Is Platelet-rich Plasma (PRP) effective for treating migraines?

Platelet-Rich Plasma (PRP) is Not Recommended for Migraine Treatment

PRP therapy is not recommended for migraine treatment as there is no evidence supporting its efficacy in current clinical guidelines for migraine management. 1

Evidence-Based Migraine Treatment Options

First-Line Pharmacological Treatments

For Acute Migraine Treatment:

• NSAIDs plus antiemetics (if needed) are the first-line treatment for mild to moderate migraine attacks 1
• Triptans are first-line for moderate to severe migraine attacks 1
• Combination therapy (triptan with NSAID or acetaminophen) should be initiated as soon as possible after migraine onset for improved efficacy 1

For Preventive Treatment:

• Beta blockers without intrinsic sympathomimetic activity (atenolol, bisoprolol, metoprolol, propranolol) 1
• Topiramate 1
• Candesartan 1

Second-Line Pharmacological Treatments

For Acute Migraine:

• Ditans or gepants when triptans fail 1

For Preventive Treatment:

• Flunarizine 1
• Amitriptyline 1
• Sodium valproate (contraindicated in women of childbearing potential) 1

Third-Line Pharmacological Treatments

• CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab, eptinezumab) for prevention 1
• CGRP antagonists-gepants (atogepant, rimegepant) for prevention in those who don't respond to first-line options 1

Evidence-Based Non-Pharmacological Options

• Non-invasive neuromodulatory devices (limited evidence) 1
• Biobehavioural therapy 1
• Acupuncture (although evidence suggests it may not be superior to sham acupuncture) 1

Treatment Approach Algorithm

1. Assess migraine frequency and severity:

   • If ≥2 days per month despite optimized acute treatment, consider preventive treatment 1

2. For acute treatment:

   • Mild to moderate attacks: NSAIDs + antiemetic if needed 1
   • If inadequate response after three consecutive attacks: Try triptans 1
   • If triptans fail: Try ditans or gepants 1

3. For preventive treatment:

   • First-line: Beta blockers, topiramate, or candesartan 1
   • Second-line: Flunarizine, amitriptyline, or sodium valproate (in men) 1
   • Third-line: CGRP monoclonal antibodies or CGRP antagonists-gepants 1

Important Considerations and Pitfalls

• Avoid opioids and butalbital for acute migraine treatment 1
• Be aware of medication overuse headache risk (≥15 days/month with NSAIDs; ≥10 days/month with triptans) 1
• Sodium valproate is strictly contraindicated in women of childbearing potential 1
• Treatment efficacy for preventive medications should be assessed after 2-3 months of use 1
• For CGRP monoclonal antibodies, efficacy should be assessed only after 3-6 months 1
• Poor adherence to preventive treatments is common but can be improved with simplified dosing schedules 1

Absence of Evidence for PRP

Current clinical guidelines from the American College of Physicians, Nature Reviews Neurology, and the VA/DoD make no mention of PRP as a treatment option for migraine 1. The comprehensive review of non-pharmacological therapies in these guidelines specifically states that "little to no evidence exists for physical therapy, spinal manipulation and dietary approaches" 1, and PRP is not mentioned among recommended or even experimental treatments.