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.