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Table 49-6

Preventive Treatments in Migrainea

DrugDoseSelected Side Effects
Pizotifenb0.5-2 mg qdWeight gain
Drowsiness
βBlocker
Propranolol40-120 mg bidReduced energy
Metoprolol25-100 mg bidTiredness
Postural symptoms
Contraindicated in asthma
Antidepressants
Amitriptyline10-75 mg at nightDrowsiness
Dosulepin25-75 mg at night
Nortriptyline25-75 mg at nightNote: Some patients may only need a total dose of 10 mg, although generally 1-1.5 mg/kg body weight is required
Venlafaxine75-150 mg/d
Anticonvulsants
Topiramate25-200 mg/dParesthesias
Cognitive symptoms
Weight loss
Glaucoma
Caution with nephrolithiasis
Valproate400-600 mg bidDrowsiness
Weight gain
Tremor
Hair loss
Fetal abnormalities
Hematologic or liver abnormalities
Serotonergic drugs
Methysergidec1-4 mg qdDrowsiness
Leg cramps
Hair loss
Retroperitoneal fibrosis (1-month drug holiday is required every 6 months)
Other classes
Flunarizineb5-15 mg qdDrowsiness
Weight gain
Depression
Parkinsonism
Candesartan16 mg dailyDizziness
Chronic migraine
Onabotulinum toxin type A155 ULoss of brow furrow
No convincing evidence from controlled trials
Verapamil
Controlled trials demonstrate no effect
Nimodipine
Clonidine
Selective serotonin reuptake inhibitors: fluoxetine

aCommonly used preventives are listed with typical doses and common side effects. Not all listed medicines are approved by the U.S. Food and Drug Administration; local regulations and guidelines should be consulted.

bNot available in the United States.

cNot currently available worldwide.