Latest AAN/AHS guidelines can help prevent migraine attacks

The latest American Academy of Neurology/American Headache Society Guidelines released this week outline evidence-based and effective treatments that can prevent migraine attacks and lessen their severity. According to guidelines published on the American Academy of Neurology's website, 38 percent of migraine sufferers require preventive therapy, but just three to 13 percent currently use it. An added concern is that patients are taking treatments that have never been demonstrated to work. Most importantly, the guidelines assert that migraine prevention requires taking medication daily, rather than only when in the throes of an attack.

"What the guidelines do is pinpoint first-line treatments based on evidence and effectiveness," said Mark Green, MD, director of the Headache Center at Mount Sinai School of Medicine, in New York. "If these guidelines are used widely, we will be able to up the odds of reducing headaches by 50 percent."

"Moreover, the stakes may be high if we undertreat migraines," said Dr. Green. "Evidence is building to suggest that if we allow migraines to progress, the frequency of attacks may increase, and they may also become harder to treat." Dr. Green compared it to the hazards linked to issues like under treating high blood pressure and asthma, which can lead to significant problems.

Evidence-Based Preventive Treatments
First-line prescription drugs with the strongest evidence for prevention must be taken every day to prevent migraine attacks and reduce the severity of attacks. The guidelines panel found the following:
•The anti-seizure medications divalproex sodium, sodium valproate, and topiramate, as well as beta blockers metoprolol, propranol, and tumolol, are effective for migraine prevention. The antiseizure drug lamotrigine was not effective in preventing migraine, and should not be used.
•The herbal preparation Petasites, or butterbur, proved effective in prevention.
•Rated "probably effective" were the following over the counter medicines: the nonsteroidal anti-inflammatory drugs fenoprofen, ibuprofen, ketoprofen, naproxen, and naproxen sodium, subcutaneous histamine and complementary treatments magnesium, MIG-99 (feverfew) and riboflavin.
•Dr. Green said that gabapentin ranked near the bottom, rated Level U. Verapamil was also in this category.