Preventive Medications for Migraines
- Consider in pts with > 1-2 episodes or 3 days of sx / month.
- OCPs: Consider continuous monophasic low-dose OCPs in pts with a menstrual trigger; however, contraindicated in pts with aura & can worsen sx or cause pt to develop aura. If that happens, d/c Rx.
Herbal / Alternative therapies:
- Petasites (butterbur) was found to be effective as a preventive. Rx: Butterbur 50 mg po TID x 4 weeks, THEN 50 mg po BID thereafter.
- Riboflavin, magnesium, and MIG-99 (feverfew) are probably effective,
- CoQ10 is possibly effective
- Botox injections. If pt fails other tx modalities, will refer to pain management or neurology for botox injections q 3mo.
Pharmacologic treatment:
- Beta blockers: Propanolol and timolol are FDA approved for migraine prevention.
- Anti-seizure meds: Valproic acid and topiramate are FDA-approved for migraine prevention.
- TCAs: Amitriptyline
- Gabapentin
Note, may use Topiramate and Propranolol together.
Common Dosages (from a neurologist)–need to check.
-Propranolol 60mg BID
-Topiramate 50mg BID. Start 25mg PO QHS x 1 week, increase by 25mg/day q week; Max: 200mg/day; Info: Taper dose gradually to d/c.