The role of prevention.
Daily migraine medication prevention is indicated when migraine frequency and disability are high. Drug selection is predicated on comorbidity in order to treat multiple disorders at the same time, and using the highest level of evidence possible. Treatment is initiated at a low dose, working up to an effective dose, and maintained for at least 2-3 months, with headache diary monitoring for outcome. Poor outcome is associated with picking the wrong drug, an excessive initial dose, an inadequate final dose, too short a duration of treatment, or unrealistic expectations. The best evidence for preventive medications exists for amitriptyline, propranolol, timolol, valproate, and topiramate.
Tepper
Stewart J
SJ
Cleveland Clinic Lerner College of Medicine, Department of Neurology, Headache Center, Cleveland Clinic, Cleveland, OH 44195, USA. teppers@ccf.org
D000639:Amitriptyline; D006261:Headache / Q000188:drug therapy; D006801:Humans; D008881:Migraine Disorders
D000639:Amitriptyline