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.

• #1 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. […] 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.

• #1 Migraine – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/migraine-headache/diagnosis-treatment/drc-20360207

  There is a wide range of disease severity in migraine. […] Those individuals need a preventive treatment regimen to reduce the frequency and severity of attacks. […] This is why preventive treatment is so crucial. With preventive treatment, we can reduce the frequency as well as the severity of attacks so that you’re not having attacks more than two times per week. […] Yes, that is an option for the preventive treatment of chronic migraine. […] Medications can help prevent frequent migraines. Your health care provider might recommend preventive medications if you have frequent, long-lasting or severe headaches that don’t respond well to treatment. […] Preventive medication is aimed at reducing how often you get a migraine, how severe the attacks are and how long they last. Options include: […] Ask your health care provider if these medications are right for you.

• #1 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. […] Migraineurs should be screened for cardiovascular risk factors, which, if present, should be aggressively treated. Migraineurs with aura should also be counseled on the increased risk of stroke with smoking and oral contraceptive use. […] 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.

• #1 How to Prevent Migraines

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

  The discomfort of migraines can seriously affect your quality of life. While there’s no cure for these painful headaches, there are ways to reduce how often they happen and how bad they are. This includes medication and lifestyle changes. Your doctor can work with you to find a treatment plan that will lessen the impact of migraines on your daily life. […] To prevent migraines, your doctor may consider these types of prescription drugs. […] You may want to consider medicine to prevent migraines if you: Have pain that affects your quality of life, Get more than four moderate to severe headaches per month, Don’t get relief from over-the-counter medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), Have uncommon migraine conditions such as continuing aura (blurred vision or seeing spots or wavy lines).

• #1 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.

• #1 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. […] Following appropriate management of acute migraine, patients should be evaluated for initiation of preventive therapy. Factors that should prompt consideration of preventive therapy include the occurrence of two or more migraines per month with disability lasting three or more days per month; failure of, contraindication for, or adverse events from acute treatments; use of abortive medication more than twice per week; and uncommon migraine conditions (e.g., hemiplegic migraine, migraine with prolonged aura, migrainous infarction). […] 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.

• #1 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

• #1 Migraine with aura – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/migraine-with-aura/diagnosis-treatment/drc-20352077

  For migraine with aura, just as with migraine alone, treatment is aimed at relieving migraine pain. […] Medications can help prevent frequent migraines, with or without aura. Your doctor might recommend preventive medications if you have frequent, long-lasting or severe headaches that don’t respond well to treatment. […] Preventive medication is aimed at reducing how often you get a migraine headache with or without aura, how severe the attacks are, and how long they last. Options include: […] Blood pressure-lowering medications. These include beta blockers such as propranolol (Inderal, InnoPran XL, others) and metoprolol tartrate (Lopressor). Calcium channel blockers such as verapamil (Verelan) can be helpful in preventing migraines with aura. […] Ask your doctor if these medications are right for you. Some of these medications are not safe to take during pregnancy. If you’re pregnant or trying to get pregnant, don’t use any of these medications without first talking with your doctor.

• #1 Migraine Aura: What Is It, Symptoms, Causes & Treatments

  https://my.clevelandclinic.org/health/diseases/22131-migraine-aura

  While migraine aura cant be prevented altogether, there are certain things you can do to reduce the length, severity and frequency of attacks. If you experience severe migraines that dont respond well to treatment, your healthcare provider might recommend: […] Nutritional supplements like magnesium, CoQ10 and riboflavin. Be sure to take these according to the recommendations of your healthcare provider. […] Medications to lower your blood pressure. Calcium channel blockers like verapamil can help prevent migraine aura. Your healthcare provider may also prescribe beta blockers, such as timolol, propranolol or metoprolol tartrate. […] Antiseizure drugs. Topiramate and valproate can reduce migraine frequency in many cases. However, they can cause undesirable side effects, such as nausea, dizziness and weight changes.

• #1 A New Aura of Relief: Emerging Treatments for Migraines

  https://www.pharmacytimes.com/view/a-new-aura-of-relief-emerging-treatments-for-migraines

  Migraines may also present with or without aura. […] Preventative therapy may be considered in patients who experience frequent migraines and are using abortive treatment 2 or more days a week or 3 or more times per month, have an overall decreased quality of life, or if abortive therapy is ineffective or contraindicated. […] Oral preventative therapies that are commonly used include beta-blockers, anti-epileptics, antidepressants, and monophasic contraceptives in patients who have migraine without aura. […] In the past few years, several new emerging therapies have been FDA-approved for migraine treatment and prevention. […] These medications vary in mechanism of action, but are different from the other commonly used therapies on the market. […] Atogepant (Qulipta) is a CGRP antagonist approved by the FDA for prevention of migraines in adults.

• #1 Treatment of Migraine | Nurtec® ODT (rimegepant) | Safety Info

  https://www.nurtec.com/

  In a study of Nurtec ODT to prevent migraine attacks: […] Reduction in monthly migraine days (MMDs): When taken every other day, Nurtec ODT can reduce the number of migraine days in a month. People taking Nurtec ODT experienced 4.3 fewer MMDs during weeks 9-12 (vs 3.5 fewer MMDs with placebo). […] help prevent migraine attacks

• #1 Differences in treatment response between migraine with aura and migraine without aura: lessons from clinical practice and RCTs | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-019-1046-4

  Migraine is a major public health problem afflicting approximately 10% of the general population and is a leading cause of disability worldwide, yet our understanding of the basis mechanisms of migraine remains incomplete. […] A number of studies also indicate that migraine with aura may respond differently to acute and preventive therapies as compared to migraine without aura. […] The purpose of this review is to provide an overview of these differences in treatment responses, and to discuss the possibility of different therapeutic strategies for migraine with vs. without aura. […] Current guidelines recommend that the same treatment be used in migraine with and without aura. […] This is not surprising because almost all studies of both acute and preventative migraine treatments are based on mixed populations of patients that include those with migraine with aura and/or without aura, and the treatment effect based on this diagnosis or attack subtype is rarely reported.

• #1 Migraine with Aura: Symptoms, Visual Disturbances, and Management

  https://headacheaustralia.org.au/migraine-aura/

  The treatment and prevention methods for migraine aura are similar to migraine without aura. Your migraine management strategies will depend on the severity and frequency of your attacks. Some options include: […] Preventive treatments are used when migraine attacks begin to significantly disrupt your day-to-day life. Typically, this will be when you have four or more migraine days per month. […] Most preventive medications are equally likely to work for patients with and without migraine aura. However one preventive medication lamotrigine is recommended specifically for people with visual aura. Some research has also suggested that low-dose daily aspirin can help prevent migraine with aura. […] Several clinicians at the Migraine World Summit have suggested aspirin may be a useful preventive for those who experience migraine with aura. More evidence is required for broad recommendation in migraine prevention, preferably from at least one larger double-blind, placebo-controlled study. […] Daily low-dose aspirin is readily available and well-tolerated. With further evidence it could play a significant role in migraine management and may be worth discussing as an option with your healthcare professional.

• #1 Migraine With Aura – Migraine World Summit

  https://migraineworldsummit.com/migraine-with-aura/

  If people have frequent aura and migraine or migraine with aura, many of the same preventatives that we use for migraine without aura will work with migraine with aura. […] If attacks are so frequent that people are disabled by them, they should be on a preventive medication. People who experience migraine should probably talk to their doctors about whats right for them, because not everything is going to work for everybody. […] Ive found that baby aspirin is really good for aura. Sometimes aura without headache, to prevent that, and also to prevent migraine with aura. But you have to know whether your system can tolerate baby aspirin or not. And that should be a conversation between a person and their primary provider. […] Ive also found calcium channel blockers can be very helpful. Things like Verapamil sometimes are very good for people with migraine with aura.

• #1 Prophylaxis of migraine with aura: a place for acetylsalicylic acid | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/1129-2377-14-S1-P195

  Aim of our study was to assess the efficacy and tolerability of Acetylsalicylic acid (ASA) in migraine with aura (MA) management, in a sample afferent to the Headache Centre of San Giovanni Battista University-Hospital of Torino. […] Positive response to treatment (measured as a reduction of at least the 50% of crisis with aura) was reported by 85.6% of patients in the ASA group and 51.9% in the control group (p 0.001). […] Our results show a large positive response to the treatment with Acetylsalicylic acid, whose probability of success was about six times greater than the one associated with other therapies. […] According to our results, asa is not only effective in the majority of MA cases, but the response is usually evident in a short time.

• #1 Migraine With Aura: Aspirin Called Best Prophylaxis | MDedge

  https://mdedge.com/clinicalneurologynews/article/56505/pain/migraine-aura-aspirin-called-best-prophylaxis

  Migraine With Aura: Aspirin Called Best Prophylaxis […] Plain old aspirin proved far and away the most effective of the various agents used for prophylaxis of migraine with aura in an Italian study, with 86% of aspirin-treated patients reporting at least a 50% reduction in frequency of attacks. […] „We found the probability of treatment success with acetylsalicylic acid at 300 mg once daily was about six times greater than with other prophylactic agents,” Dr. Lidia T. Savi reported at the European Headache and Migraine Trust International Congress. […] The primary end point was treatment success as defined at week 32 by at least a 50% reduction in the frequency of attacks of migraine with aura, compared with baseline. Eighty-six percent of patients on aspirin for prophylaxis met this end point; indeed, 41% of the aspirin-treated group also met the more rigorous standard of ‘extremely improved’ as defined by a 75% reduction in attack frequency. […] In contrast, 46% of patients on prophylactic agents other than aspirin were unimproved. Only 17% were judged extremely improved and 37% were improved. […] Aspirin prophylaxis at the 300 mg dose was, as expected, very well tolerated, with nobody switching to another agent within 32 weeks due to side effects. […] Moreover, treatment success rates in the aspirin group were the same at 16 weeks as at 32 weeks, so patients and their physicians can expect to see evidence of response to prophylactic aspirin in a relatively short time, Dr. Savi continued. […] In a multivariate analysis adjusted for age, gender, disease duration, and other variables, only prophylactic aspirin was independently associated with a positive treatment response. Patients on prophylactic aspirin were an adjusted 6.3-fold more likely than were those on other drugs to have at least a 50% reduction in migraine with aura frequency. […] Prophylactic aspirin’s mechanism of benefit in migraine with aura isn’t known. But the disorder has been linked to platelet dysfunction, and Dr. Savi’s hypothesis is that daily aspirin prevents migraine with aura attacks by curbing formation of microemboli.

• #1 Migraine With Aura: Symptoms, Causes, and Treatment

  https://www.verywellhealth.com/migraine-with-aura-headache-4171966

  Preventing migraine involves taking measures to avoid known migraine triggers and medications to manage headache pain and other symptoms. […] Acupuncture may be helpful. In a 2016 review of studies looking at the effectiveness of this ancient Chinese medical practice for preventing migraine, acupuncture was found to „be at least similarly effective as treatment with prophylactic drugs.” […] Evidence suggests magnesium can help control pain symptoms in migraine with aura. Some health professionals recommend taking magnesium to help with migraine prevention as well, but you should speak with your healthcare provider about your medical history before starting any supplements.

• #1 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. One of the most common nutraceuticals used for migraine prevention is magnesium. We’ve seen it be helpful for people with migraine and people with migraine with aura. Studies have reported decreased magnesium levels in people with migraine. At adequate levels, magnesium can inhibit glutamate, an excitatory neurotransmitter. So magnesium can certainly stabilize the brain in that sense. 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. Other studies have found melatonin effective for preventing migraine attacks while others have shown no effect. Typical treatment is 3 milligrams of melatonin before bed every day.

• #1 Reddit – The heart of the internet

  https://www.reddit.com/r/migraine/comments/oui1is/these_supplements_stopped_my_migraine_with_aura/

  I am now 2 months free of migraine aura. […] These supplements all help regulate and prevent glutamate while also boosting GABA. […] A bit of advice with these supplements-it best you take them about 2-3 hours before bed time. […] This last one actually helps regulate/reduce glutamate. […] Seriously guys. I went from 5-6 auras a week to zero as soon as I started taking these supplements.

• #1 The truth about migraines | OHSU

  https://www.ohsu.edu/womens-health/truth-about-migraines

  Truth #1: Prevention is the best treatment. The best way to treat a migraine is to not get one. Stress, poor diet, lack of sleep, dehydration and lack of exercise can all increase how often you have migraines. Other common triggers include chocolate, cured meats and alcohol. […] As far as prevention, biofeedback and relaxation techniques are very effective. Yoga, exercise, meditation and mindfulness are all great ways to help prevent migraines in the first place, but they are unlikely to help once a migraine has already started. […] A new non-drug treatment that works really well is called neural modulation. Devices like a Cefaly or a Vagus Nerve Stimulator, when placed on your forehead or neck, send signals to your nerves to break a bad migraine headache. Both devices are available by prescription.

• #1 Migraine Aura Without a Headache: Care Instructions | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.migraine-aura-without-a-headache-care-instructions.abn2972

  Without treatment, migraines can last from 4 hours to a few days. Medicines can help prevent migraines or stop them once they have started. Your doctor can help you find which ones work best for you. […] To prevent migraines, keep a diary so you can figure out what triggers your auras or headaches. Avoiding triggers may help you prevent migraines. […] If your doctor has prescribed medicine for your migraines, take it as directed. You may have medicine that you take only when you get a migraine and medicine that you take all the time to help prevent migraines. […] If your doctor has prescribed medicine to prevent migraines, take it exactly as prescribed. […] Find healthy ways to deal with stress. Migraines are most common during or right after stressful times. […] Get plenty of sleep and exercise.

• #1 Migraine: Causes, Symptoms, and Treatment

  https://patient.info/brain-nerves/migraine-leaflet

  Migraine attacks in women may be triggered by periods. Treatment of each migraine attack is no different than usual. However, there are treatments that may prevent period-related migraine attacks from occurring. […] There are also various treatments you can take to prevent migraine attacks, if you have frequent or severe attacks. It may not stop all attacks, but their number and severity are often reduced. Medicines for preventing migraines are taken every day. They are not painkillers and are different to those used to treat each migraine attack. […] There are various different things that can help to prevent migraines. These can make migraines happen less often, although it’s difficult to completely prevent all migraines. […] General things that can help to prevent migraines include: Sticking to a daily routine for eating and sleeping. Try to have regular meal times and avoid skipping meals if you can. Changes in sleeping patterns can also trigger migraine – try to get into a consistent sleep routine where you go to sleep and wake up at the same times every day. Staying hydrated. Dehydration can trigger migraines. Try sipping on water throughout the day. Aim to drink about 1.5 to 2 litres of water a day. Minimising, or avoiding, alcohol. Any type of alcohol can trigger migraines, although some drinks can be more of a trigger than others – red wine is a common culprit. Controlling caffeine intake. The links between caffeine and migraines are complicated. Caffeine is actually one of the treatments for a migraine attack. Some people, though, find that caffeine can trigger migraines for them. There is also some evidence that people who consume high amounts of caffeine regularly are more likely to get migraines. Caffeine withdrawal can also trigger migraines. So, whilst you don’t need to cut out caffeine completely, it’s a good idea to limit your consumption. Managing stress. Stress can be a major trigger for migraines. Try to minimise stress – where possible – and consider relaxation techniques or meditation to cope with stressful situations. Exercising regularly. Getting regular exercise can reduce the frequency of migraines, as well as making them less severe if they do happen. Strenuous exercise, particularly if you’re not used to it, can be a migraine trigger – so aiming for regular, short sessions of moderate intensity exercise is best, at least to start with. Controlling computer use. Many people find that computer screens can trigger migraines. Take regular breaks when using screens. Consider fitting an anti-glare screen to your monitor. Ensure your screen is neither too bright nor too dim – it should ideally be of a similar brightness to the area around the screen. […] It’s also possible to take regular preventative medicines to reduce the number of migraines you get.

• #1 Complex migraine: What to know about migraine with aura

  https://www.medicalnewstoday.com/articles/complex-migraine

  Preventing migraine with aura can be challenging, as its causes are unclear. However, there are ways for people to help reduce their risk, including: […] Identifying and avoiding triggers: A person can try keeping a migraine journal where they note potential triggers, such as foods, stress, or weather changes. This can help identify things that may bring on a migraine attack. […] Managing stress: Stress can be a significant trigger for migraine. Finding ways to manage stress, such as through exercise, yoga, or meditation, can help reduce someone’s migraine risk. […] Getting enough sleep: Lack of sleep can also trigger migraine. People should aim for at least 7-8 hours of sleep each night and maintain a regular sleep schedule. […] Avoiding certain medications: Some medications can trigger migraine. A person can speak with a doctor about alternative options.

• #1 Migraine and risk of stroke | Journal of Neurology, Neurosurgery & Psychiatry

  https://jnnp.bmj.com/content/91/6/593

  Migraine and stroke are two common and heterogeneous neurovascular disorders responsible for a significant burden for those affected and a great economic cost for the society. […] In light of the higher risk of stroke in people with migraine with aura, it is important to identify and modify any vascular risk factor. […] There is currently no direct evidence to support that a migraine prophylactic treatment can reduce future stroke in people with migraine. […] The relative risk of ischaemic stroke is doubled in people with MA compared with migraine-free individuals. […] The association between migraine and ischaemic stroke is stronger for women, women younger than 45 years, women who use oral contraceptives and women who smoke. […] Active migraine and increased attack frequency increase the risk of ischaemic stroke.

• #1 Migraine and Cardiovascular Disease: Key Points

  https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2023/08/15/14/43/migraine-and-cardiovascular-disease

  Globally, an estimated 1 billion people suffer from migraine, and is a leading cause of disability particularly among young women. The 2021 European Society of Cardiology (ESC) guidelines on CVD prevention recommend that migraine with aura should be considered in CVD risk assessment; the QRISK3 score, a tool to assess the 10-year risk of CVD, has incorporated migraine in its score. Migraine is associated with increased risk for stroke, obstructive coronary artery disease (CAD), including myocardial infarction (MI), atrial fibrillation (AF), and CV mortality. […] Ample evidence supports the association of migraine and increased risk for CVD including stroke, CAD, AF, and CV mortality. Higher rates of CV risk factors, including hypertension and dyslipidemia, are observed among patients with migraine compared to those without migraine.

• #1 Migraine With Aura – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554611/

  Migraine with aura carries an increased risk of cerebrovascular accidents, prompting timely diagnosis and appropriate treatment. […] Moreover, clinicians will learn about evidence-based strategies for managing migraines with aura, including acute treatment and preventative measures. By acquiring this knowledge, healthcare professionals can improve their ability to diagnose, treat, and prevent migraine with aura, ultimately enhancing patient outcomes and reducing healthcare costs. […] Understanding the intricacies of the pathophysiology, presentation, assessment, and management of migraine with aura is crucial for healthcare professionals. […] Migraine treatment involves abortive and prophylactic therapy. […] Prophylactic medications begin at low doses and are gradually titrated until the patient achieves the desired therapeutic benefit. The choice of preventative medication can take into account any comorbid conditions. Administration of any prophylactic medication will generally result in a 50% reduction in headache frequency.

• #1 Migraine | NHS inform

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

  Speak to your GP practice if: […] Read about migraine prevention and treatment […] Your GP may decide to refer you to a neurologist (a specialist in conditions affecting the brain and nervous system). Theyll do further assessments and offer treatment if: […] Read about the prevention and treatment of migraine […] The risk of having an ischaemic stroke is increased by the use of the combined contraceptive pill. Medical professionals generally advise women who experience migraine with aura not to use the combined contraceptive pill. […] Talk to your GP about alternative forms of contraception if you experience aura symptoms and are taking the combined contraceptive pill.

• #1 Migraine management

  https://australianprescriber.tg.org.au/articles/migraine-management.html

  Migraine prophylaxis is generally indicated in patients with: […] Prophylaxis may be recommended if a patient is having three or more migraines a month or if their migraines are difficult to manage. […] Considerations for choice of preventive medicines include evidence for efficacy, adverse effect profile, drug interactions, contraindications, patient comorbidities, costs, availability and patient preference. […] All oral prophylactic drugs for migraine were developed for other purposes such as hypertension, depression and epilepsy. […] Antihypertensives used for prophylaxis include calcium channel blockers (such as verapamil), beta blockers (such as propranolol), and angiotensin II receptor inhibitors (such as candesartan). […] Antidepressants include amitriptyline and nortriptyline. Antiepileptic drugs are also used topiramate is the most evidence-based of the oral migraine preventors, but carries potential adverse effects such as altered mood, verbal fluency issues (word finding) and paraesthesia.

• #1 The state of migraine: An update on current and emerging treatments

  https://www1.racgp.org.au/ajgp/2021/december/the-state-of-migrain

  Key to limiting the disability of migraine and progression to chronic migraine is addressing modifiable risk factors, including implementing effective preventive treatment and avoiding overuse of acute treatment. […] The key modifiable risk factors are effective preventive medication, avoidance of acute medication overuse, obesity, stress, depression and anxiety. […] Counselling and management of lifestyle risk factors for migraine are key components of effective migraine prevention, focusing on sleep, stress, exercise, diet, mental health and obesity. Identifying and minimising potential triggers to migraine are also important. […] Pharmacological treatment is indicated if individual attacks are refractory to acute treatment or there are more than four migraines/month. […] Preventive medication is indicated for patients with more than four attacks per month or if individual attacks are hard to treat, both to limit the morbidity of the disease and reduce the risk of medication overuse. […] The aim of preventive therapy is at least a 50% reduction in headaches after eight weeks. […] Choice of preventive medication should be tailored to a patients comorbidities and potential side effects, and must be trialled for 68 weeks to assess efficacy.

• #1 Patient education: Migraine in adults (Beyond the Basics) – UpToDate

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

  Patient education: Migraine in adults (Beyond the Basics) […] Preventive treatment helps to reduce the frequency and severity of migraine attacks in most people. However, it can take several weeks for medication to start to work and three to six months to see the full benefit. Your health care provider will probably start you off at a low dose and increase it gradually until you notice an effect. […] Preventive treatment is typically recommended for people who have frequent, long-lasting, or very severe migraine attacks. In some cases, both acute treatment and preventive treatment are necessary to adequately control migraine attacks. […] Lifestyle changes — It may help to change certain behaviors. For example, you can: Practice good „sleep hygiene” (set consistent bedtimes and wake times; sleep only as long as you need to feel rested; avoid caffeine, alcohol, and smoking before bed; do not look at your phone or other devices right before bed)

• #1 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. You may also experience nausea or vomiting, and be very sensitive to light and sound. The pain can be so bad that you may not be able to go about your daily routine. Migraines can last anywhere from hours to days. 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.

• #1 Migraine | healthdirect

  https://www.healthdirect.gov.au/migraine

  Migraine attacks can have many different triggers, such as stress, missing meals, eating certain foods, hormonal changes or not getting enough sleep. […] If you get migraines often, maintaining a healthy lifestyle and taking a preventive medicine can make them less frequent and severe. […] There’s no known way to prevent yourself from developing migraine, but you can help prevent a migraine attack. […] There are some lifestyle measures and complementary therapies that may help prevent migraine attacks. These include: avoiding any triggers, getting enough sleep, eating a healthy diet and maintaining a healthy weight, getting regular exercise, acupuncture, relieving stress through relaxation techniques, such as yoga and meditation, or psychological therapies such as cognitive behavioural therapy, taking magnesium, riboflavin or coenzyme Q10 supplements.

• #2 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.

• #2 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. […] Propranolol, timolol, methysergide, valproic acid, and topiramate (Topamax) have been approved by the FDA for migraine prophylaxis. However, a 2009 report suggested that long-term topiramate use in pediatric patients can cause metabolic acidosis and hypokalemia; the risk was deemed mild but statistically significant.

• #2 Comparative Effectiveness of Preventive Pharmacological Treatments for Migraine | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/migraine-prevention/research-protocol

  Ideally, preventive treatment aims to fully eliminate headache pain. […] Often, however, some degree of pain persists; therefore, treatment success is usually defined by a decrease in migraine frequency of at least 50 percent after 3 months. […] In addition to pain relief, preventive drugs can also decrease severity of migraine attacks, normalize brain activity, and eliminate photophobia, phonophobia, nausea, and vomiting. […] Long-term adherence to preventive treatments is low. Between 17 and 29 percent of patients discontinue medication because of adverse effects such as anxiety, nausea, vomiting, sleep time reduction, drowsiness, or weakness. […] Drug choices are based on efficacy and adverse effects, doctors beliefs about off-label medications, patient preferences, headache frequency, presence of aura, and comorbid conditions.

• #2 Patient education: Migraine in adults (Beyond the Basics) – UpToDate

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

  Beta blockers — Beta blockers were originally developed to treat high blood pressure. In addition, beta blockers have been found to be effective in preventing migraine attacks. Commonly used beta blockers include metoprolol, propranolol, and timolol. […] Antidepressant medications — Tricyclic antidepressants (TCAs) and certain other antidepressant medications are often recommended for migraine prevention. These include amitriptyline, nortriptyline, and doxepin. […] Anti-seizure medications — The anti-seizure (anticonvulsant) medications valproate (also called divalproex) and topiramate have been found to be effective in preventing migraine attacks. […] CGRP antagonists — These medications aim to block the transmission of pain from migraine; they are generally used in people who don’t improve with standard preventive migraine medications such as beta-blockers, antidepressants, and anti-seizure medications.

• #2 Migraine Aura: What Is It, Symptoms, Causes & Treatments

  https://my.clevelandclinic.org/health/diseases/22131-migraine-aura

  Antidepressants. Amitriptyline or other antidepressants may help prevent migraines in some people. […] Calcitonin gene-related peptide (CGRP) monoclonal antibodies. These are newer, FDA-approved injectable drugs that are used to treat migraines. They are given monthly to help prevent symptoms. […] Botox injections. In some people, Botox injections given every 12 weeks can help prevent migraines.

• #2 Migraine – Wikipedia

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

  In 2018, the first medication (Erenumab) of a new class of drugs specifically designed for migraine prevention called calcitonin gene-related peptide receptor antagonists (CGRPs) was approved by the FDA. […] As of July 2023, the FDA has approved eight drugs that act on the CGRP system for use in the treatment of migraine.

• #2 A New Aura of Relief: Emerging Treatments for Migraines

  https://www.pharmacytimes.com/view/a-new-aura-of-relief-emerging-treatments-for-migraines

  Rimegepant is also indicated for migraine prevention in patients with frequent and debilitating migraines who have not found relief with adequate trials with other therapies and is taken as a 75 mg dose once every other day. […] Eptinezumab (Vyepti) is an injectable CGRP antagonist used for the prevention of migraines in adults. […] The more medication options developed for migraines, the more inclusive migraine therapy can become.

• #2 Differences in treatment response between migraine with aura and migraine without aura: lessons from clinical practice and RCTs | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-019-1046-4

  The aura is transient in nature, and acute treatment targeting the aura itself should have an immediate effect to yield meaningful clinical efficacy (although, as discussed below, there may also be differences in acute therapies with regard to headache associated with aura within an attack). […] Similarly, preventive treatment may be given in an attempt to reduce the aura frequency, but the goal is typically to reduce the frequency of attacks in general. […] There are no currently available treatments that are well-proven treatment to abort or shorten the aura symptoms, but a number of treatments have been tested, often in case series or un-blinded studies. […] Based on clinical experience and the assumption that migraine is associated with defective platelets, aspirin have been tested for migraine aura prophylaxis.

• #2 Migraine With Aura – Migraine World Summit

  https://migraineworldsummit.com/migraine-with-aura/

  Other preventatives that are helpful preventing migraine with aura include: antidepressants, such as amitriptyline (Elavil); blood pressure medications, like beta blockers or calcium channel blockers such as candesartan (Atacand), propranolol (Inderal), timolol (Timoptic); anti-seizure drugs, such as topiramate (Topamax), valproate sodium (Depacon); Calcitonin Gene Related Peptide (CGRP) monoclonal antibodies: erenumab (Aimovig), fremanezumab (Ajovy), galcanezumab (Emgality), eptinezumab (Vyepti); Botox; neuromodulation devices. […] Theres some data to suggest that some medications may be helpful for aura. Theres some small studies on a drug called Lamotrigine which suggests that maybe that had some beneficial effect on aura. […] Theres a drug called Flunarizine which is used quite widely throughout Europe, and theres again anecdotal evidence from a pediatric study that it was more effective in hemiplegic migraine groups, so maybe a bit more effective in aura. […] If youre light-sensitive, sometimes FL-41 or the tinted lenses can be really helpful in preventing migraine attacks, in-between attacks. […] Polarized sunglasses are not considered a preventive for those with a light sensitivity unless used outdoors to help reduce glare.

• #2 Migraine with aura – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/migraine-with-aura/diagnosis-treatment/drc-20352077

  When symptoms of migraine with aura start, try heading to a quiet, darkened room. Close your eyes and rest or take a nap. Place a cool cloth or an ice pack wrapped in a towel or cloth on your forehead. […] Other practices that might soothe migraine with aura pain include: […] Relaxation techniques. Biofeedback and other forms of relaxation training teach you ways to deal with stressful situations, which might help reduce the number of migraines you have. […] Develop a sleeping and eating routine. Don’t sleep too much or too little. Set and follow a consistent sleep and wake schedule daily. Try to eat meals at the same time every day. […] Drink plenty of fluids. Staying hydrated, particularly with water, might help.

• #2 Migraine treatment and prevention | NHS inform

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

  Topiramate is a type of medication originally developed to prevent seizures in people with epilepsy. It’s now much more commonly used for migraine. […] Other less common options of preventative medications for migraine include: pizotifen, flunarizine. […] There are some complementary therapies and supplements which might help to prevent your migraine symptoms. […] 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. […] Hormonal contraceptives like the combined contraceptive pill or vaginal ring are not used if you have migraine with aura symptoms. This is because this can increase your risk of having a stroke.

• #2 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. […] A doctor will inject small amounts of the toxin around your face and scalp every 3 months to keep migraines from happening. […] 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. […] Researchers have looked into many supplements to prevent or treat migraine.

• #2 Migraine – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/headache/migraine

  Monoclonal antibodies and gepants that are used to prevent migraines block the activation of calcitonin gene-related peptide (CGRP), which can precipitate migraines. […] Neuromodulatory treatments can also help. Transcutaneous supraorbital nerve stimulation, using a device applied to the forehead, can reduce the frequency of migraines. Transcranial magnetic stimulation, using a device applied to the back of the skull, is indicated for the acute and prophylactic treatment of migraine headache in adolescents and adults.

• #2 Migraine Aura Without a Headache: Care Instructions | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.migraine-aura-without-a-headache-care-instructions.abn2972

  Eat regular meals, and avoid foods and drinks that often trigger migraines. […] Limit caffeine by not drinking too much coffee, tea, or soda. […] Do not smoke or allow others to smoke around you. […] If you are taking birth control pills or hormone therapy, talk to your doctor about whether they are triggering your migraines.

• #2 Nerivio | Understanding The Aura Migraine Phase

  https://www.nerivio.com/blog/aura

  Many individuals also find that relaxing in a dark room away from bright or flickering lights and from noise can help soothe symptoms. […] Avoid any foods that typically set off a migraine. A few common food triggers are caffeine, chocolate, and wine. […] Other triggers may be hormonal fluctuations, menstrual cycle, or environmental factors including weather. Engaging in physical activities may also help the symptoms pass. Be sure to update a doctor when discovering specific triggers and patterns in your symptoms.

• #2 Migraine With Aura – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554611/

  Management includes both abortive and preventive therapies tailored to individual patient needs. Triptans and NSAIDs are common abortive treatments, while beta-blockers and antiepileptic drugs are often used for prevention. […] Patients with migraine with aura should avoid taking oral contraceptives due to the increased risk of stroke. […] Trigger avoidance is essential in migraine prevention. Additionally, maintaining a regular sleep schedule, practicing stress reduction techniques, engaging in regular exercise, and following a balanced diet can help decrease the frequency of migraines.

• #2 What Is a Migraine Aura? All About Migraines With Aura | Excedrin

  https://www.excedrin.com/headache-and-migraine-academy/migraines/migraine-types/aura-migraines/

  Making adjustments in your lifestyle can sometimes help to reduce the frequency of migraines. Try these tips: Exercise regularly, practice relaxation techniques to avoid stress, eat on a consistent schedule, stay well hydrated, keep a headache diary to help identify potential triggers, make sure you get enough sleep (but not too much).

• #2 Migraine and Cardiovascular Disease: Key Points

  https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2023/08/15/14/43/migraine-and-cardiovascular-disease

  Heart disease including MI has been associated with migraines. People with migraine have a higher prevalence of angina pectoris (1.29, 95% confidence interval [CI], 1.171.43) and an increased risk of MI (1.33, 95% CI, 1.081.64) compared with people without migraine. […] Medication for acute and prophylactic treatments of migraine is frequently prescribed in CVD patients. Antiemetics, painkillers such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), and combination products that include caffeine are commonly used as first-choice therapeutic medications. […] Other medications used for prophylactic treatment of migraines include beta-blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers. Beta-blockers remain contraindicated in patients with vasospastic angina, and therefore, other medications should be considered in patients with migraine with INOCA when coronary spasm is suspected.

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

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

  Your doctor will assess several things when deciding which medicine to prescribe. The best migraine prevention medication for you will depend on several factors. […] There are certain preventive medicines that you cannot take if you are pregnant or it’s possible you could get pregnant. […] Your doctor will want to monitor whether your medicine is helping to reduce the number of migraine attacks you get. […] If your preventive migraine medication is not helping, talk to your doctor. They can review whether they may be able to increase your dose or try a different treatment.

• #2 Migraine Prophylaxis: 5 Preventive Therapies

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

  This treatment is given as an injection, and the migraine prophylaxis effects last for several months. […] Calcitonin gene-related peptide (CGRP) therapy uses monoclonal antibodies to reduce the inflammation and pain associated with chronic migraine episodes. […] Choosing the right treatment option for migraine prophylaxis is often a matter of trial and error, which can be difficult and frustrating, especially when your quality of life is negatively impacted by chronic migraine. […] However, your doctor will work closely with you to help find the medication that will work for you. […] 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.

• #2 Complex migraine: What to know about migraine with aura

  https://www.medicalnewstoday.com/articles/complex-migraine

  Taking preventive medications: If someone experiences frequent and severe migraine with aura, healthcare professionals may recommend preventive medications to reduce their frequency. […] It is important to remember that what works for one person might not work for another. Individuals should work with a healthcare professional to determine the best approach for them. […] Lifestyle changes, such as getting enough sleep, reducing stress, and avoiding triggers, can help reduce the frequency of migraine with aura. Medications, physical therapy, and other treatments may also improve the overall quality of a person’s life.

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

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

  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. 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. We rarely if ever use opioids.

• #2 Migraine management

  https://australianprescriber.tg.org.au/articles/migraine-management.html

  Adverse effects and a patients comorbidities often influence the choice of drug. […] Preventive strategies to reduce migraine attacks include lifestyle modifications, management of comorbidities, behavioural and physical therapies, and pharmacological treatments. […] Novel preventive therapies such as the anti-CGRP monoclonal antibodies are targeted therapies to consider.

• #2 Migraine | healthdirect

  https://www.healthdirect.gov.au/migraine

  If you get more than 4 migraine episodes a month, your doctor might suggest you try a preventive medicine. […] There are many different medicines that can reduce how often you get a migraine attack and how severe they are. […] It’s best to maintain a healthy weight, as obesity can increase your risk.

• #2

  https://www.today.com/health/mind-body/neurologists-prevent-treat-migraine-attacks-rcna90037

  „It’s so important to pay attention to your triggers and to put a lot of energy upfront into that,” Rao says, „because prevention for migraines is much easier than the cure.” […] Starling finds that fluctuations in blood sugar levels can trigger her migraine attacks, so „I try to stick to (foods) that have a really good glycemic index because you’re trying to prevent those peaks and valleys in your sugar levels,” she says. […] Broner also realized that sleeping in on the weekends was triggering her attacks, so she now wakes up at the same time throughout the week. […] „What I tell myself, as well as my patients, is if there’s something very, very obvious that triggers your migraine attacks specifically, by all means, avoid it if at all possible,” she says. „But you may be avoiding every trigger that you can think of and still have migraine attacks because it is a genetic, neurologic disease. Triggers are not the cause.”

• #2 Migraine with Aura: Symptoms & Treatments | Ada Health

  https://ada.com/conditions/migraine-with-aura/

  Where people have frequent attacks, medication may be prescribed to prevent migraine headaches. The medications that have been found most effective at migraine prevention include: Anticonvulsant medications (commonly used for epilepsy). […] A couple of blood pressure medications: Beta-blockers and calcium channel blockers. […] Antidepressants such as tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs). […] OnabotulinumtoxinA (Botox) injections are approved by the FDA as a treatment for chronic migraine. […] Finding the right preventative and relieving treatment, as well as the best lifestyle changes, can positively reduce the frequency and severity of attacks and their negative effects on life, work, and sleep.

• #3 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. […] Set realistic goals. Successful treatment is defined as a 50% reduction in the number of headache attacks or days, a significant decrease in the duration of attacks, or an improvement in response to acute therapy. […] 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. […] Reevaluate therapy. Patient may have partial response and require dose titration. Consider changing therapy if no response occurs after two months.

• #3 Patient education: Migraine in adults (Beyond the Basics) – UpToDate

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

  Calcium channel blockers — Calcium channel blockers were developed to treat high blood pressure. Calcium channel blockers are widely used for migraine prevention. Examples of calcium channel blockers include verapamil and nifedipine extended release. […] Herbal therapies — Different herbs have been evaluated for the treatment of migraine, including feverfew and butterbur. Of these, feverfew has been the most widely studied. […] Botulinum toxin — Botulinum toxin type A (brand name: Botox) is a toxin produced by a bacteria that temporarily paralyzes muscles. There is some evidence that it may be helpful as a treatment for chronic migraine (usually defined as headaches that happen for 15 days or more each month). […] Avoiding medication overuse headache — It is essential to use anti-migraine medications according to your prescription and your provider’s instructions. Overuse of certain medications for migraine, including over-the-counter drugs such as acetaminophen and NSAIDs, or prescription drugs such as triptans, can lead to medication-overuse headaches (also called rebound headaches). […] If you get menstrual migraine attacks, or migraine symptoms that otherwise seem triggered by hormonal changes, talk to your health care provider about your options for treatment and prevention.

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

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

  The classes of medications that are effective for migraine prevention include: Antiepileptics, Antidepressants, Antihypertensives, Botulinum toxin, Calcitonin gene-related peptide (CGRP) inhibitors. […] Antiepileptics are generally well tolerated. The main adverse effects of topiramate are weight loss and dysesthesia. Valproic acid (Depakote) is useful as a first-line agent. […] 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. […] The first CGRP inhibitor approved by the FDA for migraine prophylaxis was erenumab (Aimovig) in May 2018. Approval was based on findings from the LIBERTY, ARISE, and STRIVE clinical trials.

• #3

  https://www.today.com/health/mind-body/neurologists-prevent-treat-migraine-attacks-rcna90037

  „Migraine disease fluctuates,” Starling explains. There may be times in your life when the attacks are more frequent, and it’s beneficial to start using a daily preventive medication, for instance. […] That could include supplements, a preventive medication or even a non-invasive migraine treatment device. […] If you struggle with migraine attacks and need help with treatment, see your primary care provider, who can refer you to an appropriate specialist.

• #3 How to Prevent Migraines

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

  While the studies so far have been small, early evidence shows that this mineral may slightly reduce how often people have migraines. […] Your everyday habits can go a long way to help you have fewer and less severe migraines. […] A highly effective way to manage migraine symptoms is to combine a medication plan and work with a mental health provider with experience in headache treatment. […] There isn’t a cure for migraines yet. But there are plenty of treatment options that can help reduce the frequency and severity of migraine attacks. Work with your doctor to find the right combination of preventive treatments, including medication, medical devices, supplements, and alternative treatments.

• #4 Migraine Headache Prophylaxis | AAFP

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

  Discontinue therapy. If headaches are controlled for at least six to 12 months, consider slowly tapering and discontinuing therapy. […] Several medications have been studied for the prevention of episodic migraines. Based on guidelines from the American Headache Society and the American Academy of Neurology, agents with the most quality evidence to support their use should generally be considered first for migraine prevention. […] OnabotulinumtoxinA (Botox) is ineffective and should not be offered for preventing episodic migraine. However, there is evidence supporting the use of onabotulinumtoxinA in the prevention of chronic migraines. […] Erenumab (Aimovig) was approved by the U.S. Food and Drug Administration in May 2018 for migraine prevention. […] Petasites, an extract of the butterbur plant, is effective for the prophylactic treatment of migraines in dosages of 50 to 75 mg twice a day. […] 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.

Zobacz więcej