The latest migraine prevention guidelines will be presented at the American Academy of Neurology's annual meeting in New Orleans and published simultaneously in the journal Neurology.
About 36 million people in the U.S. have migraine headaches, according to the Migraine Research Foundation. Migraines are painful, often disabling headaches that may be accompanied by nausea, vomiting, and sensitivity to light. In some the attacks may be few and far between and respond well to available treatments. Others experience more frequent headaches that interfere with their life and don't respond well to treatments. The latter group may be candidates for the preventive treatments outlined in the guidelines. Preventive treatments usually are taken every day to prevent attacks from occurring as often and to lessen their severity and duration when they do occur.
About 38% of people with migraine headaches could benefit from prevention, but less than a third of them use them, says guideline author Stephen D. Silberstein, of Jefferson Headache Center at Thomas Jefferson University in Philadelphia, in a news release. Researchers analysed studies on migraine prevention treatments to determine which are or are not effective.
The guidelines say that some drugs that can be sued for prevention include anti-seizure drugs Depacon (valproate sodium), Depakote (divalproex sodium), and Topamax (topiramate) and high blood pressure medications metoprolol, propranolol, and timolol. The anti-seizure drug Lamictal (lamotrigine) is not effective in preventing migraine, the guidelines state.
Certain nonsteroidal anti-inflammatory drugs (NSAIDS) and complementary therapies can also help prevent migraine headache. These include NSAIDs including fenoprofen, ibuprofen, ketoprofen, naproxen, and naproxen sodium. Histamine shots, which are a common allergy/asthma treatment, Magnesium, MIG-99, an herb also known as feverfew and Riboflavin or vitamin B12 may also help.
The new guidelines are similar to those from 2000 with a few changes: Topiramate is now considered effective in migraine prevention; and gabapentin and verapamil were downgraded from probably effective to a category of treatments with inadequate evidence to support or refute its use. But experts emphasize the guidelines are not the be-all, end-all.
According to Dr. Mark W. Green, anyone who has six or more migraine attacks a month or someone who has fewer migraines that don't respond to treatments is a potential candidate for preventive therapy. Green is the director of the Center for Headache and Pain Medicine and professor of neurology and anesthesiology at the Mount Sinai School of Medicine in New York City. “See a headache specialist if your headaches are frequent, disabling, and/or you are not doing well with other treatments,” he said.
“There are many, many different treatments and they have many effects on brain physiology,” said Dr. Joel Saper, director of the Michigan Headache and Neurological Institute in Ann Arbor. “Some people need one kind of an effect to feel better; some need another. Some need multiple treatments at the same time.”
“Some people say, ‘I really don't want be on a medication’,” said Dr. Audrey Halpern, a neurologist at NYU Langone's Joan H. Tisch Center for Women's Health in New York City. “It may be appropriate for them to start with a natural supplement or other complementary therapy to get them going.” But Halpern stressed that natural doesn't necessarily mean safe. “Some supplements may interact with other medications,” she said. “It's really important for people to talk to their doctors before starting any therapy.”
Robert Duarte, director of the Pain Center at the Cushing Neuroscience Institute of the North Shore-LIJ Health System in Manhasset, N.Y. said, many people hesitate to take medications because they want to avoid the side effects that come with taking medication every day. “Taking preventive migraine medication that has been shown to reduce frequency and intensity of headaches will result in less dysfunction,” he said. “These benefits often outweigh any risks.” Richard B. Lipton, director of the Montefiore Headache Center in New York City added, “Many people with migraine don't think of it as a treatable medical disorder…They don't consult doctors and don't know that what they have is a migraine problem.” Others don't think that they will benefit from prevention. That said, not all people with migraine headache need to take preventive treatments.
“Some people have one migraine a month, take over-the-counter medication, and can return to their usual activities,” Lipton said. “Others might have 10 headache days a month that are disabling on five or six days, and they almost certainly need prevention and effective treatments for when they do get a headache.”
Five of the six co-authors of the new guidelines, including Silberstein, disclosed that they receive research funding, speaking fees and other payments from drug companies.
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