From the Guidelines
Prophylactic treatment for migraine headaches should be initiated with first-line agents such as propranolol (80 to 240 mg/d), timolol (20 to 30 mg/d), amitriptyline (30 to 150 mg/d), divalproex sodium (500 to 1500 mg/d), and sodium valproate (800 to 1500 mg/d) to reduce the frequency, severity, and duration of migraines. When considering prophylactic treatment for migraine headaches, it is essential to evaluate the patient's specific needs and medical history. The decision to start prophylactic treatment is typically based on the frequency and severity of migraine attacks, as well as the presence of any contraindications to acute treatments or the use of abortive medication more than twice per week 1. Key factors to consider when selecting a prophylactic treatment include:
- The patient's medical history and potential interactions with other medications
- The presence of any contraindications to specific medications
- The potential for adverse events or side effects
- The patient's preferences and lifestyle It is also crucial to educate migraine sufferers about the control of acute attacks and preventive therapy, and to engage them in the formulation of a management plan 1. Regular follow-up and reevaluation of therapy are necessary to ensure optimal results and to make any necessary adjustments to the treatment plan. By taking a patient-centered approach and considering the latest evidence-based recommendations, healthcare providers can help patients with migraine headaches achieve significant reductions in frequency, severity, and duration of attacks, ultimately improving their quality of life.
From the FDA Drug Label
Migraine: Propranolol hydrochloride extended-release capsules are indicated for the prophylaxis of common migraine headache The propranolol is used for prophylactic treatment of migraine headache.
- The drug is indicated for preventing migraine headaches, but not for treating an attack that has already started. 2
From the Research
Prophylactic Treatment for Migraine Headache
- The aim of prophylactic treatment of migraine is to reduce the frequency and severity of migraine attacks 3.
- Identifying relevant trigger factors can help reduce the frequency of migraine attacks, and a headache diary can be useful in identifying these factors and assessing the efficacy of medication 3.
- Prophylactic drugs should be considered when attacks are frequent or severe and acute treatments are not effective 3.
Recommended Prophylactic Drugs
- Lomerizine, propranolol, valproate, and amitriptyline are useful prophylactic drugs for migraine 3.
- Topiramate, propranolol, nadolol, metoprolol, amitriptyline, gabapentin, candesartan, butterbur, riboflavin, coenzyme Q10, and magnesium citrate have received strong recommendations for use 4, 5.
- The choice of prophylactic drug should be based on evidence for efficacy, side-effect profile, migraine clinical features, and co-existing disorders 4.
Considerations for Prophylactic Treatment
- Comorbid medical and psychologic illnesses should be considered when choosing preventive drugs 6.
- The presence of co-existent hypertension or depression and/or anxiety should be taken into account when selecting a prophylactic drug 4.
- Patient preference, reproductive potential, and planning should also be considered when choosing a preventive treatment 5.
Treatment Strategies
- First-time strategies for patients who have not had prophylaxis before, such as a beta-blocker and a tricyclic strategy, can be effective 4.
- Low side-effect strategies, including both drug and herbal/vitamin/mineral strategies, can be considered 4.
- Refractory migraine strategies and strategies for prophylaxis during pregnancy and lactation should also be developed 4.