Migraine prevention in adults

The American Academy of Neurology and the American Headache Society have published their new guideline on pharmacologic treatment for episodic migraine prevention in adults. The highest level (Level A) recommendation for prevention was given to antiepileptic drugs, including divalproex sodium, sodium valproate, and topiramate. Other level A drugs included the beta-blockers metoprolol, propranolol, and timolol as well as the triptan frovatriptan, but this last agent is just for short-term use for menstrually associated migraine (MAM) prevention. Level B drugs included the antidepressants amitriptyline and venlafaxine, the beta-blockers atenolol and nadolol, and the triptans naratriptan and zolmitriptan (also only for short-term MAM prevention). Possibly effective medications included lisinopril, candesartan, some beta-blockers, and carbamazepine. There was little or no evidence to support any other drugs including selective serotonin reuptake inhibitors, calcium channel blockers, or acetazolamide. Drugs that should not be offered include lamotrigine and clomipramine. In a separate section on nonsteroidal anti-inflammatory drugs (NSAIDs) and complementary treatments, Petasites hybridus (butterbur) were given recommended status, while NSAIDs were listed as probably effective (Neurology published online April 24, 2012; doi: 10.1212/WNL.0b013e3182535d20, and doi: 10.1212/WNL.0b013e3182535d0).