From the Guidelines
Candesartan, telmisartan, erenumab, fremanezumab, and galcanezumab are considered among the best prophylaxis options for migraines, as recommended by the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline for the management of headache 1.
Key Prophylaxis Options
- Candesartan and telmisartan are typically used for the prevention of episodic migraine.
- Erenumab, fremanezumab, and galcanezumab are recommended for the prevention of episodic or chronic migraine.
Alternative Options
Other options such as lisinopril, topiramate, propranolol, and valproate may also be considered, but the choice of medication and dosage should be individualized based on patient-specific factors, including medical history, comorbidities, and potential side effects 1.
Monitoring and Treatment
It is essential to monitor patients regularly to assess the effectiveness and tolerability of the chosen prophylaxis. The treatment plan should be reevaluated on a regular basis, taking into account patient expectations and goals for therapy 1.
Key Considerations
- Patient education and engagement in the formulation of a management plan are crucial for effective migraine prophylaxis.
- Regular monitoring and adjustments to the treatment plan can help optimize outcomes and minimize side effects.
From the FDA Drug Label
Migraine: Propranolol hydrochloride extended-release capsules are indicated for the prophylaxis of common migraine headache The initial oral dose is 80 mg propranolol hydrochloride extended-release capsules once daily. The usual effective dose range is 160 to 240 mg once daily.
The best prophylaxis for migraines, according to the provided drug labels, is propranolol (PO), with a typical effective dose range of 160 to 240 mg once daily 2 2.
From the Research
Migraine Prophylaxis Options
The following are some of the most effective prophylaxis options for migraines:
- Beta blockers, such as propranolol, which have been shown to be effective in reducing migraine frequency 3, 4, 5
- Anticonvulsants, such as topiramate and valproic acid, which have been found to be effective in reducing migraine frequency and severity 6, 7, 4, 5
- Amitriptyline, an antidepressant that has been shown to be effective in preventing migraines 3, 4, 5
- Flunarizine, a serotonergic antagonist that has been found to be effective in preventing migraines, but can cause extrapyramidal disorders and weight gain 3
Comparison of Prophylaxis Options
Studies have compared the efficacy of different prophylaxis options, including:
- Topiramate and propranolol, which have been found to have similar efficacy profiles 6, 7
- Topiramate and valproic acid, which have been found to be effective in reducing migraine frequency and severity 7, 4
- Amitriptyline and beta blockers, which have been found to be effective in preventing migraines, but can have different side effect profiles 3, 4, 5
Choosing a Prophylaxis Option
The choice of prophylaxis option should be based on the individual patient's needs and medical history, including: