Renato Roxas Jr, MD
Which drugs are effective for preventing migraine headaches?
Included studies evaluated drugs that are commonly used in North America and Europe for preventing migraine headaches in adults who met International Headache Society or ad hoc criteria for migraine. Studies of chronic headache (daily, tension-type, or migraine) were excluded. The most consistently reported outcome was responder rate (≥ 50% reduction in migraine frequency).
MEDLINE and EMBASE/Excerpta Medica were searched (to Apr 2008) for double-blind, randomized controlled trials (RCTs), and the Cochrane Library was searched for systematic reviews. 1 Cochrane review evaluating propranolol (26 placebo-controlled trials, n = 668; limited data reported for drug–drug comparisons) and 59 RCTs evaluating 17 drugs met the selection criteria. Drugs evaluated were flunarizine, botulinum toxin type A, topiramate, divalproex sodium, pizotifen, amitriptyline, feverfew, gabapentin, nadolol, venlafaxine, verapamil, riboflavin, magnesium, butterbur, lisinopril, candesartan, and coenzyme Q10. Most trials were placebo-controlled. Data were not reported for all eligible trials.
The main results are in the Table. Divalproex sodium, topiramate, and propranolol reduced migraine frequency (Table); botulinum toxin had no effect.
Some drugs prevent migraine headache in adults; limited evidence exists on the relative effectiveness of different drugs.
Drug treatment for preventing migraine headaches*
*NR = not reported; OR = odds ratio; RCT = randomized controlled trial; RR = risk ratio; other abbreviations defined in Glossary. Only drugs with > 1 RCT reporting data are included in the table.
†ORs and RRs > 1 favor treatment for ≥ 50% reduction in migraine frequency.
‡Led to treatment discontinuation in < 10% of patients (infrequent) or 10% to 25% of patients (occasional).
§Data from a Cochrane review.
Jr RR. Review: Some drugs are effective for preventing migraine headache; limited evidence exists on the relative effectiveness of drugs. Ann Intern Med. ;153:JC5–4. doi: 10.7326/0003-4819-153-10-201011160-02004
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Published: Ann Intern Med. 2010;153(10):JC5-4.
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