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Table 51-6

Preventive Treatments in Migrainea

DRUGDOSESELECTED SIDE EFFECTS
Beta blocker
 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 pts 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
Calcitonin gene-related peptide (CGRP) monoclonal antibodies
 Erenumab-aooe140 mg monthly SQ injectionInjection site reactions
 Fremanezumab675 mg quarterly SQ injection or 225 mg monthly SQ injectionInjection site reactions
Serotonergic drugs
 Pizotifenb0.5-2 mg qdWeight gain
Drowsiness
Other classes
 Flunarizineb5-15 mg qdDrowsiness
Weight gain
Depression
Parkinsonism
 Candesartan4-24 mg dailyDizziness

Neuromodulation

 Single pulse transcranial magnetic stimulation (sTMS)

4-24 pulses per day

Lightheadedness

Tingling

Tinnitus

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

a Commonly 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.b Not available in the United States.