New Migraine Guidelines Stress Prevention

American Academy of Neurology unveils new migraine guidelines

April 23, 2012 / Author:  / Reviewed by: Robert Carlson, M.D

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(dailyRx News) Many patients suffering from chronic migraines may be eligible to take preventative medications, yet few take them. New guidelines for treating migraines stress using available therapies to prevent such attacks.

The guidelines were issued by the American Academy of Neurology with development assistance from the American Headache Society.

Stephen D. Silberstein, MD, FACP, FAHS, a guideline author from Jefferson Headache Center at Thomas Jefferson University, noted that studies indicate migraines are underrecognized and undertreated.

He said about 38 percent of patients who suffer from chronic migraines could benefit from preventative treatment, but fewer than a third of those candidates utilize medications to prevent attacks, and lessen their severity and duration.

Previous studies have suggested preventative drugs could prevent about half of attacks from occurring in patients with chronic migraines. In comparison, acute migraine treatment lessens pain and symptoms associated with migraines following onset.

Following a review of evidence, the guideline authors found prescription medications including seizure drugs divalproex sodium (Depakote), sodium valproate (Epilim) and topiramate (Topamax), and beta-blockers metoprolol (Toprol), propranolol (Inderal) and timolol (Blocadren), to be effective in preventing migraines. They determined that seizure medication lamotrigine (Lamictal) does not help prevent migraines.

In addition, the authors reviewed over-the-counter treatments, including supplements and holistic treatments. Herbal treatment Petasites, commonly known as butterbur, was found effective in preventing migraines. Other treatments reviewed were considered "probably effective."

Those therapies include: non-steroidal anti-inflammatory drugs ibuprofen, fenoprofen, ketoprofen, naproxen and naproxen sodium; intravenous histamines, and natural or supplemental treatments magnesium, MIG-99 (feverfew) and riboflavin (vitamin B2).

Though many drugs that made the list don't require a prescription, Dr. Silberstein still suggests following up with a physician.

“Migraines can get better or worse over time, and people should discuss these changes in the pattern of attacks with their doctors and see whether they need to adjust their dose or even stop their medication or switch to a different medication,” Dr. Silberstein said.

“In addition, people need to keep in mind that all drugs, including over-the-counter drugs and complementary treatments, can have side effects or interact with other medications, which should be monitored.”

The guidelines will be announced at the American Academy of Neurology’s 64th Annual Meeting in New Orleans and published in the April 24 issue of Neurology, the medical journal of the American Academy of Neurology.