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.
Disputes & Debates: Rapid online correspondence
- Problematic recommendations in ANN's guidelines on drug prevention of migraine.
- Re: Question on Guidelines: Are There Additional Complementary Treatments for the Prevention of Episodic Migraine?
- Question on Guidelines: Are There Additional Complementary Treatments for the Prevention of Episodic Migraine?
NOTE: All authors' disclosures must be entered and current in our database before comments can be posted. Enter and update disclosures at http://submit.neurology.org. Exception: replies to comments concerning an article you originally authored do not require updated disclosures.
- Stay timely. Submit only on articles published within the last 8 weeks.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- 200 words maximum.
- 5 references maximum. Reference 1 must be the article on which you are commenting.
- 5 authors maximum. Exception: replies can include all original authors of the article.
- Submitted comments are subject to editing and editor review prior to posting.