Migraine prevention
The goals of preventive therapy are:
- Reduce attack frequency, severity, and/or duration
- Improve responsiveness to acute attacks
- Reduce disability
1. Oral Medications:
Currently, the major oral prophylactic medications for migraine work via one of the following mechanisms:
- 5-HT2 antagonism - Methysergide (second line, high efficacy medication)
- Regulation of voltage-gated ion channels - Calcium channel blockers e.g. Verapamil (first line, low efficacy medication)
- Modulation of central neurotransmitters - Beta blockers e.g. Propranolol and Timolol (first line, high efficacy medication) and Tricyclic Antidepressants (first line, high efficacy medication)
- Enhancing GABA inhibition - Valproic acid, gabapentin (second line, unproven efficacy)
All these medication have significant side effects and most only have modest efficacies of less than 50% when compared with placebo. Each medication should be tried for at least 30 days at the maximum tolerated dose before being considered a failure. Topiramate (Topamax) is a commonly prescribed to prevent migraines and in studies has been shown to decrease the frequency of migraines by 72% however this compared with 44% in participants receiving placebo. Long term use in children can cause metabolic acidosis and low potassium and other main adverse effects are weight loss and dysesthesia (abnormal sensation).
2. Injectable medication at trigger points in the scalp
This is now approved in patients with chronic migraine that have failed to respond to at least 3 conventional preventive medications. The injections are administered to the scalp and temple. In a recent PREEMPT (Research Evaluating Migraine Prophylaxis Therapy) clinical trial in almost 1400 patients they have been demonstrated to reduce the frequency of migraine attacks by over 50%. Secondary benefits included significantly reduced headache-related disability and improved functioning, vitality, and overall health-related quality of life.
Get frequent migraines? Act now!
If you or a member of your family suffer from frequent migraines then we may be able to help. Simply contact us to book an appointment for assessment and treatment at one of our clinics (or if you have any questions).
