Preventive (also called prophylactic) treatment of migraines can be an important component of migraine management. Such treatments can take many forms, including taking preventive drugs, migraine surgery, taking nutritional supplements, lifestyle alterations such as increased exercise, and avoidance of migraine triggers, .
The goals of preventive therapy are to reduce the frequency, painfulness, and/or duration of migraines, and to increase the effectiveness of abortive therapy. Another reason to pursue these goals is to avoid medication overuse headache (MOH), otherwise known as rebound headache. This is a common problem among migraneurs, and can result in chronic daily headache.
Many of the preventive treatments are quite effective. Even with a placebo, one-quarter of patients find that their migraine frequency is reduced by half or more, and actual treatments often far exceed this figure.
Preventive migraine drugs are considered effective if they reduce the frequency or severity of migraine attacks by at least 50%. The major problem with migraine preventive drugs, apart from their relative inefficacy, is that unpleasant side effects are common. For this reason, preventive medication is limited to patients with frequent or severe headaches.
There are many medicines available to prevent or reduce frequency, duration and severity of migraine attacks. They may also prevent complications of migraine. Beta blockers such as Propranolol, atenolol, and metoprolol, calcium channel blockers such as amlodipine, flunarizine and verapamil, the anticonvulsants sodium valproate, divalproex gabapentin and topiramate and tricyclic antidepressants are some of the commonly used drugs.
Tricyclics have been found to be more effective than SSRIs. Tricyclic antidepressants have been long established as efficacious prophylactic treatments. These drugs, however, may give rise to undesirable side effects, such as insomnia, sedation or sexual dysfunction. There is no consistent evidence that SSRI antidepressants are effective for migraine prophylaxis. While amitryptiline (Elavil) is the only tricyclic to have received FDA approval for migraine treatment, other tricyclic antidepressants are believed to act similarly and are widely prescribed, often to find one with a profile of side-effects that is acceptable to the patient. In addition to tricyclics a, the anti-depressant nefazodone may also be beneficial in the prophylaxis of migraines due to its antagonistic effects on the 5-HT2A and 5-HT2C receptors It has a more favorable side effect profile than amitriptyline, a tricyclic antidepressant commonly used for migraine prophylaxis. Anti-depressants offer advantages for treating migraine patients with comorbid depression. Selective serotonin reuptake inhibitors (SSRIs) are not approved by the U.S. Food and Drug Administration (FDA) for treatment of migraines, but have been found to be effective by some practitioners.
There is some evidence that low-dose asprin has benefit for reducing the occurrence of migraines in susceptible individuals.
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