Migraine by Woshibai

Medications such as amitriptyline, venlafaxine, atenolol, and nadolol are probably effective but should be second-line therapy. First-line medications established as effective based on clinical evidence include divalproex, topiramate, metoprolol, propranolol, and timolol. Identifying and managing environmental, dietary, and behavioral triggers are useful strategies for preventing migraines. Some indications for preventive therapy include four or more headaches a month, eight or more headache days a month, debilitating headaches, and medication-overuse headaches. Preventive therapy may also improve quality of life and prevent the progression to chronic migraines.

Preventive medication therapy reduces migraine frequency, severity, and headache-related distress. Approximately 38% of patients with episodic migraines would benefit from preventive therapy, but less than 13% take prophylactic medications.

Migraines impose significant health and financial burdens.