New guidelines released this week by the American Academy of Neurology focus on the preventive treatment of migraine headache.  In a new study published in Neurology, the author panel addresses the million-dollar question: What drugs are effective in preventing migraines?

Among the recommendations for prescription pharmacologic agents:

Most antiepileptic drugs (divalproex sodium, topiramate, sodium valproate), certain beta-blockers (metoprolol, propranolol, timolol), and one triptan (frovatriptan) are effective and should be offered to patients.
Certain antidepressants (amitriptyline, venlafaxine), other beta-blockers (atenolol, nadolol), and other triptans (naratriptan, zolmitriptan) are probably effective and should be considered.
Lamotrigine is not effective and should not be given.

In the guideline on NSAIDs and complementary therapies:

Petasites is effective and should be offered to reduce frequency and severity of attacks.
Several NSAIDs (fenoprofen, ibuprofen, ketoprofen, naproxen), riboflavin, magnesium, feverfew, and histamine SC are probably effective and should also be considered.
Montelukast is probably ineffective and should not be considered.

Physician’s Weekly wants to know…what has worked for you and your patients?