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Guidelines Update: Preventive Treatments for Migraine

Guidelines Update: Preventive Treatments for Migraine

About 38% of people who suffer from migraine could benefit from preventive treatments, but less than one-third currently uses them. Some analyses have shown that migraine attacks can be reduced by more than half with preventive therapies. In 2000, the American Academy of Neurology (AAN) published guidelines for migraine prevention. In the April 24, 2012 issue of Neurology, the AAN and the American Headache Society issued updated guidelines to account for new evidence. One set of guidelines was developed specifically for prescription products, while another was created for OTC drugs and complementary therapies. In each guideline, the safety and efficacy of pharmacologic therapies for migraine prevention was addressed. The reviews addressed the strength of evidence backing a given drug’s superiority relative to placebo. Prescription Drugs for Migraine Among prescription medications, several β-blockers (metoprolol, propranolol, and timolol) and seizure drugs (divalproex sodium, sodium valproate, and topiramate) established “proven efficacy” for migraine prevention based on clinical research. One selective serotonin receptor agonist (frovatriptan) was also proven effective. It’s recommended that clinicians consider offering these medications to migraineurs to reduce the frequency and severity of attacks.             Topiramate was elevated to a Level A recommendation (indicating “proven efficacy”) on the strength of five randomized trials. Other drugs that had previously been used for migraine prevention were downgraded from higher recommendations in 2000 because the current evidence failed to clearly support their efficacy. OTCs & Complimentary Therapies for Migraine Petasites, also known as butterbur, were shown to be effective in preventing migraine. Several NSAIDs were found to be “probably effective,” including fenoprofen, ibuprofen, ketoprofen, naproxen and naproxen sodium,...
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