Evidence based migraine prophylactic drug therapy.

Area of Science:

• Neurology
• Pharmacology

Background:

• Prophylactic drug therapy is crucial for managing frequent migraines when symptomatic treatments fail.
• Current drug selection relies on clinical trials due to unknown mechanisms of action.
• Individualized treatment considers contraindications, side effects, associated symptoms, and cost.

Purpose of the Study:

• To review the evidence supporting current prophylactic migraine drugs.
• To highlight the need for better understanding of drug mechanisms and improved clinical trial design.

Main Methods:

• Review of existing clinical trial data and scientific literature on migraine prophylactic medications.
• Analysis of evidence supporting specific drugs like metoprolol, divalproex, amitriptyline, atenolol, flunarizine, and naproxen.

Main Results:

• Varying degrees of scientific evidence support different prophylactic drugs.
• Metoprolol, divalproex, amitriptyline, atenolol, flunarizine, and naproxen have the strongest evidence.
• Some drugs appear to have rapid onset and offset of prophylactic effects, requiring further investigation.

Conclusions:

• Clinical experience is valuable but can be confounded by placebo effects and migraine variability.
• More well-designed trials are essential to guide the use of prophylactic migraine drugs.
• Understanding migraine pathogenesis and drug mechanisms is key for future advancements.