AAN issues migraine prevention recommendations
AAN: Recommendations for Migraine Prevention Issued
HealthDay News -- Seven different drugs are available to effectively manage migraine symptoms and several more are likely helpful, according to new evidence-based guidelines announced at the American Academy of Neurology annual meeting in New Orleans.
The announcement coincides with the publication of two practice guidelines on preventing episodic migraine -- one for prescription products and another for nonsteroid anti-inflammatory drugs (NSAIDs) and complementary and alternative therapies -- in the April 24 issue of Neurology.
Three betablockers, three anti-epileptic drugs and one triptan agent were among prescription drugs Stephen D. Silberstein, MD, from Jefferson Headache Center at Thomas Jefferson University in Philadelphia, and colleagues, identified as having "proven effectiveness" against migraines.
Proven effectiveness was defined as a significant benefit in at least two high-quality randomized trials in an analysis that involved 29 Class I or II articles that the researchers selected from 284 abstracts published on the efficacy of various medications available in the United States for migraine prevention between June 1999 and May 2009.
The researchers granted Level A recommendations to several medications which they state should be offered to patients to reduce the frequency and severity of migraine attacks:
- Divalproex sodium (Depakote)
- Sodium valproate (Depacon)
- Topiramate (Topamax)
- Metoprolol (Lopressor, Toprol-XL)
- Propranolol (Inderal)
- Timolol effectively
- Frovatriptan (Frova; specifically recommendedfor menstrual migraine)
"Evidence to support pharmacologic treatment strategies for migraine prevention indicates which treatments might be effective but is insufficient to establish how to choose an optimal therapy," the researchers noted. "Treatment regimens, therefore, need to be designed case by case, which may include complex or even nontraditional approaches."
Only one OTC product -- the herbal supplement Petasites, also known as butterbar -- met qualifications for established efficacy.
No NSAIDs were able to achieve the highest rating for proof of efficacy, but several are "probably effective" according to the guideline, including: naproxen (Naprosyn, Aleve), ibuprofen (Advil), ketoprofen, and fenoprofen (Nalfon). Magnesium, riboflavin, histamine SC and the herbal supplement feverfew (MIG-99) were other OTC products identified as having probable efficacy.
Products listed as "probably or possibly ineffective" for preventing migraines are:
- Lamotrigine (Lamictal)
- Clomipramine (Anafranil)
- Acebutolol (Sectral)
- Clonazepam (Klonopin)
- Nabumetone (Relafen)
- Oxcarbazepine (Trileptal)
- Telmisartan (Micardis)
- Montelukast (Singulair)
The new recommendations are the first update to previous AAN recommendations for episodic migraine prophylaxis published in 2000, and include three major changes:
- Topimarate was upgraded to a Level A treatment, due to positive results in five clinical trials published since the initial recommendations were released
- Verapamil (Calan) and gabapentin (Neurontin) were downgraded after current evidence failed to support their efficacy.
Several researchers disclosed financial ties to the pharmaceutical industry.
Silberstein S et al. "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." Neurology. 2012;78:1337-45.
Holland S et al. "Evidence-based guideline update -- NSAIDs and other complementary treatments for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society." Neurology. 2012; 78:1346-53.