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Evidence Based Migraine Prophylactic Drug Therapy

Published online by Cambridge University Press:  02 December 2014

W.J. Becker
W.J. Becker*
Affiliation:
University of Calgary, Calgary, Alberta, Canada
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Abstract

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Prophylactic drug therapy is a major component of overall migraine management. However, because we do not know how currently used prophylactic drugs exert their beneficial effects in migraine, their use is based primarily on clinical trials. In general, prophylactic drugs are indicated when patients have three or more attacks a month and symptomatic medication use alone is not satisfactory. The choice of drug must be individualized, and is influenced by contraindications, potential side effects, the need to treat associated symptoms like tension-type headache and insomnia, and drug cost. Whether an individual patient will respond to a given drug cannot be predicted, but there are varying degrees of scientific evidence supporting the use of each prophylactic drug in migraine. This evidence is best for metoprolol, divalproex, amitriptyline, atenolol, flunarizine and naproxen. Based on placebo-controlled crossover studies, it would appear that at least some prophylactic drugs exert the greater part of their prophylactic effects very quickly, and that these also disappear very quickly once the drug is stopped. This may not apply to all prophylactic drugs and more research is needed. More well designed clinical trials are needed to guide our use of migraine prophylactic drugs. Although clinical experience is useful, placebo responses and variations in the migraine tendency over time can make interpretation of this experience difficult. Major advances will likely only occur once the pathogenesis of migraine and the mode of action of the prophylactic drugs is better understood.

Résumé

RÉSUMÉ

La médication prophylactique est un aspect important du traitement de la migraine. Cependant, parce que nous ne savons pas comment les médicaments utilisés en prophylaxie de la migraine exercent leurs effets bénéfiques, leur utilisation est basée principalement sur des essais cliniques. En général, les médicaments utilisés en prophylaxie sont indiqués quand les patients ont trois accès de migraine ou plus par mois et que l’utilisation d’une médication symptomatique seule n’est pas satisfaisante. Le choix de la médication doit être individualisé et est influencé par les contre- indications, les effets secondaires potentiels, la nécessité de traiter les symptômes associés tels la céphalée de tension et l’insomnie, et le coût de la médication. Il est impossible de prédire si un patient répondra à tel ou tel médicament, mais il existe des données scientifiques de valeur inégale supportant l’utilisation de chaque médicament utilisé en prophylaxie de la migraine. Ces données sont plus probantes pour le métoprolol, le divalproex, l’amitriptyline, l’aténolol, la flunarizine et le naproxen. Il semble que, d’après les études en chassé-croisé contrôlées par placebo, certains médicaments exercent la plus grande partie de leur effet prophylactique très rapidement et que ces effets disparaissent également très rapidement quand le médicament est cessé. Cette observation ne s’applique peut-être pas à tous les médicaments utilisés en prophylaxie de la migraine et il faut faire plus de recherche sur ce sujet. D’autres essais cliniques bien conçus sont nécessaires pour guider notre utilisation de ces médicaments. Bien que l’expérience clinique soit utile, l’effet placebo et les variations dans le temps de la tendance à la migraine peuvent rendre difficile l’interprétation de ces expériences. Il est probable que des progrès significatifs ne seront accomplis que lorsque la pathogenèse de la migraine et le mode d’action des médicaments prophylactiques seront mieux connus.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 26 , Issue 3 , November 1999 , pp. 27 - 32
Copyright
Copyright © The Canadian Journal of Neurological 1999

References

1. Goadsby, PJ. How do the currently used prophylactic agents work in migraine? Cephalalgia 1997;17:85–92.CrossRefGoogle ScholarPubMed
2. Brewerton, TD, Murphy, DL, Mueller, EA, Jimerson, DC. Induction of migraine-like headaches by the serotonin agonist m-chlorophenylpiperazine. Clin Pharmacol Therapy 1998;43:605–9.CrossRefGoogle Scholar
3. Cutrer, FM, Limmroth, V, Moskowitz, MA. Possible mechanisms of valproate in migraine prophylaxis. Cephalalgia 1997;17:93–100.CrossRefGoogle ScholarPubMed
4. Olesen, J, Thomsen, LL, Lassen, LH, Jansen-Olesen, I. The nitric oxide hypothesis of migraine and other vascular headaches. Cephalalgia 1995;15:94–100.CrossRefGoogle ScholarPubMed
5. Pryse-Phillips, WEM, Dodick, DW, Edmeads, JG, Gawel, MJ, Nelson, RF, et al. Guidelines for the diagnosis and management of migraine in clinical practice. Can Med Assoc J 1997;156:1273–87.Google ScholarPubMed
6. Silberstein, SD, Lipton, RB, Sliwinski, M. Classification of daily and near-daily headaches. Neurology 1996;47:871–875.CrossRefGoogle ScholarPubMed
7. Silberstein, SD. Preventive treatment of migraine: an overview. Cephalalgia 1997;17:67–72.CrossRefGoogle ScholarPubMed
8. Adelman, JU, Brod, A, Von Seggern, RL, Mannix, LK, Rapoport, AM. Migraine preventive medications: a reappraisal. Cephalalgia 1998;18:605–11.CrossRefGoogle ScholarPubMed
9. Gawel, MJ, Kreeft, J, Nelson, RF, Simard, D, Arnott, WS. Comparison of the efficacy and safety of flunarizine to propranolol in the prophylaxis of migraine. Can J Neurol Sci 1992;19:340–345.CrossRefGoogle ScholarPubMed
10. Steardo, L, Marano, E, Barone, P, Denman, DW, Monteleone, P, Cardone, G. Prophylaxis of migraine attacks with a calcium-channel blocker: flunarizine versus methysergide. J Clin Pharmacol 1986;26:524–528.CrossRefGoogle ScholarPubMed
11. Kjaersgard Rasmussen, MJ, Holt Larsen, B, Borg, L, Sorensen, PS, Hansen, PE. Tolfenamic acid versus propranolol in the prophylactic treatment of migraine. Acta Neurol Scand 1994;89(6):446–50.CrossRefGoogle ScholarPubMed
12. Ramadan, NM, Schultz, LL, Gilkey, SJ. Migraine prophylactic drugs: proof of efficacy, utilization and cost. Cephalalgia 1997;17:73–80.CrossRefGoogle ScholarPubMed
13. Sorensen, PS, Hansen, K. Olesen, J. A placebo-controlled, double-blind, cross-over trial of flunarizine in common migraine. Cephalalgia 1986;6:7–14.CrossRefGoogle ScholarPubMed
14. Klapper, J, on behalf of the Divalproex Sodium in Migraine Prophylaxis Study Group. Divalproex sodium in migraine prophylaxis: a dose-controlled study. Cephalalgia 1997;17:103–108.CrossRefGoogle Scholar
15. Mathew, NT, Saper, JR, Silberstein, SD, Rankin, L, Markley, HG, et al. Migraine prophylaxis with divalproex. Arch Neurol 1995;52:281–286.CrossRefGoogle ScholarPubMed
16. Pradalier, A, Serratrice, G, Collard, M, Hirsch, E, Feve, J et al. Long-acting propranolol in migraine prophylaxis: results of a doubleblind, placebo-controlled study. Cephalalgia 1989;9:247–53.CrossRefGoogle ScholarPubMed
17. Jensen, R, Brinck, T, Olesen, J. Sodium valproate has a prophylactic effect in migraine without aura: a triple-blind, placebo-controlled crossover study. Neurology 1994;44:647–651.CrossRefGoogle Scholar
18. Nuti, A, Lucetti, C, Pavese, N, Dell’Agnello, G, Rossi, G, Bonuccelli, U. Long term follow-up after flunarizine or nimodepine discontinuation in migraine patients. Cephalalgia 1996;16:337–340.CrossRefGoogle ScholarPubMed
19. Andersson, PG, Dahl, S, Hansen, JH, Hansen, PE, Hedman, C, et al. Prophylactic treatment of classical and non-classical migraine with metoprolol-a comparison with placebo. Cephalalgia 1983;3:207–12.CrossRefGoogle ScholarPubMed
20. Steiner, TJ, Findley, LJ, Yuen, AWC. Lamotrigine versus placebo in the prophylaxis of migraine with and without aura. Cephalalgia 1997;17:109–12.CrossRefGoogle ScholarPubMed
21. Steiner, TJ, Joseph, R, Hedman, C, Rose, FC. Metoprolol in the prophylaxis of migraine: parallel-groups comparison with placebo and dose-ranging follow-up. Headache 1988;28:15–23.CrossRefGoogle ScholarPubMed
22. Schoenen, J, Jacquy, J, Lenaerts, M. Effectiveness of high-dose riboflavin in migraine prophylaxis. A randomized controlled trial. Neurology 1998;50:466–470.CrossRefGoogle ScholarPubMed
23. Barbirolli, B, Montagna, P, Cortelli, P, et al. Abnormal brain and muscle energy metabolism shown by 3IP magnetic resonance spectroscopy in patients affected by migraine with aura. Neurology 1992;42:1209–1214.CrossRefGoogle Scholar
24. Kathpal, GS. Role of selected antiepileptic drugs in migraine prophylaxis. Headache 1998;38:387.Google Scholar
25. Welch, KMA, D’Andrea, TN, Barkley, G, Ramadan, NM. The concept of migraine as a state of central neuronal hyperexcitability. Neurol Clin 1990;8:817–828.CrossRefGoogle ScholarPubMed
26. Tfelt-Hansen, P, Welch, KMA. General principles of pharmacological treatment. In: Olesen, J, Tfelt-Hansen, P, Welch, KMA(Eds). The Headaches. New York: Raven Press, 1993:299–303.Google Scholar