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Migraine Headache Prophylaxis.

Hien Ha¹, Annika Gonzalez¹

¹Christus Santa Rosa Family Medicine Residency Program, San Antonio, TX, USA.

American Family Physician

|January 3, 2019

Summary

Preventive therapies significantly reduce migraine frequency and severity. While many medications and complementary treatments exist, identifying triggers and utilizing non-pharmacologic options are key for effective migraine management.

Area of Science:

Neurology
Pharmacology

Background:

Migraines present substantial health and financial burdens.
Preventive therapy benefits many episodic migraine patients, yet underutilization is high.
Preventive treatments reduce migraine frequency, severity, and improve quality of life.

Purpose of the Study:

To review the evidence for various migraine preventive therapies.
To identify effective pharmacologic and non-pharmacologic migraine prevention strategies.

Main Methods:

Literature review of clinical evidence for migraine preventive medications.
Analysis of complementary and non-pharmacologic treatment efficacy.
Categorization of treatments based on evidence levels (effective, probably effective, limited evidence, ineffective).

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Main Results:

First-line effective medications include divalproex, topiramate, metoprolol, propranolol, and timolol.
Second-line options like amitriptyline and venlafaxine show probable effectiveness.
Complementary (Petasites, feverfew, magnesium, riboflavin) and non-pharmacologic therapies (relaxation, biofeedback, CBT) are also supported by good evidence.

Conclusions:

A range of pharmacologic, complementary, and non-pharmacologic options exist for migraine prevention.
Identifying and managing triggers is crucial.
Newer CGRP-targeting agents require further long-term study.