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. […] First-line medications established as effective based on clinical evidence include divalproex, topiramate, metoprolol, propranolol, and timolol. […] Preventive therapy for episodic migraines may decrease headache frequency, severity, and prevent progression to chronic migraines.

• #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 Prevention 101: What It Is, When To Use It and Why

  https://americanmigrainefoundation.org/resource-library/migraine-prevention-101/

  Looking for ways to help prevent migraine attacks? Learn all about preventive medications for migraine and how to create a preventive treatment strategy with your headache specialist. […] Instead of treating migraine attacks once they begin, preventive migraine medications and strategies work to reduce the frequency, severity, and duration of migraine attacks. They can also help your acute treatments work more effectively. […] Migraine prevention may include a combination of: Prescription and non-prescription medications, Natural supplements, vitamins or minerals, Lifestyle changes. […] Ideally, a preventive migraine strategy should involve a conversation between you and your caregiver. Work with your provider to find the right strategy for you based on your migraine symptoms, any other health conditions you have and medications you’ve already tried, plus any side effects you’ve experienced.

• #4 Migraine Prevention 101: What It Is, When To Use It and Why

  https://americanmigrainefoundation.org/resource-library/migraine-prevention-101/

  While an essential part of any treatment plan, acute migraine treatments can lead to medication overuse headache (previously known as rebound headache) if used too frequently. A preventive strategy focuses on preventing migraine; reducing the frequency, severity or intensity of attacks; and improving responsiveness to acute medications when needed. […] Preventive migraine treatments can also be used to help with other health issues, such as high blood pressure, depression, trouble sleeping and more. Other benefits of a successful migraine prevention plan include reducing the level of disability, reducing excessive use of acute treatments and maintaining lower cost of care for migraine management. […] Lifestyle changes are one way to prevent migraine or reduce the frequency or severity of attacks.

• #5 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.

• #6 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), migraine is having a big impact on your daily life (your migraine attacks might be very severe or last a long time), acute medicines are not helping, even at the maximum doses you can tolerate, you are regularly taking acute medicines on more than two days a week – this increases the risk of medication overuse headache.

• #7 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.

• #8 Migraine Prophylaxis in Adults | Doctor

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

  Migraine prophylaxis can reduce the frequency and severity of migraine, but is under-used by people who might benefit from it. […] The aim of preventative treatment is to reduce the frequency, severity, and duration of migraine attacks, and avoid medication-induced headache. […] British Association for the Study of Headache (BASH) guidelines state that prophylaxis should be used when symptoms are inadequately controlled with acute prescriptions, or the frequency of attacks is leading to overuse of acute medicines. […] The National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summary (CKS), synthesising information from different guidelines, suggests prophylaxis where: Migraine attacks are having a significant impact on quality of life and daily function – eg, they occur frequently (more than once a week on average) or are prolonged and severe despite optimal acute treatment.

• #9 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.

• #10 Preventive Treatments for Migraine | American Migraine Foundation

  https://americanmigrainefoundation.org/resource-library/understanding-migrainepreventive-treatments/

  Preventive migraine medications are taken on a regular basis to prevent the occurrence of migraine attacks. Unlike acute migraine treatments, they are not intended to treat pain and other symptoms of an attack that has already started. […] Migraine prevention is a critical part of any migraine management plan, even if you only typically have one attack per year. People who have more frequent attacks will need more aggressive prevention strategies, which may include medication. […] Migraine prevention is intended to reduce the degree of disability associated with migraine attacks. Unfortunately, preventive treatment strategies rarely eliminate migraine attacks completely, but they can reduce the frequency and severity of attacks. […] The ultimate goals of migraine prevention therapy are to: Reduce the frequency, severity and duration of attacks; Improve responsiveness to acute treatment during attacks; Reduce the level of disability experienced due to migraine attacks; Reduce the need for emergency room visits; Reduce excessive overuse of acute medications.

• #11 Migraine prophylaxis considerations An educational update for providers | HFS

  https://hfs.illinois.gov/medicalproviders/pharmacy/migraineprophylaxis.html

  The AAN guidelines do not quantify the number of migraine attacks or the amount of acute treatments used before preventative therapy should be considered. They note that the goals of preventative treatment are to reduce the frequency, severity, and duration of attacks; improve responsiveness to treatment of acute attacks; and improve overall patient function and reduce disability.

• #12 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. […] Botulinum toxin A (onabotulinumtoxinA; BOTOX) may be beneficial in patients with intractable, chronic migraine that has failed to respond to at least 3 conventional preventive medications. […] 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.

• #13 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. […] Propranolol has been compared with placebo in about 60 trials; in data pooled from nine of these studies, the calculated responder ratio (comparable to relative risk) was 1.9 (95% confidence interval [CI], 1.60 to 2.35). […] Timolol (Blocadren) has been compared with placebo in three trials; its effect size is comparable to propranolol. […] Amitriptyline is a first-line agent for migraine prophylaxis and is the only antidepressant with consistent evidence supporting its effectiveness for this use.

• #14 Medications for Migraine Prophylaxis | AAFP

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

  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. […] First-line therapies for migraine prophylaxis in adults include propranolol (Inderal), timolol (Blocadren), amitriptyline, divalproex (Depakote), sodium valproate, and topiramate (Topamax).

• #15 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. […] The choice of treatment depends on factors such as patient preference, drug interactions, and other comorbidities. […] 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. […] Propranolol hydrochloride (80-160 mg daily, in divided doses) is recommended as first-line preventative treatment in patients with episodic or chronic migraine. […] Topiramate can be given if a beta-blocker is unsuitable.

• #16 Medications for Migraine Prophylaxis | AAFP

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

  A more recent article on migraine headache prophylaxis is available. […] Sufficient evidence and consensus exist to recommend propranolol, timolol, amitriptyline, divalproex, sodium valproate, and topiramate as first-line agents for migraine prevention. […] There is fair evidence of effectiveness with gabapentin and naproxen sodium. […] Botulinum toxin also has demonstrated fair effectiveness, but further studies are needed to define its role in migraine prevention. […] Limited evidence is available to support the use of candesartan, lisinopril, atenolol, metoprolol, nadolol, fluoxetine, magnesium, vitaminB2 (riboflavin), coenzyme Q10, and hormone therapy in migraine prevention. […] Evidence supports the use of timed-release dihydroergotamine mesylate, but patients should be monitored closely for adverse effects.

• #17 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. This article outlines initial treatment options that can be offered in primary care to patients with migraine who are seeking help to reduce the frequency and impact of migraines. Treatment starts with education, and many excellent resources are available. Recommendations are based on evidence of effectiveness, alongside practical considerations for primary care, such as ease of use, safety, availability, and side effects.

• #18 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

• #19 Medications for Migraine Prophylaxis | AAFP

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

  Divalproex (Depakote) and sodium valproate are well supported by evidence for use in migraine prevention. […] Two clinical trials have found gabapentin (Neurontin) to be effective at dosages of 1,200 to 2,400 mg per day. […] Several open-label and controlled studies indicate that topiramate (Topamax) is effective in migraine prophylaxis, and it is considered a first-line agent for this use. […] 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. […] The angiotensin receptor blocker candesartan (Atacand) was evaluated in a prospective, randomized, double-blind, crossover study with 60 patients. […] Other agents that have been assessed for the prevention of migraine have limited evidence, have shown limited effectiveness, or have side-effect limitations.

• #20 Migraine Prophylaxis in Adults | Doctor

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

  Amitriptyline hydrochloride is effective (25-75 mg at night) for migraine prophylaxis and should be considered for patients with episodic or chronic migraine. […] 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. […] Treatment with botulinum toxin type A that is initially recommended should be stopped in people whose condition is not adequately responding to treatment. […] Preventative options for menstrual migraine include standard prophylaxis options as discussed above, taken continuously. […] Often migraine improves during pregnancy and prophylaxis is not required.

• #21 Migraine Preventive Therapies

  https://practicalneurology.com/articles/2019-may/migraine-preventive-therapies

  Migraine preventive therapy is indicated for patients with 4 or more migraine headache days per month, significant disability associated with individual attacks, or frequent acute medication use. […] Unfortunately, available preventive therapy has been inadequate even when delivered optimally, with more than 80% of patients discontinuing preventive treatment within a year of initiation. […] With the development, approval, and recent release of monoclonal antibodies (MAb) to calcitonin gene-related peptide (CGRP) or the CGRP receptor for prevention of migraine, the field of headache medicine has the first treatment specifically designed for migraine prevention. […] When considering migraine preventive treatment, it is important to distinguish between episodic migraine (fewer than 15 headache days monthly) (EM) and chronic migraine (15 or more headache days monthly) (CM).

• #22 Migraine Preventive Therapies

  https://practicalneurology.com/articles/2019-may/migraine-preventive-therapies

  If a patient with CM does not respond to at least 1 medication from at least 2 classes of oral medications, botulinum toxin is an option. […] It is important to note that MAb CGRP antagonists have changed the treatment landscape significantly. […] The MAb CGRP antagonists are approved to prevent both episodic and CM, whereas onabotulinumtoxinA is approved to prevent CM only. […] The safety profile of all 3 MAbs is close to that of placebo. […] Erenumab may resolve medication overuse in patients with CM. […] The addition of the anti-CGRP and anti-CGRP receptor MAbs to the physicians armamentarium has revolutionized migraine treatment.

• #23 The comparative effectiveness of migraine preventive drugs: a systematic review and network meta-analysis | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-023-01594-1

  While there are several trials that support the efficacy of various drugs for migraine prophylaxis against placebo, there is limited evidence addressing the comparative safety and efficacy of these drugs. […] We conducted a systematic review and network meta-analysis to facilitate comparison between drugs for migraine prophylaxis. […] We found high certainty evidence that monoclonal antibodies acting on the calcitonin gene related peptide or its receptor (CGRP(r)mAbs), gepants, and topiramate increase the proportion of patients who experience a 50% or more reduction in monthly migraine days, compared to placebo. […] We found moderate certainty evidence that beta-blockers, valproate, and amitriptyline increase the proportion of patients who experience a 50% or more reduction in monthly migraine days, and low certainty evidence that gabapentin may not be different from placebo.

• #24 The comparative effectiveness of migraine preventive drugs: a systematic review and network meta-analysis | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-023-01594-1

  We found high certainty evidence that, compared to placebo, valproate and amitriptyline lead to substantial adverse events leading to discontinuation, moderate certainty evidence that topiramate, beta-blockers, and gabapentin increase adverse events leading to discontinuation, and moderate to high certainty evidence that (CGRP(r)mAbs) and gepants do not increase adverse events. […] (CGRP(r)mAbs) have the best safety and efficacy profile of all drugs for migraine prophylaxis, followed closely by gepants. […] We show that CGRP(r)mAbs have the highest efficacy and the lowest incidence of adverse events compared to placebo, closely followed by gepants. […] Our results suggest that CGRP(r)mAbs and gepants are the most effective and better tolerated drugs for migraine prophylaxis. […] CGRP(r)mAbs are the most effective and tolerated treatment for migraine prophylaxis, followed closely by gepants. Commonly used older classes of drugs appear to not only be less effective than CGRP(r)mAbs and gepants, but they are also associated with substantially higher risk of adverse events.

• #25 Migraine Prevention 101: What It Is, When To Use It and Why

  https://americanmigrainefoundation.org/resource-library/migraine-prevention-101/

  Below, we review a list of commonly used preventive medications and their corresponding medication classes. Use this list to see which class of medications may make the most sense for you while being aware of possible side effects. […] Anti-CGRP therapies are injections designed specifically for treating and preventing migraine. […] These are old standbys in migraine prevention. Evidence favors the beta-blockers metoprolol, propranolol and timolol, followed by atenolol and nadolol. […] This group of medications can be equally as effective as beta blockers. […] Amitriptyline is an old, inexpensive medication that effectively prevents episodic migraine. […] The supplement group is usually well tolerated by most people, although the effectiveness may not match stronger prescription counterparts.

• #26 Treat & Help Prevent Migraine | Nurtec® ODT (rimegepant) | Safety Info

  https://www.nurtec.com/why-nurtec

  Only Nurtec ODT can be used to treat or help prevent migraine […] help prevent migraine attacks […] People taking Nurtec ODT every other day experienced the following at 12 weeks: Significant reduction in monthly migraine days (MMDs) […] People taking Nurtec ODT experienced 4.3 fewer MMDs during weeks 9-12 (vs 3.5 fewer MMDs with placebo) […] Monthly migraine days cut in half […] Almost 50% of people saw their days with moderate-to-severe headache pain intensity cut in half with Nurtec ODT vs 41.5% with placebo […] You can take Nurtec ODT as soon as symptoms begin to stop migraine attacks or every other day to prevent them because with migraine, you don’t have time to wait […] Nurtec ODT works by helping block CGRP receptors […] This prevents CGRP from binding to the receptors, which can help treat and prevent migraine attacks.

• #27 An Overview of New Biologics for Migraine Prophylaxis

  https://www.uspharmacist.com/article/an-overview-of-new-biologics-for-migraine-prophylaxis

  The efficacy and tolerability of these medications are patient-driven and may not replicate the endpoints used in clinical trials; however, they may be useful in practice if mean headache days per month are reduced and the patient has minimal side effects with effective results. According to the AHS, because these novel treatment options unlike other first-line treatments do not result in constriction of blood vessels, they may be useful in patients with cardiovascular contraindications. […] CGRP antagonists appear to significantly improve treatment outcomes in patients who experience episodic or chronic migraines. Previously, there were no medications specifically designed for the prophylactic treatment of migraines until the release of these three new monoclonal antibodies. These agents have ushered a new era of migraine therapy.

• #28 Migraine Headache Prophylaxis | AAFP

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

  Petasites has been established as effective and can be considered for migraine prevention. […] 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. […] Erenumab (Aimovig) was approved by the U.S. Food and Drug Administration in May 2018 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. […] The complementary treatments petasites, feverfew, magnesium, and riboflavin are probably effective.

• #29 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. Riboflavin, also known as vitamin B2, is frequently used for migraine prevention. A common dose is 400 milligrams a day. Coenzyme Q10, often called CoQ10, is also considered an essential player in mitochondrial electron transport chain and energy metabolism in the brain. Research has found that 300 milligrams a day of CoQ10 can reduce migraine frequency in adults. 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. 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.

• #30 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. It’s been shown to help prevent 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. These include: magnesium, vitamin B2 (riboflavin), coenzyme Q10, acupuncture. […] 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.

• #31 Supplements for migraine – The Migraine TrustVisualV1 – SearchVisualV1 – CrossVisualV1 – Home VisualV1 – CrossVisualV1 – DownloadVisualV1 – Arrow

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

  Supplements for migraine include riboflavin, magnesium and co-enzyme Q10. […] Some supplements have been suggested as being helpful for migraine. Many people with migraine take them to try and relieve their symptoms or prevent migraine attacks. […] You can take supplements alongside migraine medicines. Some people find this helps with their migraine more than taking either one alone. […] As with preventive medicines for migraine, it takes time to see if a supplement is helping. It may take up to three months to see the full benefit. […] Taking high doses of riboflavin (400 mg a day) for at least three months may help prevent migraine attacks. […] Magnesium supplements may reduce frequency and severity of migraine attacks for some people. […] Clinical trials have shown that co-enzyme Q10 may help to reduce frequency, severity and duration of migraine attacks. […] Several other supplements have been suggested as being helpful for migraine. […] It’s important to check with your GP, pharmacist or specialist before starting a new supplement for migraine. […] Magnesium and riboflavin are considered safe to take during pregnancy.

• #32 Behavioral Interventions for Migraine Prevention | Effective Health Care (EHC) Program

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

  Children/adolescents: a combination of CBT, biofeedback, and relaxation training may lead to lower migraine attack frequency and disability compared with education alone (SOE: low). […] In adults with chronic migraine, behavioral sleep modification may reduce headache frequency at 6 weeks (SOE: low); no studies were included for children. […] Several behavioral interventions appear to reduce migraine/headache attack frequency in adults. Evidence consisted primarily of underpowered trials of multicomponent interventions compared with various types of control groups. Future research should enroll children and adolescents, standardize intervention components to improve reproducibility, use comparison groups that control for expectation confounds, enroll larger samples, consider digital and telehealth modes of care delivery, and improve the completeness of data collection.

• #33 Migraine prophylaxis: Newer options for migraine management | Medmastery

  https://www.medmastery.com/guides/headaches-clinical-guide/migraine-prophylaxis-newer-options-migraine-management?srsltid=AfmBOopQRG1vxT0CMzZxiQCXUx73IZk1IzgM8_7t-oHeY-URqkP6Gvc_

  Other treatments have been tried with varying success: Acupuncture, Behavioral training for relaxation, Biofeedback, Cervical facet blocks, Cognitive behavioral therapy (CBT), Physical therapy, Craniosacral manipulation, Neurostimulation using noninvasive transcranial magnetic stimulation, Trigeminal nerve stimulation using the CEFALY device (used for both prevention and acute treatment).

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

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

  Medicine is a proven way to both treat and prevent migraines. But medicine is only part of the story. It’s also important to take good care of yourself and understand how to cope with migraine pain when it strikes. […] Combining medicine with behavioral measures and lifestyle can often be the most effective way to handle migraines. […] Your eating habits can influence your migraines. Consider the basics: […] Avoid foods that trigger migraines. If you suspect that a certain food is triggering migraines, remove it from your diet to see what happens. These foods may include aged cheese, chocolate, caffeine and alcohol. […] During physical activity, your body releases certain chemicals that block pain signals to your brain. These chemicals also help reduce anxiety and depression two conditions that can make migraines worse.

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

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

  There are several different types of medicine that can be used to prevent migraine attacks. The most common ones are listed below. […] 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. This is because they can cause harm to a developing baby. […] 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.

• #36 Preventive Treatments for Migraine | American Migraine Foundation

  https://americanmigrainefoundation.org/resource-library/understanding-migrainepreventive-treatments/

  Many different preventive treatments are available. The type of migraine prevention that works for you will depend on many factors, including any co-existing conditions like high blood pressure, depression and/or anxiety, obesity, asthma, diabetes or pregnancy (among others). […] Your doctor will work with you to create a migraine prevention plan based on your specific needs. This means taking into account any other conditions for which you are currently taking medication and/or which may be impacted by certain preventive migraine treatments. […] When talking to your doctor about the preventive therapies that are right for you, there are several key things to keep in mind: Setting Expectations, Dosage and Administration, Duration of Treatment, Side Effects, Drug Interactions and Co-Existing Conditions.

• #37 Migraine management

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

  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. In general, they alter the neurotransmitters involved in migraine. Their efficacy can only be fully assessed after 812 weeks at a therapeutic dose. […] 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. Sodium valproate is also prescribed as prophylaxis for migraines.

• #38 Migraine management

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

  Adverse effects and a patients comorbidities often influence the choice of drug. For instance, medicines with a high risk of weight gain (e.g. pizotifen or sodium valproate) should be avoided in obese patients and beta blockers should be avoided in those with asthma. Antihypertensive drugs should not be given to people with hypotension. Choosing a sedative option at night (e.g. amitriptyline or pizotifen) may be suitable for someone with insomnia. […] In Australia, if a patient has chronic migraine but has failed to improve with three oral prophylactic medicines or could not tolerate them, they qualify for Pharmaceutical Benefit Scheme (PBS) subsidised onabotulinum toxin A (Botox) therapy. […] A new class of injectable prophylactic drugs targeting calcitonin gene-related peptide (CGRP) have emerged recently. These appear to be well tolerated and reduce migraine frequency.

• #39 Prevention of migraine attacks – Wikipedia

  https://en.wikipedia.org/wiki/Prevention_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. […] 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. […] The antidepressants amitriptyline and venlafaxine are probably also effective. […] Medications in the anti-calcitonin gene-related peptide, including eptinezumab, erenumab, fremanezumab, and galcanezumab, appear to decrease the frequency of migraines by one to two per month.

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

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

  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. […] Some guidelines recommend preventive treatments for patients who have five or more migraine attacks per month, while others suggest it for those who experience a headache on most days of the month. […] Often, preventive treatment is recommended for only 6 to 9 months; however, researchers have yet to fully examine migraine frequency after discontinuation of preventive treatment.

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

  https://migrainecanada.org/management-treatment/preventive-treatments/

  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 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. […] Research shows that continuing with a preventive increases the chances of remaining stable in the long term. If something works, keep doing it!

• #42 Migraine Treatments | What Options Do You Have?

  https://www.migrainedisorders.org/migraine-disorders/migraine-treatments/

  Preventive treatment is considered a success if it reduces both the number of migraine days you have and the severity of your attacks by at least 50 percent, without intolerable side effects. […] If a preventive treatment works well, then it is typically continued for several months (usually 6-12 months).

• #43 Migraine Prevention 101: What It Is, When To Use It and Why

  https://americanmigrainefoundation.org/resource-library/migraine-prevention-101/

  When it comes to other migraine treatment methods, there are many different types: High blood pressure medications, Anti-seizure medications (anticonvulsants), Anti-calcitonin gene-related peptides (CGRP), Antidepressants, Natural supplements, Neuromodulation devices, Neurotoxins. […] It may take two to three months before you notice a decrease in the frequency or severity of attacks even after reaching “the beneficial dose.” You may require treatment for six to twelve months or longer, but it’s important to stay optimistic, monitor your migraine attacks and stick with the prescribed course of treatment. […] Another thing to consider when working with your provider to create a preventive migraine strategy is to recognize that you may have more than one medical concern that can be treated simultaneously.

• #44 Preventive Treatments for Migraine | American Migraine Foundation

  https://americanmigrainefoundation.org/resource-library/understanding-migrainepreventive-treatments/

  It may take two to three months before you notice a decrease in the frequency or severity of attacks even after reaching the beneficial dose of a new medication. […] It is crucial to take medications at the recommended times to ensure maximum effectiveness. Additionally, it is important to communicate with your doctor if you experience any adverse effects or if the medication does not seem to be working as expected.

• #45 How to Prevent Migraines

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

  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. They may also recommend a preventive drug that has the lowest risk possible. […] The time it takes for your migraine prevention medicine to work varies from person to person. While you may notice a difference within a few weeks, it could be several months before you see significant improvement. […] Researchers have looked into many supplements to prevent or treat migraine. Some of them have shown promise, but they still need to do more research to know for sure that they work. […] Your everyday habits can go a long way to help you have fewer and less severe migraines. Some things that may help include: […] 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.

• #46 The sense of stopping migraine prophylaxis | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-023-01539-8

  Migraine prophylactic therapy has changed over recent years with the development and approval of monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (CGRP) pathway. […] However, there is a lack of robust evidence looking at the duration of successful prophylaxis and the effects of therapy discontinuation. […] Reasons to guide decision-making in stopping prophylactic migraine therapies include adverse events, efficacy failure, drug holiday following long-term administration, and patient-specific reasons. […] The current suggestion to discontinue CGRP(-receptor) targeted mAbs after 6 to 12 months is based on expert opinion, as opposed to robust scientific evidence. […] Current guidelines advise the clinician to assess the success of CGRP(-receptor) targeted mAbs after three months.

• #47 The sense of stopping migraine prophylaxis | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-023-01539-8

  The suggestion to discontinue prophylactic therapy with CGRP(-receptor) mAbs after 6 to 12 months of successful treatment is based on expert opinion and agrees with recommendations for the use of oral prophylactic drugs in migraine. […] However, multi-year observations assessing discontinuing prophylactic treatment, i.e. drug holidays are still lacking especially considering that mAbs are the youngest prophylactic drugs in migraine and real-life studies are still needed. […] Recommendations on discontinuing CGRP(-receptor) targeted mAbs as a prophylactic treatment of migraine have evolved over the last few years as high-quality data on their safety and efficacy has been collected, both from randomized controlled trials and real-world observations. […] The stopping rules of CGRP mAbs vary amongst different countries, mainly due to the limitations of reimbursement programs for the use of these drugs. […] Current guidelines advise clinicians to assess the success of CGRP(-receptor) targeted mAbs after three months and to continue when the treatment is successful.

• #48 Prevention of migraine – GPnotebook

  https://gpnotebook.com/pages/neurology/management/prevention-of-migraine

  Identifying and avoiding trigger factors can reduce the frequency of migraine attacks by up to 50%. Migraine recurring four or more times per month should be treated prophylactically. This is because prophylactic agents only have limited success and risk chronic side effects. NICE suggests that topiramate or propranolol are the suggested first-line prophylactic agents for the prophylaxis of migraine, offer topiramate or propranolol after a full discussion of the benefits and risks of each option. Amitriptyline is also an option for the prophylactic treatment of migraine according to the person’s preference, comorbidities and risk of adverse events. Do not offer gabapentin for the prophylactic treatment of migraine. If both topiramate and propranolol are unsuitable or ineffective, consider a course of up to 10 sessions of acupuncture over 5-8 weeks according to the person’s preference, comorbidities and risk of adverse events. Review the need for continuing migraine prophylaxis 6 months after the start of prophylactic treatment. Advise people with migraine that riboflavin (400 mg once a day) may be effective in reducing migraine frequency and intensity for some people. Botulinum toxin type A is recommended as an option for the prophylaxis of headaches in adults with chronic migraine. Fremanezumab is recommended as an option for preventing migraine in adults, only if the migraine is chronic, that is, 15 or more headache days a month for more than 3 months with at least 8 of those having features of migraine. Galcanezumab is recommended as an option for preventing migraine in adults, only if they have 4 or more migraine days a month and at least 3 preventive drug treatments have failed. Erenumab is recommended as an option for preventing migraine in adults, only if they have 4 or more migraine days a month and at least 3 preventive drug treatments have failed.

• #49

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

  To reduce your chances of having migraine attacks, you can: […] take medicines that prevent migraine attacks. […] Your GP may prescribe medicines to prevent attacks if you: […] Medicines include: […] You may need to take a medicine for a few months before you can see if it works. […] Topiramate can: […] Propranolol is used to treat angina and high blood pressure. It also prevents migraines. […] Amitriptyline can also help to prevent migraine attacks. […] It may take up to 6 weeks before you feel the full benefit of the medicine. […] It may be possible to prevent them with: […] You take the medicines as tablets 2 to 4 times a day from either the start of your period or 2 days before.

• #50 Medications for Migraine Prophylaxis | AAFP

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

  A Cochrane review identified only one effective medication for migraine prophylaxis in children: propranolol. […] Preventive therapy for chronic migraine in women who are pregnant should be approached cautiously and initiated only with the consent of the patient after informed evaluation of the risks.

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