From the Guidelines
Phentermine is not recommended for treating migraines. According to the provided evidence, there is no mention of phentermine as a treatment option for migraines 1. The evidence suggests that first-line therapy for migraines includes aspirin, ibuprofen, naproxen sodium, tolfenamic acid, and the combination agent acetaminophen plus aspirin plus caffeine 1. For patients whose migraine attack has not responded to NSAIDs, migraine-specific agents such as triptans and DHE are recommended 1. Some key points to consider when treating migraines include:
- Selecting a nonoral route of administration for patients whose migraines present early with nausea or vomiting as a significant component of the symptom complex 1
- Treating nausea and vomiting with an antiemetic 1
- Evaluating migraine sufferers for use of preventive therapy, with recommended first-line agents including propranolol, timolol, amitriptyline, divalproex sodium, and sodium valproate 1 Using phentermine for migraines would be off-label and potentially risky due to its stimulant properties and cardiovascular effects. Additionally, phentermine can cause side effects like insomnia, nervousness, and increased blood pressure that might trigger or worsen headaches. If you're experiencing migraines, it's best to consult with a healthcare provider who can recommend evidence-based treatments specifically designed for migraine prevention and relief.
From the Research
Migraine Treatment Options
Established Treatments
- Acetaminophen, nonsteroidal anti-inflammatory drugs, triptans, antiemetics, ergot alkaloids, and combination analgesics have evidence supporting their effectiveness in the treatment of migraine 2
- Triptans are first-line treatments for moderate to severe migraines, while acetaminophen and nonsteroidal anti-inflammatory drugs are first-line treatments for mild to moderate migraines 2
- Calcitonin gene-related peptide receptor antagonists, lasmiditan, dihydroergotamine, ergotamine plus caffeine, acetaminophen, antiemetics, butorphanol, and tramadol in combination with acetaminophen are significantly associated with pain reduction and increase in mild adverse events 6
Novel Treatments
- Novel anti-migraine drugs target CGRP signaling through either stimulation of 5-HT1F receptors on trigeminovascular nerves or direct blockade of CGRP or its receptor 3
- Lasmiditan is a highly selective 5-HT1F receptor agonist and has been approved for clinical use 3, 6
- CGRP receptor antagonists, such as erenumab, and small-molecule antagonists, such as gepants, have been developed for acute migraine treatment 3
- Rimegepant and ubrogepant have been approved for clinical use, while atogepant is in the last stage before approval 3, 5