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Updated: Jul 6, 2026
10:39
3D-Neuronavigation In Vivo Through a Patient's Brain During a Spontaneous Migraine Headache
Published on: June 2, 2014
Update on the prophylaxis of migraine
Markus Schürks1, Hans-Christoph Diener, Peter Goadsby
1Hans-Christoph Diener, MD Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany hans.diener@uni-duisburg-essen.de.
Current Treatment Options in Neurology
|March 8, 2008
Summary
Migraine prevention involves lifestyle changes and medication. First-line treatments include beta-blockers, topiramate, and valproic acid, with nutraceuticals and other options available for persistent migraines.
Area of Science:
- Neurology
- Pharmacology
- Preventive Medicine
Background:
- Migraine prophylaxis is a stepwise approach, beginning with lifestyle modifications.
- When lifestyle changes are insufficient, pharmacological and nutraceutical interventions are considered.
- Treatment selection is influenced by drug availability, patient comorbidities, and potential adverse effects.
Purpose of the Study:
- To outline a stepwise strategy for migraine prophylaxis.
- To review evidence-based options for migraine prevention, including lifestyle, nutraceuticals, and pharmacotherapeutics.
- To discuss the efficacy and safety profiles of various first- and second-line prophylactic migraine treatments.
Main Methods:
- Review of current literature on migraine prophylaxis.
- Categorization of prophylactic agents into lifestyle modifications, nutraceuticals, and pharmacotherapeutics.
- Analysis of first-line (beta-adrenoceptor blockers, flunarizine, topiramate, valproic acid) and second-line agents.
Main Results:
- Lifestyle adjustments (regular sleep, meals, exercise, stress management) are foundational.
- First-line medications include beta-blockers (useful for hypertension/tachycardia), topiramate (effective for episodic/chronic migraine, potential weight loss), valproic acid, and flunarizine.
- Nutraceuticals (riboflavin, feverfew, coenzyme Q10) and certain antihypertensives (lisinopril, candesartan) offer alternatives with favorable safety profiles; acupuncture is innocuous; botulinum toxin A is ineffective for episodic migraine prophylaxis.
Conclusions:
- A systematic, stepwise approach to migraine prophylaxis is recommended.
- First-line pharmacotherapies offer effective options, but careful consideration of side effects and patient-specific factors is crucial.
- Combination therapy may be necessary if monotherapies fail, before resorting to second-line agents with potentially higher risks.
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