Canadian Headache Society guideline for migraine prophylaxis
- PMID: 22683887
Canadian Headache Society guideline for migraine prophylaxis
Abstract
Objectives: The primary objective of this guideline is to assist the practitioner in choosing an appropriate prophylactic medication for an individual with migraine, based on current evidence in the medical literature and expert consensus. This guideline is focused on patients with episodic migraine (headache on ≤ 14 days a month).
Methods: Through a comprehensive search strategy, randomized, double blind, controlled trials of drug treatments for migraine prophylaxis and relevant Cochrane reviews were identified. Studies were graded according to criteria developed by the US Preventive Services Task Force. Recommendations were graded according to the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group. In addition, a general literature review and expert consensus were used for aspects of prophylactic therapy for which randomized controlled trials are not available.
Results: Prophylactic drug choice should be based on evidence for efficacy, side-effect profile, migraine clinical features, and co-existing disorders. Based on our review, 11 prophylactic drugs received a strong recommendation for use (topiramate, propranolol, nadolol, metoprolol, amitriptyline, gabapentin, candesartan, butterbur, riboflavin, coenzyme Q10, and magnesium citrate) and 6 received a weak recommendation (divalproex sodium, flunarizine, pizotifen, venlafaxine, verapamil, and lisinopril). Quality of evidence for different medications varied from high to low. Prophylactic treatment strategies were developed to assist the practitioner in selecting a prophylactic drug for specific clinical situations. These strategies included: first time strategies for patients who have not had prophylaxis before (a beta-blocker and a tricyclic strategy), low side effect strategies (including both drug and herbal/vitamin/mineral strategies), a strategy for patients with high body mass index, strategies for patients with co-existent hypertension or with co-existent depression and /or anxiety, and additional monotherapy drug strategies for patients who have failed previous prophylactic trials. Further strategies included a refractory migraine strategy and strategies for prophylaxis during pregnancy and lactation.
Conclusions: There is good evidence from randomized controlled trials for use of a number of different prophylactic medications in patients with migraine. Medication choice for an individual patient requires careful consideration of patient clinical features.
Similar articles
-
Preventive Migraine Treatment.Continuum (Minneap Minn). 2015 Aug;21(4 Headache):973-89. doi: 10.1212/CON.0000000000000199. Continuum (Minneap Minn). 2015. PMID: 26252585 Free PMC article. Review.
-
A Comparative Effectiveness Meta-Analysis of Drugs for the Prophylaxis of Migraine Headache.PLoS One. 2015 Jul 14;10(7):e0130733. doi: 10.1371/journal.pone.0130733. eCollection 2015. PLoS One. 2015. PMID: 26172390 Free PMC article.
-
Canadian Headache Society Guideline: acute drug therapy for migraine headache.Can J Neurol Sci. 2013 Sep;40(5 Suppl 3):S1-S80. Can J Neurol Sci. 2013. PMID: 23968886 Review.
-
Treatment of migraine with prophylactic drugs.Expert Opin Pharmacother. 2008 Oct;9(15):2565-73. doi: 10.1517/14656566.9.15.2565. Expert Opin Pharmacother. 2008. PMID: 18803445 Review.
-
Medications for migraine prophylaxis.Am Fam Physician. 2006 Jan 1;73(1):72-8. Am Fam Physician. 2006. PMID: 16417067 Review.
Cited by
-
Trigeminal Neuralgia Triggering Recurrent Attacks of Migraine in a Chronic Migraineur: A Hidden Etiology Between the Lines.Cureus. 2024 Feb 27;16(2):e55028. doi: 10.7759/cureus.55028. eCollection 2024 Feb. Cureus. 2024. PMID: 38550434 Free PMC article.
-
Real-world observations and impacts of Chinese herbal medicine for migraine: results of a registry-based cohort study.Front Pharmacol. 2024 Feb 2;15:1330589. doi: 10.3389/fphar.2024.1330589. eCollection 2024. Front Pharmacol. 2024. PMID: 38370478 Free PMC article.
-
Evidence-Based Opinions from Multidisciplinary Experts on Use of Naturopathic Herbal Remedies in Pain Management.J Pain Res. 2024 Feb 8;17:599-608. doi: 10.2147/JPR.S432090. eCollection 2024. J Pain Res. 2024. PMID: 38347854 Free PMC article. Review.
-
Involvement of Coenzyme Q10 in Various Neurodegenerative and Psychiatric Diseases.Biochem Res Int. 2023 Nov 1;2023:5510874. doi: 10.1155/2023/5510874. eCollection 2023. Biochem Res Int. 2023. PMID: 37946741 Free PMC article. Review.
-
Exposure to medication for neurological disease in pregnancy - time to consider the long-term implications?EClinicalMedicine. 2023 Aug 24;63:102157. doi: 10.1016/j.eclinm.2023.102157. eCollection 2023 Sep. EClinicalMedicine. 2023. PMID: 37662523 Free PMC article. Review.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical