Migraine prevent

Posted On February 14, 2020
  • Beta Blocker: avoid in bradycardia, copd, asthma
    • First trimester exposure did not show increase in major congenital malformations
    • Metoprolol ER: start 50 mg qd available in 50, 100, 200 mg
      • up to 200 mg per day
    • Propronol ER: start 40 mg qd, available in 60, 80, 120, 160 mg qd
    • up to 160 mg per day
  • Calcium channel Blocker: data are weak and conflicting
    • Verapamil er: 120 mg qd, available in 120, 180, 240 mg qd, up to 240 mg per day
    • Pregnancy: limited data, but showed evidence of increased risks of stillbirth, preterm bith and cardiovascular malformations
  • ACEI: small study, not widely used
    • Lisinopril: 10 mg qd, then 20 mg qd
    • Should be avoided in females who has reproductive potential not on contraceptive.
  • Antidepressants:
    • Venlafaxine er: 37.5 mg qd, available in 37.5, 75, 150 mg, up to 150 mg qd, pregnancy Risk: class C
  • Anticonvulsants:
    • Topramate: 25 mg qd, available in 25, 50, 100 mg, up to 100 mg bid.
      • Pregnancy: may cause fetal harm, increased risk of oral clefts and saml for gestational age
    • Valproate ER: 500 mg qd, available in 250, 500 mg, up to 1500 mg per day.
      • Watch for tremor, weight gain
      • Do not use for female who has reproductive potential
    • Gabapentine does not help
  • CGRP antagonists: CGRP is a small protein in the sensory nerves that supply the head and the neck.
    • Erenumab (Aimovig): 70 mg to 140 mg sq once a month
      • adverse event not observed in animal reproductive studies
    • Fremanezumab (Ajovy): 225 mg sq once a month, or 3 injections every 3 months
      • Adverse events were not observed in animal reproduction studies.
    • Galcanezumab (Emgality): 120 mg sq x2, then 120 mg sq once a month
      • Adverse events were not observed in animal reproduction studies.
  • Botulinum toxin: AAN concluded not effective for episodic migraine
    • Effective for chronic migraine, over 15 days per month for 3 months.
  • OVER THE COUNTER supplement: small trial showed effectiveness
    • Coenzyme Q10: Available in 100 mg tab, 100 mg tid
  • Riboflavin: 100 mg tab or 400 mg cap: take 200 mg to 400 mg qd

References