From the Guidelines
For daily preventive treatment of migraine headaches without aura, I recommend starting with a beta-blocker such as propranolol (80-240 mg daily) or divalproex sodium (500-1500 mg/d), as these medications have strong evidence for reducing migraine frequency, as stated in the study by 1.
Recommended Medications
- Propranolol (80-240 mg daily)
- Divalproex sodium (500-1500 mg/d)
Acute Treatment
For acute treatment during headaches, use NSAIDs like ibuprofen (400-600 mg) or naproxen (500-550 mg), or triptans such as sumatriptan (50-100 mg) for more severe episodes, as recommended by 1.
Important Considerations
- Limit acute medications to 2-3 days per week to prevent medication overuse headache.
- Preventive medications typically need 4-8 weeks to show effectiveness and should be continued for at least 3-6 months before reassessing.
- Combining medication with lifestyle modifications like regular sleep, stress management, and trigger avoidance enhances treatment effectiveness.
- Regular follow-up with a healthcare provider is essential to monitor response and adjust treatment as needed, as emphasized in the study by 1.
Additional Options
- Amitriptyline (30-150 mg/d) and sodium valproate (800-1500 mg/d) are also effective options for preventive treatment, as stated in the study by 1.
- For patients who do not respond to first-line treatments, consider using CGRP antagonists-gepants (rimegepant, ubrogepant, or zavegepant) or ergot alkaloid (dihydroergotamine), as recommended by 1.
From the Research
Recommended Daily Medication for Migraine Headaches without Aura
The following medications are recommended for migraine prevention:
- Beta-blockers such as propranolol, timolol, and metoprolol 2, 3, 4
- Anticonvulsants such as topiramate, valproate, and divalproex 2, 3, 4, 5
- Antidepressants such as amitriptyline 2, 3, 4, 6
- Other medications such as gabapentin, naproxen, and botulinum toxin may also be effective 2, 3, 4
First-Line Agents
First-line agents for migraine prevention include:
Second-Line Agents
Second-line agents for migraine prevention include:
Important Considerations
When choosing a preventive treatment for migraine, it is essential to consider the presence of comorbid and coexistent illnesses, patient preference, reproductive potential and planning, and the best available evidence 4. Additionally, the potential side effects of each medication should be carefully evaluated, particularly for women of childbearing potential 5.