New Guidelines Issued on Migraine Prevention

The blinding pain of a migraine headache can often be prevented, but many migraine sufferers apparently haven't gotten the message.

The blinding pain of a migraine headache can often be prevented, but many migraine sufferers apparently haven't gotten the message.

Although 40 percent of people with migraines could be helped with preventive medications, only about a third of that total are getting help, according the new migraine guidelines from the American Academy of Neurology and the American Headache Society.

Preventive treatment should be unique to each migraine sufferer. A variety of medication types are available, ranging from antidepressants to beta blockers. Some are prescription medicines and others are sold over the counter. Herbal medications also can be effective.

"Although there is no cure for migraine, preventive medications can decrease migraine occurrence by 50 percent or more, as well as reduce the severity and duration of headaches that do occur," says Brian M. Grosberg, M.D., at the Montefiore Headache Center in New York City.

Migraine headaches affect millions of Americans. Some may have only an occasional migraine, but others suffer frequent, unpredictable attacks. The pain of a migraine can be excruciating and debilitating. Symptoms can include throbbing or pulsing in one area of the head, nausea, vomiting and extreme sensitivity to light and sound. Migraine attacks are more common in women, and may last for hours or days.

Once a migraine begins, it can be treated with several types of acute medications. But health care providers would rather offer ways to prevent a migraine, where possible. Typically, the preventive medications are taken daily and are different from those used during an attack.

Effective medicines

The new guidelines, published in this week's issue of the journal Neurology, offer these suggestions for medications that reduce the number and severity of migraine attacks:

• Antiepileptic drugs such as divalproex sodium (Depakote), topiramate (Topamax), and sodium valproate

• Blood pressure drugs metoprolol (Lopressor, Toprol), propranolol (Inderal) and timolol (Blocadren), all of which belong to the class of medications known as beta blockers

• Migraine drug frovatriptan (Frova)

Other candidates

The antidepressant Effexor (venlafaxine) appears to have some preventive benefit. Over-the-counter drugs Motrin (ibuprofen) and Aleve (naproxen), as well as riboflavin (vitamin B2) and the herb butterbur may also play a role in prevention.

Dr. Grosberg says patients should discuss the various treatment options with their doctor. "The preventive strategy should always be tailored to the individual patient, bearing in mind personal preference, co-existing medical conditions, frequency of dosing and cost, as well as other factors."