Preventive Treatments in Migrainea
| Drug | Dose | Selected Side Effects |
|---|---|---|
| Pizotifenb | 0.5-2 mg qd | Weight gain |
| Drowsiness | ||
| βBlocker | ||
| Propranolol | 40-120 mg bid | Reduced energy |
| Metoprolol | 25-100 mg bid | Tiredness |
| Postural symptoms | ||
| Contraindicated in asthma | ||
| Antidepressants | ||
| Amitriptyline | 10-75 mg at night | Drowsiness |
| Dosulepin | 25-75 mg at night | |
| Nortriptyline | 25-75 mg at night | Note: Some patients may only need a total dose of 10 mg, although generally 1-1.5 mg/kg body weight is required |
| Venlafaxine | 75-150 mg/d | |
| Anticonvulsants | ||
| Topiramate | 25-200 mg/d | Paresthesias |
| Cognitive symptoms | ||
| Weight loss | ||
| Glaucoma | ||
| Caution with nephrolithiasis | ||
| Valproate | 400-600 mg bid | Drowsiness |
| Weight gain | ||
| Tremor | ||
| Hair loss | ||
| Fetal abnormalities | ||
| Hematologic or liver abnormalities | ||
| Serotonergic drugs | ||
| Methysergidec | 1-4 mg qd | Drowsiness |
| Leg cramps | ||
| Hair loss | ||
| Retroperitoneal fibrosis (1-month drug holiday is required every 6 months) | ||
| Other classes | ||
| Flunarizineb | 5-15 mg qd | Drowsiness |
| Weight gain | ||
| Depression | ||
| Parkinsonism | ||
| Candesartan | 16 mg daily | Dizziness |
| Chronic migraine | ||
| Onabotulinum toxin type A | 155 U | Loss 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.