma-aminobutyric acid-ergic (GABAergic) inhibition – Valproic acid, gabapentin, Prevention of acetylcholine from presynaptic membrane Botulinum toxin, Calcitonin gene-related peptide (CGRP) inhibitors Atogepant, eptinezumab, erenumab, fremanezumab, galcanezumab. […] The classes of medications that are effective for migraine prevention include: Antiepileptics, Antidepressants, Antihypertensives, Botulinum toxin, Calcitonin gene-related peptide (CGRP) inhibitors.

• #9 Preventive Treatments | Complete list of Preventives Available in Canada, including Classes, Mechanisms of Action, and Side Effects – Migraine Canada

  https://migrainecanada.org/posts/the-migraine-tree/branches/preventive-treatments/migraine-preventives-classes-and-mechanism-of-action/

  Preventive treatments for migraine aim to reduce the frequency, severity, and duration of migraine attacks. Unlike acute treatments, which are taken during a migraine attack to help relieve symptoms, preventive treatments work in combination with lifestyle adaptations to prevent or lessen the intensity of an attack. […] Generally, when people have 4 or more migraine attacks per month, the impact is significant enough to consider prevention. Still, making changes to your lifestyle can be a first option. If you are having more than 10 days of migraine attacks per month, the risk of becoming chronic is very high and a preventive should be prescribed. […] There are several types of preventive medications and they act through different mechanisms in the brain to increase the migraine threshold (the limit your brain has for migraine occurrence) and make the brain less susceptible to triggers that result in a migraine attack.

• #10 Medications for Migraine Prophylaxis | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0101/p72.html

  Sufficient evidence and consensus exist to recommend propranolol, timolol, amitriptyline, divalproex, sodium valproate, and topiramate as first-line agents for migraine prevention. […] Preventive therapy, which can reduce the frequency of migraines by 50 percent or more, is used by less than one half of persons with migraine headache. […] Following appropriate management of acute migraine, patients should be evaluated for initiation of preventive therapy. […] The goal of preventive therapy is to improve patients quality of life by reducing migraine frequency, severity, and duration, and by increasing the responsiveness of acute migraines to treatment. […] An algorithm for pharmacologic migraine prophylaxis is provided in Figure 1, and several evidence-based guidelines for the management of migraine headache are available elsewhere.

• #11 Prevention of migraine attacks – Wikipedia

  https://en.wikipedia.org/wiki/Prevention_of_migraine_attacks

  Preventive drugs are used to reduce the frequency, duration, and severity of migraine attacks. […] Preventive migraine medications are considered effective if they reduce the frequency or severity of the migraine attacks by at least 50%. […] Guidelines are fairly consistent in rating the anticonvulsants topiramate and divalproex/sodium valproate, and the beta blockers propranolol and metoprolol as having the highest level of evidence for first-line use for migraine prophylaxis in adults. […] Propranolol and topiramate have the best evidence in children; however, evidence only supports short-term benefit as of 2020. […] The beta blocker timolol is also effective for migraine prevention and in reducing migraine attack frequency and severity. […] Tentative evidence also supports the use of magnesium supplementation.

• #12 Migraine Prophylaxis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK507873/

  It is important to determine the frequency, duration, and severity of headaches and any triggers that may precipitate them. All patients with migraine headaches should maintain a headache diary to determine the frequency, severity, and duration of headaches. It also helps identify any triggers that can cause a migraine headache. Some common triggers include environmental factors such as noise, odor, medications (like oral contraceptive pills, hormone replacement therapy, and H2-receptor blockers), food (cheese, wine, chocolate), and behavioral factors such as sleep deficit or excessive sleep. Preventive drug therapy may not be needed if triggers can be identified and modified. […] Various medications are available for migraine prophylaxis and prevention. Choosing the right agent is essential. The efficacy, side effects, contraindications, cost, and compliance should be considered when deciding on the right agent.

• #13 Migraine Headache Guidelines: Guidelines Summary

  https://emedicine.medscape.com/article/1142556-guidelines

  According to guidelines released by the American Academy of Neurology (AAN) and the American Headache Society (AHS), the following medications are established as effective and should be offered for migraine prevention (level A recommendation): Antiepileptic drugs (AEDs): divalproex sodium, sodium valproate, topiramate […] The following medications are probably effective and should be considered for migraine prevention (level B recommendation): Antidepressants: amitriptyline, venlafaxine […] The following therapy is established as effective and should be offered for migraine prevention (level A recommendation): Petasites (butterbur) […] The following therapies are probably effective and should be considered for migraine prevention (level B recommendation): NSAIDS: fenoprofen, ibuprofen, ketoprofen, naproxen, naproxen sodium

• #14 Topiramate for Migraine Prevention: An Update – Understanding Migraine

  https://americanmigrainefoundation.org/resource-library/topiramate-migraine-prevention-update/

  Although the drug topiramate initially was developed for the treatment of epilepsy and received its first US Food and Drug Administration (FDA) approval for that purpose, it subsequently was shown to be effective for the prevention of migraine headaches and is FDA approved for that indication as well. […] While the clinical trials for migraine prevention that earned topiramate its FDA approval involved patients with episodic migraine (ie, less than 15 headache days per month), 1 large, randomized, placebo-controlled study indicated that topiramate may be effective for patients with chronic migraine as well (ie, 15 or more headache days per month). […] Fifty milligrams twice daily was the dose proven to be the most effective and best tolerated in the clinical research trials conducted. […] Treatment options vary, from acute treatment to relieve symptoms to preventive treatment to reduce the number of attacks you experience.

• #15 Medications for Migraine Prophylaxis | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0101/p72.html

  Various types of medications have been evaluated for migraine prophylaxis, including beta blockers, antidepressants, anticonvulsants, nonsteroidal anti-inflammatory drugs (NSAIDs), angiotensin blockade agents, and calcium channel blockers. […] Evidence consistently supports the use of the beta blocker propranolol (Inderal) in migraine prophylaxis. […] Amitriptyline is a first-line agent for migraine prophylaxis and is the only antidepressant with consistent evidence supporting its effectiveness for this use. […] Divalproex (Depakote) and sodium valproate are well supported by evidence for use in migraine prevention. […] Evidence supports the use of naproxen sodium (Anaprox) and naproxen (Naprosyn) for migraine prevention. […] The angiotensin-converting enzyme inhibitor lisinopril (Zestril) has demonstrated some effectiveness in the prevention of migraine. […] Other agents that have been assessed for the prevention of migraine have limited evidence, have shown limited effectiveness, or have side-effect limitations.

• #16 Migraine Headache Treatment & Management: Approach Considerations, Emergency Department Considerations, Reduction of Migraine Triggers

  https://emedicine.medscape.com/article/1142556-treatment

  Prophylactic therapy with divalproex and amitriptyline were equally effective in relieving allodynia. […] The NSAID naproxen sodium has also been used for prophylaxis. In controlled clinical trials, naproxen sodium demonstrated better efficacy than placebo and similar efficacy to propranolol. However, this agent should be reserved for short-term use, such as for menstrual migraines. […] Inhibiting the calcitonin gene-related peptide (CGRP) pathway is a new method to prevent migraines. CGRP is a potent vasodilator and is a key neuropeptide that is central to migraine pathophysiology.

• #17 Migraine Headache Guidelines: Guidelines Summary

  https://emedicine.medscape.com/article/1142556-guidelines

  Preventive migraine treatment: Consider preventive treatment for migraine patients in any of the following situations: Migraine attacks are frequent (4 migraine headache days per month) and/or the attacks interfere with patients daily routines even with acute treatment […] Oral treatments should be offered for migraine prevention. These include antiepileptic drugs, beta-blockers, and frovatriptan. […] The AAN/AHS guidelines also address the use of NSAIDs and complementary treatments in preventing episodic migraine. […] The following medications are possibly effective and may be considered for migraine prevention (level C recommendation): ACE inhibitors: lisinopril […] The following therapies are possibly effective and may be considered for migraine prevention (level C recommendation): NSAIDs: flurbiprofen, mefenamic acid

• #18 Migraine Headache Treatment & Management: Approach Considerations, Emergency Department Considerations, Reduction of Migraine Triggers

  https://emedicine.medscape.com/article/1142556-treatment

  The goals of preventive therapy are as follows: Reduce attack frequency, severity, and/or duration, Improve responsiveness to acute attacks, Reduce disability. […] Currently, the major prophylactic medications for migraine work via one of the following mechanisms: 5-HT2 antagonism – Methysergide, Regulation of voltage-gated ion channels – Calcium channel blockers, Modulation of central neurotransmitters – Beta blockers, tricyclic antidepressants, Enhancing gamma-aminobutyric acid-ergic (GABAergic) inhibition – Valproic acid, gabapentin, Prevention of acetylcholine from presynaptic membrane Botulinum toxin, Calcitonin gene-related peptide (CGRP) inhibitors Atogepant, eptinezumab, erenumab, fremanezumab, galcanezumab. […] The classes of medications that are effective for migraine prevention include: Antiepileptics, Antidepressants, Antihypertensives, Botulinum toxin, Calcitonin gene-related peptide (CGRP) inhibitors.

• #19 Migraine Prophylaxis: 5 Preventive Therapies

  https://www.healthline.com/health/migraine/migraine-prophylaxis

  Migraine prophylaxis is one of the most important treatment approaches for reducing the frequency and severity of chronic migraine episodes. […] Preventive treatment options for migraine include medications such as antidepressants, anticonvulsants, beta-blockers, and more. […] Talk with a doctor about which preventive treatment options are available to you.

• #20 Migraine Information, Prevention, & Treatments NYC | Mount Sinai – New York

  https://www.mountsinai.org/care/pain-management/services/migraine

  Maintain a regular schedule. If you sleep, eat, and exercise on a regular schedule, you may experience fewer migraine symptoms. […] Manage your stress. Decreasing feelings of stress through therapy can help, as can relaxation techniques such as meditation. […] Prepare for menstrual migraines. Women who tend to get migraines around their period can take preventive medicine in advance to help. […] Try prevention devices. Transcutaneous supraorbital nerve stimulation (t-SNS) is a sort of portable headband. This device sends electrical impulses to the trigeminal nerve, which is associated with migraines. The device may cause a tingling or massaging feeling. […] Use preventive medications. At Mount Sinai, we can prescribe medication to help prevent migraines. These can include anticonvulsants, beta-blockers, Botox, calcium-channel blockers, anti-depressants, and calcitonin gene-related peptide (CGRP) inhibitors.

• #21 How to Prevent Migraines

  https://www.webmd.com/migraines-headaches/preventive-migraine-medicine

  If you can’t take medication or prefer not to, you and your doctor could consider medical devices such as: Cefaly, a small headband device that sends electrical pulses through the forehead to stimulate a nerve linked with migraines, Spring TMS or eNeura sTMS, a device for people who have an aura before migraine headaches. […] Botulinum toxin is a neurotoxin. When injected into specific muscles in the forehead and neck, it can disrupt the pain pathways associated with migraines. […] If you have severe migraines, your doctor may suggest that you first try a treatment that’s not a drug such as biofeedback, relaxation therapy, or stress management training. […] The time it takes for your migraine prevention medicine to work varies from person to person. […] Your everyday habits can go a long way to help you have fewer and less severe migraines.

• #22 Migraine Headache Prophylaxis | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0101/p17.html

  Preventive therapy for episodic migraines may decrease headache frequency, severity, and prevent progression to chronic migraines. […] Once the need for prophylactic treatment is established, adhering to the following consensus-based principles of care may improve the success of preventive therapy. […] Start therapy with medications that have the highest level of evidence-based effectiveness. […] Allow an adequate trial for each treatment. The patient may see improvement in six to eight weeks, but it may take up to six months for full effect. […] A U.S. Headache Consortium meta-analysis concluded that relaxation training, thermal biofeedback combined with relaxation training, electromyographic biofeedback, and cognitive behavior therapy may be considered as treatment options for the prevention of migraine. Additionally, behavioral therapy (i.e., relaxation, biofeedback) may be combined with preventive drug therapy (i.e., propranolol, amitriptyline) for patients to achieve additional clinical improvement for migraine relief.

• #23 Migraine Prophylaxis in Adults | Doctor

  https://patient.info/doctor/migraine-prophylaxis-in-adults

  Consider non-pharmacological therapies as an adjunct or alternative to pharmacological therapy – for example: Biofeedback, relaxation technique, and cognitive behavioural therapies have shown efficacy in the prevention of episodic migraine but data regarding efficacy in chronic migraine are limited. […] Treatment should be started at a low dose and gradually increased to the maximum effective and tolerated dose. […] Preventative treatment should be tried for at least three months at the maximum tolerated dose, before deciding whether or not it is effective. […] A good response to treatment is defined as a 50% reduction in the severity and frequency of migraine attacks. […] A review of ongoing prophylaxis should be considered after 6-12 months; treatment can be gradually withdrawn in many patients.

• #24 Preventive Treatments | Complete list of Preventives Available in Canada, including Classes, Mechanisms of Action, and Side Effects – Migraine Canada

  https://migrainecanada.org/posts/the-migraine-tree/branches/preventive-treatments/migraine-preventives-classes-and-mechanism-of-action/

  Ultimately, the goal is to decrease the impact of migraine on your life. There are two types of improvement: on frequency and on severity. […] A preventive treatment decreases migraine frequency by 50% in 50% of patients who try it. Some people may have a super response to some medications (75% better). […] Preventive medications need to be taken at effective doses for several months. One month is never enough to make a decision. […] Preventive agents are not necessarily used for many years. After 8-12 months of successful treatment, one could slowly taper and try to discontinue the preventive medication. If migraine attacks increase, then the treatment is still needed and may be continued. […] Preventive medications do not cause addiction (opioids and cannabinoids do). If effective, they are continued for at least a year before considering a dose reduction. Always consult your healthcare provider before stopping any medication. […] Using migraine preventives can lead to a virtuous circle that may allow you to stop the drug. Its easier to adopt a healthy, migraine-friendly lifestyle when one is feeling better and life becomes more predictable.

• #25 3. Headache prophylaxis treatment advice | Right Decisions

  https://rightdecisions.scot.nhs.uk/neurology-pathways-including-headache/headache/3-headache-prophylaxis-treatment-advice/

  If headache worsens on phasing out / stopping an effective treatment this should be reinstated. […] The recommendations for the prophylaxis of migraine in secondary care reflect the advice given for prophylaxis of migraine in primary care, with sequential trials (if needed) of amitriptyline, candesartan, propranolol, and topiramate being recommended. […] Medication overuse with analgesics should be addressed prior to initiating treatment. […] Response to treatment should be assessed after 3 months using headache diaries. […] If there is a good response to treatment, the agent may be continued for a pre-defined period as determined locally (e.g. 12-24 months), before consideration of a treatment holiday. […] If there is recurrence of headache during a treatment holiday, treatment may be re-initiated. […] In HFEM if one agent is ineffective after 3 months a second agent can be trialled. […] Criteria for continuing and stopping may take into account a number of indices: […] Chronic migraine: reduction of at least 30% in frequency or severity of headache / migraine.

• #26 Migraine Headache Prophylaxis | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0101/p17.html

  For menstrual migraines, starting preventive therapy before the time of expected migraine onset can help prevent disability and reduce severity. […] Guidelines on preventing migraines in pregnancy suggest considering nonpharmacologic options before drug therapy. If drug therapy is needed, an agent with the lowest risk of harm to the fetus can be considered at the lowest effective dose.

• #27

  https://www2.hse.ie/conditions/migraine/treatment-and-prevention/

  To reduce your chances of having migraine attacks, you can: […] identify and avoid triggers […] take medicines that prevent migraine attacks. […] The best way to prevent migraine attacks is to find out things that trigger an attack and try to avoid them. […] Your GP may prescribe medicines to prevent attacks if you: […] avoid triggers but you still have migraine attacks […] have severe migraine attacks […] have frequent migraine attacks. […] Medicines include: […] topiramate […] propranolol […] amitriptyline. […] You may need to take a medicine for a few months before you can see if it works. […] These migraine attacks usually happen from 2 days before the start of your period, to 3 days after. […] It may be possible to prevent them with: […] non-steroidal anti-inflammatory medicines (NSAIDs) – such as ibuprofen […] triptans – medicines that reverse the widening of blood vessels.

• #28 3. Headache prophylaxis treatment advice | Right Decisions

  https://rightdecisions.scot.nhs.uk/neurology-pathways-including-headache/headache/3-headache-prophylaxis-treatment-advice/

  The decision if or when to start oral prophylaxis should be tailored to the individual patient. […] Migraine prophylactics may take many weeks to work. Judgment of efficacy should be made once on the target dose or highest tolerated dose at 8 weeks. […] If the migraine prophylactic is ineffective at 8 weeks, it should be weaned over 2 weeks and an alternative considered. […] If it is effective (i.e. reduced monthly headache days by at least 30-50%) consider weaning the drug after 6 to 12 months (it should be weaned at the approximate rate it was increased). […] Migraine prophylaxis is usually not required in pregnancy, and certain medications are contraindicated in pregnancy. […] We recommend consideration of withdrawal of migraine prophylactics prior to conception. […] Where prophylactic treatment is not successful after three preventative medications from different classes, consider referral to relevant secondary care services as per local arrangements.

• #29 Migraine treatment and prevention | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/migraine-treatment-and-prevention/

  Preventing migraine is important. It’s essential to maintain a generally healthy lifestyle, including regular exercise, sleep, and meals, ensuring you stay well hydrated, and limiting your intake of caffeine and alcohol. […] One of the best ways of preventing migraine is recognizing the things that trigger an attack and trying to avoid them. Keeping a migraine diary can help you identify possible triggers and monitor how well any medication you’re taking is working. […] Medication is available to help prevent migraine attacks. Preventive medication is normally used if your migraine headaches remain frequent (more than 1 migraine attack per week) following a period of avoiding possible triggers. […] Preventive medication is not a cure for migraine attacks. The aim is to reduce how severe and often migraine attacks occur. A good response to preventive medication would be a 30% to 50% reduction in frequency and severity. […] You might be offered advanced therapies for migraine that can only be prescribed by a neurologist. […] Menstrual-related migraine usually occurs between 2 days before the start of your period to 3 days after. They can be preventable using either non-hormonal or hormonal treatments.

• #30 Headache Prevention, Treatment, & Relief | K Health

  https://khealth.com/learn/headache/prevention/

  Not all headaches can be avoided, but there are steps you can take to decrease the frequency of your headaches and prevent some from happening at all. […] Every headache is different and understanding what triggers yours is key to headache prevention, whether you suffer from chronic headaches or the more occasional discomfort. This article will give you tips both on how to prevent headaches and what to do if you missed the prevention window and are in pain. […] Keeping track of them is key to headache prevention. […] If you track the foods and drinks you consume, any medicines you take, the times you go to sleep and wake up, any exercise you do as well as when you get headaches, you will start to identify patterns. These patterns can help you understand why you are suffering from frequent headaches, so you can focus on how to prevent headaches.

• #31 Headache Prevention

  https://www.froedtert.com/headache/prevention

  There are ways to reduce your risk of a migraine or at least make it less severe. Following these tips and maintaining a healthy lifestyle is a good start. […] Moderate exercise three to five times each week for 30 minutes will help reduce stress and keep you physically fit and alter the body chemicals that cause and prevent a headache. […] A normal adult should drink about eight glasses of water throughout the day. Dehydration may cause headaches. […] Caffeine is a stimulant and caffeine withdrawal may cause headaches when blood levels of caffeine drop. […] Alcohol may be a trigger for headaches. […] Stress is the number one trigger for a migraine. Relaxation and stress management may help reduce headaches. […] Manage the factors you can and maintain a healthy lifestyle to minimize the effects of the triggers that are out of your control. […] Don’t discontinue use. Talk to your physician if you think medications are triggering your migraines. […] Stress letdown on the weekends or during vacations, or after completing a project or stressful task. […] Headache Prevention.

• #32 Tips for Migraine and Headache Prevention

  https://www.everydayhealth.com/headache-migraine/headache-prevention.aspx

  Consistency is key, says Strauss. I recommend going to bed and getting up at around the same time every day, even on weekends, and avoiding naps if possible, she says. […] Hydration is one of the other healthy habits where consistency can make a big difference in migraine prevention, says Strauss. […] Regular aerobic exercise can work as a preventive medication all on its own, and there are also some studies to suggest that yoga and HIIT (high-intensity interval training) can be helpful as well, she says. […] Its a good practice for people with headaches or migraine to have breakfast, lunch, and dinner with some snacks throughout the day, she adds. […] Strauss says that her office saw people who were experiencing headache for the first time during the pandemic, and the general shift in how and where many people work since the pandemic has brought some new workplace stresses as well.

• #33 Migraine Information, Prevention, & Treatments NYC | Mount Sinai – New York

  https://www.mountsinai.org/care/pain-management/services/migraine

  Migraine headaches cause moderate to severe throbbing. […] At Mount Sinai, we can help you learn to prevent migraines and manage symptoms when they occur. […] If you get migraine headaches, you may not be able to prevent them completely, but you can take steps to get them less often. First, determine your personal migraine triggers so you can try to prevent or manage them. […] At Mount Sinai, we offer a treatment, biofeedback, to help determine your triggers by monitoring your body’s response to stress and prompts. This treatment can teach you how to relax under stress and decrease your migraine attacks. […] In addition to avoiding your personal triggers, you can try to prevent migraine pain or find migraine relief in these ways: […] Exercise regularly. Aerobic exercises like walking, jogging, running, and cycling are associated with a decrease in migraine attacks.

• #34 Migraines: Simple steps to head off the pain

  https://www.mayoclinic.org/diseases-conditions/migraine-headache/in-depth/migraines/art-20047242

  Migraines cause pain as real as the pain of injuries with one difference: Healthy habits and simple remedies sometimes stop migraines before they start. […] The same lifestyle choices that promote overall good health also can reduce the number of migraines you have and lessen the migraine pain. […] Combining medicine with behavioral measures and lifestyle can often be the most effective way to handle migraines. […] At the first sign of a migraine, take a break and step away from whatever you’re doing if possible. […] Light and sound can make migraine pain worse. Relax in a dark, quiet room. Sleep if you can. […] Your eating habits can influence your migraines. Consider the basics: Eat at about the same time every day. […] Fasting increases the risk of migraines. […] Keeping track of the foods you eat and when you have migraines can help you find potential food triggers.

• #35 Migraine Information, Prevention, & Treatments NYC | Mount Sinai – New York

  https://www.mountsinai.org/care/pain-management/services/migraine

  Maintain a regular schedule. If you sleep, eat, and exercise on a regular schedule, you may experience fewer migraine symptoms. […] Manage your stress. Decreasing feelings of stress through therapy can help, as can relaxation techniques such as meditation. […] Prepare for menstrual migraines. Women who tend to get migraines around their period can take preventive medicine in advance to help. […] Try prevention devices. Transcutaneous supraorbital nerve stimulation (t-SNS) is a sort of portable headband. This device sends electrical impulses to the trigeminal nerve, which is associated with migraines. The device may cause a tingling or massaging feeling. […] Use preventive medications. At Mount Sinai, we can prescribe medication to help prevent migraines. These can include anticonvulsants, beta-blockers, Botox, calcium-channel blockers, anti-depressants, and calcitonin gene-related peptide (CGRP) inhibitors.

• #36 Incorporating Nutraceuticals for Migraine… | American Headache Society

  https://americanheadachesociety.org/news/incorporating-nutraceuticals-for-migraine-prevention

  Certain supplements have been found to be helpful in migraine prevention. These nutraceuticals can play a role in an effective preventative strategy for migraine. Many people with migraine can benefit from nutraceuticals. Nutraceuticals can be a good option for patients looking for a more natural approach or as a first step in migraine prevention. The most common nutraceuticals used for migraine include riboflavin, coenzyme Q10, magnesium, melatonin and feverfew. When creating a preventative strategy for your patients, consider combining nutraceuticals with medications and lifestyle modifications. One of the most common nutraceuticals used for migraine prevention is magnesium. Studies have reported decreased magnesium levels in people with migraine. At adequate levels, magnesium can inhibit glutamate, an excitatory neurotransmitter. Feverfew may help reduce the frequency and duration of migraine attacks. It can also help reduce symptoms of migraine, such as pain, nausea, vomiting, and light or noise sensitivity. Typical treatment is 3 milligrams of melatonin before bed every day. As with many forms of migraine management, a headache diary is the best way to track the efficacy of nutraceuticals. When incorporating nutraceuticals into migraine prevention, encourage your patients to keep a simple record of headache frequency and severity to see whether there is a reduction over time.

• #37 Migraine prophylaxis: Over-the-counter treatment options | Medmastery

  https://www.medmastery.com/guides/headaches-clinical-guide/migraine-prophylaxis-over-counter-treatment-options?srsltid=AfmBOorTV1Vc5LhFz6-eAG9cSfzmqUXqzosSX5g2Wq1Tp7ayOK_lZB25

  Prophylactic treatments for headache pain are especially relevant for patients suffering from migraine headaches. […] Prophylactic treatment should be considered. […] Once you’ve decided that your patient is ready for a prophylactic approach to headache pain management, there are over-the-counter medicines and prescription drugs to choose from. […] We recommend certain over-the-counter supplements as prophylaxis for all patients, whether they take prescription medication or not. […] These over-the-counter preparations are magnesium oxide (400-800 mg daily) and riboflavin, or vitamin B2 (400 mg daily). Other treatments which may have a beneficial effect include coenzyme Q10, vitamin B12, feverfew, and butterbur. […] There are three major goals of preventative therapy: reducing headache frequency by at least 50%, reducing headache severity and duration, and increasing the efficacy of abortive or symptomatic therapies.

• #38 Exercise-Induced Headaches: Prevention, Management, and Treatment

  https://www.uspharmacist.com/article/exerciseinduced-headaches-prevention-management-and-treatment

  Implementation of an appropriate warm-up can help prevent exercise-induced headaches in people engaging in more strenuous physical activity, as well as help patients develop a tolerance to exercise-induced headaches and reduce the overall monthly occurrence of migraines. […] Although guidelines for the prevention of migraines and headaches do not address potential prophylactic options for exertional headaches, application of these guidelines to exertional headaches may still provide viable options and benefits for these patients. […] Magnesium: Guidelines classify magnesium as probably effective for migraine prevention and note that it should be considered. […] Riboflavin and CoQ10: Both riboflavin and ubiquinone (coenzyme Q10, or CoQ10) were shown to decrease migraine frequency compared with placebo and are preventive options for exercise-induced migraines.

• #39 Migraine Headache Prophylaxis | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0101/p17.html

  Preventive therapy should be considered in patients having four or more headaches a month or at least eight headache days a month, significantly debilitating attacks despite appropriate acute management, difficulty tolerating or having a contraindication to acute therapy, medication overuse headache, patient preference, or the presence of certain migraine subtypes (i.e., hemiplegic migraine; migraine with brainstem aura; migrainous infarction; or frequent, persistent, or uncomfortable aura symptoms). […] Divalproex (Depakote), topiramate (Topamax), metoprolol, propranolol, and timolol are effective for migraine prevention and should be offered as first-line treatment. […] Behavioral treatments, such as relaxation training, thermal biofeedback combined with relaxation training, electromyographic biofeedback, and cognitive behavior therapy, are effective options for migraine prevention.

• #40 Cluster headache – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cluster-headache/diagnosis-treatment/drc-20352084

  Galcanezumab (Emgality). The Food and Drug Administration recently approved this medicine for the treatment of episodic cluster headache. It’s given as a monthly shot until the cluster period ends. […] Lithium (Lithobid). This medicine is used to treat bipolar disorder. It might help prevent long-lasting, known as chronic, cluster headache. It’s used for people who can’t take other medicines or for whom other medicines haven’t worked. […] Noninvasive VNS uses a hand-held controller to send electrical stimulation to the vagus nerve through the skin. Although more research is needed, some studies have found that VNS helped reduce the frequency of cluster headaches. […] Other preventive medicines used for cluster headache include anti-seizure medicines, such as topiramate (Topamax, Qudexy XR).

• #41 Patient education: Headache treatment in adults (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/headache-treatment-in-adults-beyond-the-basics

  For chronic tension-type headache, effective treatment involves the use of daily preventive medications (eg, tricyclic antidepressants), behavioral therapies, and lifestyle changes (eg, regular exercise and dietary changes). […] Preventive therapy is usually started as soon as possible and taken every day when a new cluster of headaches develops. Some people require a combination of medicines. Preventive medicines may be gradually stopped after the cluster has passed but can be restarted if symptoms recur. […] Some simple lifestyle adjustments can help to reduce the frequency of headaches. These include: Stop smoking, Reduce the amount of alcohol you drink, Decrease or avoid caffeine, Get an adequate amount of sleep on a regular schedule, Eat healthy and regular meals; stay well-hydrated, Exercise several times per week, Reduce stress, Keep a headache diary to monitor headache and response to treatment.

• #42 Migraine prevention: initial treatment options | The BMJ

  https://www.bmj.com/content/382/bmj-2021-069494

  Tailor treatments for migraine prevention to the individual and always couple with education. […] Effective preventive treatments for migraine in primary care include non-pharmacological therapies, nutriceuticals (vitamins and supplements), and prescribed medications. […] Good evidence supports the use of many low cost treatments, including propranolol, topiramate, and amitriptyline. […] Evidence based treatments to prevent migraine include non-pharmacological treatments, nutraceuticals, and prescribed medications. […] Recommendations are based on evidence of effectiveness, alongside practical considerations for primary care, such as ease of use, safety, availability, and side effects.

• #43 Prevention of migraine attacks – Wikipedia

  https://en.wikipedia.org/wiki/Prevention_of_migraine_attacks

  A 2006 review article by S. Modi and D. Lowder offers some general guidelines on when a physician should consider prescribing drugs for migraine prevention: Following appropriate management of acute migraine, patients should be evaluated for initiation of preventive therapy. […] Preventive medication has to be taken on a daily basis, usually for a few weeks, before the effectiveness can be determined. […] A large number of medications with varying modes of action can be used. […] Selection of a suitable medication for any particular patient is a matter of trial and error, since the effectiveness of individual medications varies widely from one patient to the next. […] Often preventive medications do not have to be taken indefinitely. Sometimes as little as six months of preventive therapy is enough to „break the headache cycle” and then they can be discontinued.

• #44 Migraine Prophylaxis in Adults | Doctor

  https://patient.info/doctor/migraine-prophylaxis-in-adults

  Botulinum toxin type A is recommended for prophylaxis of chronic migraine where medication overuse has been addressed and where three or more oral prophylactic treatments have failed. […] Preventative options for menstrual migraine include: Standard prophylaxis options as discussed above, taken continuously. […] Arrange follow-up to monitor effectiveness, titrate dose and assess for adverse effects. […] Consider the need for referral to neurology if prophylactic treatment in primary care fails, is not appropriate or any red flags or atypical clinical features develop.

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