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April 24, 2012; 78 (17) Special Articles

Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults

Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society

S.D. Silberstein, S. Holland, F. Freitag, D.W. Dodick, C. Argoff, E. Ashman
First published April 23, 2012, DOI: https://doi.org/10.1212/WNL.0b013e3182535d20
S.D. Silberstein
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S. Holland
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F. Freitag
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D.W. Dodick
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C. Argoff
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Citation
Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults
Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society
S.D. Silberstein, S. Holland, F. Freitag, D.W. Dodick, C. Argoff, E. Ashman
Neurology Apr 2012, 78 (17) 1337-1345; DOI: 10.1212/WNL.0b013e3182535d20

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This article has a correction. Please see:

  • Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society - February 26, 2013
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Abstract

Objective: To provide updated evidence-based recommendations for the preventive treatment of migraine headache. The clinical question addressed was: What pharmacologic therapies are proven effective for migraine prevention?

Methods: The authors analyzed published studies from June 1999 to May 2009 using a structured review process to classify the evidence relative to the efficacy of various medications available in the United States for migraine prevention.

Results and Recommendations: The author panel reviewed 284 abstracts, which ultimately yielded 29 Class I or Class II articles that are reviewed herein. Divalproex sodium, sodium valproate, topiramate, metoprolol, propranolol, and timolol are effective for migraine prevention and should be offered to patients with migraine to reduce migraine attack frequency and severity (Level A). Frovatriptan is effective for prevention of menstrual migraine (Level A). Lamotrigine is ineffective for migraine prevention (Level A).

GLOSSARY

AAN=
American Academy of Neurology;
AE=
adverse event;
CI=
confidence interval;
ER=
extended-release;
MAM=
menstrually associated migraine;
PMP=
perimenstrual period;
RCT=
randomized controlled trial

Footnotes

  • Appendices e-1–e-5, reference e1, and tables e-1 and e-2 are available on the Neurology® Web site at www.neurology.org.

  • Approved by the Quality Standards Subcommittee on February 19, 2011; by the Practice Committee on June 19, 2011; by the AHS Board of Directors on March 29, 2012; and by the AAN Board of Directors on January 27, 2012.

  • Study funding: This guideline was developed with financial support from the American Academy of Neurology and the American Headache Society. None of the authors received reimbursement, honoraria, or stipends for their participation in development of this guideline.

  • See page 1346

  • Supplemental data at www.neurology.org

  • Received June 27, 2011.
  • Accepted January 25, 2012.
  • Copyright © 2012 by AAN Enterprises, Inc.
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Disputes & Debates: Rapid online correspondence

  • Problematic recommendations in ANN's guidelines on drug prevention of migraine.
    • Peer Carsten Tfelt-Hansen, Consultant, Department of neurology, Glostrup Hospital, Denmarkptha@regionh.dk
    • Peer Carsten Tfelt-Hansen
    Submitted August 21, 2012
  • Re: Question on Guidelines: Are There Additional Complementary Treatments for the Prevention of Episodic Migraine?
    • Starr Holland, Savannah GA;, Armstrong Atlantic State Universityguidelines@aan.com
    • S.D. Silberstein, MD, FACP, Philadelphia, PA; F. Freitag, DO, Dallas, TX; D.W. Dodick, MD, Scottsdale, AZ; C. Argoff, MD, Albany, NY
    Submitted May 11, 2012
  • Question on Guidelines: Are There Additional Complementary Treatments for the Prevention of Episodic Migraine?
    • Larry Charleston IV, Physician, Director SHMG's Comprehensive Headache Care Center, Spectrum Health Medical Group- Neuroscience Divisiondr_lciv@hotmail.com
    • Larry Charleston IV, Grand Rapids, MI, USA
    Submitted May 07, 2012
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