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Preventive Migraine Treatment

Silberstein, Stephen D. MD, FAAN, FACP

CONTINUUM: Lifelong Learning in Neurology: August 2015 - Volume 21 - Issue 4, Headache - p 973–989
doi: 10.1212/CON.0000000000000199
Review Articles

Purpose of Review: This article reviews the evidence base for the preventive treatment of migraine.

Recent Findings: Evidence-based guidelines for the preventive treatment of migraine have recently been published by the American Academy of Neurology (AAN) and the Canadian Headache Society (CHS), providing valuable guidance for clinicians. Strong evidence exists to support the use of metoprolol, timolol, propranolol, divalproex sodium, sodium valproate, and topiramate for migraine prevention, according to the AAN. Based on best available evidence, adverse event profile, and expert consensus, topiramate, propranolol, nadolol, metoprolol, amitriptyline, gabapentin, candesartan, Petasites (butterbur), riboflavin, coenzyme Q10, and magnesium citrate received a strong recommendation for use from the CHS.

Summary: Migraine preventive drug treatments are underutilized in clinical practice. Principles of preventive treatment are important to improve compliance, minimize side effects, and improve patient outcomes. Choice of preventive treatment of migraine should be based on the presence of comorbid and coexistent illness, patient preference, reproductive potential and planning, and best available evidence.

Address correspondence to Dr Stephen D. Silberstein, Thomas Jefferson University, Jefferson Headache Center, 900 Walnut Street, Suite 200, Philadelphia, PA 19107,

Relationship Disclosure: Dr Silberstein receives honoraria for serving as a consultant and/or advisory panel member from Alder Biopharmaceuticals Inc; Allergan, Inc; Amgen Inc; Avanir Pharmaceuticals, Inc; Depomed, Inc; Dr. Reddy’s Laboratories; electroCore Medical LLC; eNeura Inc; Ipsen Biopharmaceuticals Inc; Medscape, LLC; Medtronic plc; Mitsubishi Tanabe Pharma Development America, Inc; National Institute of Neurological Disorders and Stroke (NINDS); St. Jude Medical, Inc; Supernus Pharmaceuticals, Inc; Teva Pharmaceutical Industries Ltd; and Trigemina, Inc. Dr Silberstein is a consultant on the clinical trials of calcitonin gene-related peptide that are discussed in this article.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Silberstein discusses the unlabeled/investigational use of pharmaceuticals for the preventive treatment of migraine, none of which are approved by the US Food and Drug Administration.

© 2015 American Academy of Neurology
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