Migraine Guidelines Focus on Prevention

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Updated: 11/13/2012 7:08 pm

April 23, 2012 -- New guidelines may help people with frequent migraine headaches get their lives back on track.

The 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.

For some, migraines are 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, MD, of Jefferson Headache Center at Thomas Jefferson University in Philadelphia, in a news release. Researchers analyzed studies on migraine prevention treatments to determine which are or are not effective.

New Migraine Guidelines Focus on Headache Prevention

According to the new guidelines, effective migraine preventive treatments include:

  • The anti-seizure drugs Depacon (valproate sodium), Depakote (divalproex sodium), and Topamax (topiramate)
  • The 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:

  • Petasites, an herb also known as butterbur
  • NSAIDs including fenoprofen, ibuprofen, ketoprofen, naproxen, and naproxen sodium
  • Histamine shots, which are a common allergy/asthma treatment
  • Magnesium, a mineral
  • MIG-99, an herb also known as feverfew
  • Riboflavin or vitamin B12

There is not enough evidence to suggest a role for aspirin or the NSAID indomethacin as way to stave off migraine headache.

Do You Need Migraine Prevention Treatment?

Mark W. Green, MD, says that 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. 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 says.

Robert Duarte, MD, is the director of the Pain Center at the Cushing Neuroscience Institute of the North Shore-LIJ Health System in Manhasset, N.Y. He says 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 says. "These benefits often outweigh any risks."

That is not the only reason, says Richard B. Lipton, MD. He is the director of the Montefiore Headache Center in New York City. "Many people with migraine don't think of it as a treatable medical disorder," he says. "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.

If you have, or think you have, migraine headaches, the first step is to see a specialist and get a proper diagnosis, Lipton says. Treatment will depend on the frequency and severity of your headaches.

"Some people have one migraine a month, take over-the-counter medication, and can return to their usual activities," he says. "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."

Learning what triggers your migraine headache and taking steps to avoid those triggers also helps, he says.

Buyer Beware of Butterbur

The new guidelines support the use of the herb butterbur. But if the herb is not extracted properly then the drug isn't safe, Lipton says. Choose a well-known brand, and follow the dosing instructions on the label.

Some butterbur products may contain pyrrolizidine alkaloids (PAs). PAs can damage the liver, lungs, and blood circulation, and possibly cause cancer. Butterbur products that contain PAs are unsafe when taken by mouth.

Exactly how butterbur may stave off migraine headache is not clear, but it may have anti-inflammatory properties like NSAIDs.

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