Migraine Headache Guidelines

Updated: May 10, 2017
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Helmi L Lutsep, MD  more...
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Guidelines

US Headache Consortium

Pharmacologic treatment for episodic migraine prevention in adults

According to guidelines released by the American Academy of Neurology and the American Headache Society, [138] the following medications are established as effective and should be offered for migraine prevention (level A recommendation):

  • Antiepileptic drugs (AEDs): divalproex sodium, sodium valproate, topiramate
  • β-Blockers: metoprolol, propranolol, timolol
  • Triptans: frovatriptan for short-term MAMs prevention

The following medications are probably effective and should be considered for migraine prevention (level B recommendation):

  • Antidepressants: amitriptyline, venlafaxine
  • β-Blockers: atenolol, nadolol
  • Triptans: naratriptan, zolmitriptan for short-term MAMs prevention

The following medications are possibly effective and may be considered for migraine prevention (level C recommendation):

  • ACE inhibitors: lisinopril
  • Angiotensin receptor blockers: candesartan
  • α-Agonists: clonidine, guanfacine
  • AEDs: carbamazepine
  • β-Blockers: nebivolol, pindolol

NSAIDs and other complementary treatments for episodic migraine prevention in adults

The American Academy of Neurology and the American Headache Society also released guidelines regarding the use of NSAIDs and complementary treatments in preventing episodic migraine. [139]

The following therapy is established as effective and should be offered for migraine prevention (level A recommendation):

  • Petasites (butterbur)

The following therapies are probably effective and should be considered for migraine prevention (level B recommendation):

  • NSAIDS: fenoprofen, ibuprofen, ketoprofen, naproxen, naproxen sodium
  • Herbal therapies, vitamins, and minerals: riboflavin, magnesium, MIG-99 (feverfew)
  • Histamines: histamine SC

The following therapies are possibly effective and may be considered for migraine prevention (level C recommendation):

  • NSAIDs: flurbiprofen, mefenamic acid
  • Herbal therapies, vitamins, and minerals: Co-Q10, estrogen
  • Antihistamines: cyproheptadine
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American Headache Society

In 2016, the American Headache Society released guidelines for the management of adults with acute migraine in the emergency department. They recommend intravenous metoclopramide, intravenous prochlorperazine, and subcutaneous sumatriptan to treat these patients (level B recommendation). Dexamethasone should be offered to these patients to prevent recurrence of headache (level B). Opioids (injectable morphine and hydromorphone) should be avoided. [140, 141]

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