Theophylline for Headache Prevention: Not Recommended
Theophylline has no established role in headache prevention and should not be used for this indication. The available evidence does not support theophylline as an effective preventive therapy for migraines or other primary headache disorders.
Evidence Base for Theophylline
- Theophylline is a bronchodilator and respiratory stimulant with established efficacy only for respiratory conditions including acute and chronic asthma, Cheyne-Stokes respirations, and apnea in newborns 1
- No controlled trials or guideline recommendations support the use of theophylline for headache prevention 2, 3
- Theophylline does not appear in any evidence-based migraine prevention guidelines from major societies including the American Academy of Neurology or American Headache Society 3
Proven First-Line Preventive Options Instead
For patients requiring migraine prevention, use medications with Level A evidence:
- Beta-blockers: Propranolol 80-240 mg/day or timolol 20-30 mg/day have the strongest evidence and FDA approval for migraine prevention 2, 3
- Anticonvulsants: Divalproex sodium, sodium valproate, and topiramate are effective first-line options with proven efficacy 2, 3
- Tricyclic antidepressants: Amitriptyline 30-150 mg/day has consistent evidence supporting efficacy, particularly for patients with mixed migraine and tension-type headache or comorbid depression 2, 4
Indications for Preventive Therapy
- Two or more migraine attacks per month producing disability lasting 3+ days 2
- Use of acute rescue medications more than twice per week 2
- Contraindication to or failure of acute treatments 2
Critical Pitfall to Avoid
Do not experiment with medications lacking evidence for headache prevention. Theophylline has significant adverse effects related to serum concentration, requires therapeutic drug monitoring, and can cause life-threatening toxicity at high levels 1. Using an unproven medication delays implementation of effective preventive therapy and exposes patients to unnecessary risks without potential benefit.