Amitriptyline appears to have solid evidence to support its efficacy as an intervention for migraines. To gauge efficacy of these interventions, researchers organized a randomized, parallel-group study with 218 participants for a term of 12 weeks.A 4-week baseline period examined pre-intervention headache pain based on a headache index score.
Physical examination is normal except for obesity. 2013;6(3):271-288. Randomized, placebo-controlled trial of propranolol added to topiramate in chronic migraine.
These are potential 'second line' drugs.For continuous prophylaxis, β-blockers are commonly used.Antiepileptic drugs are highly effective for migraine prophylaxis compared with placebo.Tricyclic antidepressants can prevent migraine in some patients.Calcium channel blockers (e.g., verapamil) and ACE inhibitors (e.g., lisinopril) can prevent migraine attacks, but appear to be weak.There are other pharmacological agents that are referred to as metabotropic drugs: riboflavin, coenzyme Q10 (CoQ10) supplementation and thioctic acid.Expert Rev Clin Pharmacol. Migraine relief medications that combine caffeine, aspirin and acetaminophen (Excedrin Migraine) may be helpful, but usually only against mild migraine pain. (1987) assessed the efficacy of Amitriptyline versus Propranolol for migraine prophylaxis. We found six trials comparing flunarizine to placebo. Brain. Neurotherapeutics.
Prophylaxis of childhood migraine: topiramate versus propranolol. Of these children, 25 were administered low-dose Amitriptyline (average = 0.26 mg/kg/day) and 93 were administered low-dose Propranolol (average = 0.4 mg/kg/day). Study participants in the trials were eligible if they were adults and met International Headache Society We searched Ovid MEDLINE (1950 to April 2008) and EMBASE (1980 to April 2008) using a search strategy that combined the subject search with a highly sensitive search string for randomized controlled trials. 1987;27:421–6.Ryan RE Sr, Ryan RE Jr, Sudilovsky A. Nadolol: its use in the prophylactic treatment of migraine. Acta Neurol Scand. Central effects of drugs used in migraine prophylaxis evaluated by visual evoked potential. 1985;25:107–13.Steiner TJ, Joesph R, Hedman C, et al.
(2009) compared the efficacy and tolerability of popular antimigraine agent Topamax with that of Amitriptyline for the management of episodic migraines. Patients were assigned at random to receive either spinal manipulation therapy or Amitriptyline for 6 weeks.A baseline phase of 2 weeks recorded pre-treatment headache intensity, frequency, over-the-counter medication usage, and health status. Pharm Acta Helv. Migraine prevention with timolol. Significant efficacy was noted in 71% of Amitriptyline users, 56% of the Prozac users, and just 38% of the Maprotiline users.Among responders, all agents were capable of reducing severity and duration of migraine attacks. Sometimes the headache returned the next day, necessitating a second dose.
Drug Intell Clin Pharm. Six of these trials Five studies compared pizotifen to placebo for prophylaxis of migraine. Lifestyle factors, including stress, meal-skipping, obesity, and erratic sleep and work schedules, can precipitate migraine.Prophylactic therapy should be considered for patients whose migraine episodes have a substantial impact on their lives (i.e., causing them to miss workdays and family activities) despite appropriate use of symptomatic medications, or whose frequency of episodes is such that reliance on acute medications alone puts them at risk for medication overuse headache. 2007;115:81–3.Silberstein SD, Dodick DW, Lindblad AS, Holroyd K, Harrington M, Mathew NT, et al. Although the primary effect of prophylactic medications is a reduction in frequency, some patients report that they also experience reduced intensity of their headaches and improved response to symptomatic medication while taking a prophylactic medication.
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