Oh, My Aching Head: How to Prevent Migraines by Dr. Sharon Orrange/Primary Care Physician: at DailyStrength Doctors and Advisors

Dr. Orrange received her BA in Biology at the University of California, San Diego, and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health. She received her MD from the USC Keck School of…

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LOCATION: Santa Monica, CA, USA

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Assistant Professor of Clinical Medicine, Division of Geriatric, Hospital and General Internal Medicine, Keck School of Medicine, University of Southern California

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Oh, My Aching Head: How to Prevent Migraines

Posted in Migraine Headac... by Dr. Sharon Orrange on Feb 11, 2013

Oh those miserable migraines. Wouldn’t it be great if we could help the 17% of women and 6% of men who suffer from migraines? This year, The American Academy of Neurology published updated guidelines in the use of medications that will prevent migraines (prophylaxis.) There are some promising new options and yes, there is light at the end of the tunnel.

For patients with more than four migraines a month OR migraines that last longer than 12 hours, taking a prevention medication will reduce your disabling headaches.

Here is your best plan for prevention of migraine headaches.

- The antiepileptic drugs Depakote (divalproex) and Topamax (topiramate) have been evaluated in multiple studies and show the best effectiveness for prevention of migraine headaches.

- Long-term use of Depakote has been associated with weight gain; while as many as 15% of patients treated with Topamax have weight loss. Topamax is a frontrunner for this reason.

- Beta-blockers including metoprolol, propranolol, timolol, atenolol, and nadolol also have been found effective for migraine headache prevention.

- The antidepressant medications amitriptyline and Effexor (venlafaxine) have been shown to be as effective as Topamax for migraine prevention but the side effect profile isn’t as great.

- Frova (Frovatriptan) used around your menstrual cycle to prevent menstrual-associated migraines has been shown to be effective.

- Butterbur extract has strong evidence for prevention of migraine while other “natural” options have less evidence including riboflavin (Vitamin B2) and magnesium. Butterbur 50-75 mg twice a day is a no brainer, so give it a try.

What path has not been shown to be helpful for the prevention of migraines?

- Despite studies, the following medications have not been shown to be effective for prevention: Lamictal (lamotrigine), clomipramine, acebutolol, clonazepam, Relafen (nabumetone), Trileptal (oxcarbazepine), Singulair (Montelukast), and Micardis (Telmisartan.)

- Prozac (fluoxetine) and calcium-channel blockers have not been found to be effective either.

The goal for whatever path you take is to find the medication with a favorable side effect profile that helps you reduce the number and severity of your migraines.

Keep calm and fight migraines.

- Dr. O

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