New Migraine Prevention Guidelines

According to the journal, Neurology, some over-the-counter meds, such as ibuprofen & naproxen may prevent migraines.

The guidelines also recommend spikey plant petasites, also known as butterbur, beta-blockers and some prescription drugs for migraine prevention.

Dr. Stewart Tepper treats migraine headaches at Cleveland Clinic.

“This is an easy way for a doctor or care provider to look at what is likely to work and on what basis is that drug likely to work.”

Dr. Tepper recommends you seek out a board certified headache medicine specialist if nothing works.

MIGRAINE SYMPTOMS

By Mayo Clinic staff

Migraine headaches often begin in childhood, adolescence or early adulthood. Migraines may progress through four stages — prodrome, aura, attack and postdrome — though you may not experience all the stages.

Prodrome
One or two days before a migraine, you may notice subtle changes that may signify an oncoming migraine, including:

  • Constipation
  • Depression
  • Diarrhea
  • Food cravings
  • Hyperactivity
  • Irritability
  • Neck stiffness

Aura
Most people experience migraine headaches without aura. Auras are usually visual but can also be sensory, motor or verbal disturbances. Each of these symptoms typically begins gradually, builds up over several minutes, then commonly lasts for 10 to 30 minutes. Examples of aura include:

  • Visual phenomena, such as seeing various shapes, bright spots or flashes of light
  • Vision loss
  • Pins and needles sensations in an arm or leg
  • Speech or language problems

Less commonly, an aura may be associated with aphasia or limb weakness (hemiplegic migraine).

Attack
When untreated, a migraine typically lasts from four to 72 hours, but the frequency with which headaches occur varies from person to person. You may have migraines several times a month or much less frequently. During a migraine, you may experience some of the following symptoms:

  • Pain on one side of your head
  • Pain that has a pulsating, throbbing quality
  • Sensitivity to light, sounds and sometimes smells
  • Nausea and vomiting
  • Blurred vision
  • Diarrhea
  • Lightheadedness, sometimes followed by fainting

Postdrome
The final phase — known as postdrome — occurs after a migraine attack, when you may feel drained and washed out, though some people report feeling mildly euphoric.

When to see a doctor
Migraine headaches are often undiagnosed and untreated. If you regularly experience signs and symptoms of migraine attacks, keep a record of your attacks and how you treated them. Then make an appointment with your doctor to discuss your headaches and decide on a treatment plan.

Even if you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different.

See your doctor immediately or go to the emergency room if you have any of the following signs and symptoms, which may indicate other, more serious medical problems:

  • An abrupt, severe headache like a thunderclap
  • Headache with fever, stiff neck, rash, mental confusion, seizures, double vision, weakness, numbness or trouble speaking
  • Headache after a head injury, especially if the headache gets worse
  • A chronic headache that is worse after coughing, exertion, straining or a sudden movement
  • New headache pain if you’re older than 50

New Guidelines: Treatments Can Help Prevent Migraine

NEW ORLEANS – Research shows that many treatments can help prevent migraine in certain people, yet few people with migraine who are candidates for these preventive treatments actually use them, according to new guidelines issued by the American Academy of Neurology. The guidelines, which were co-developed with the American Headache Society, were announced at the American Academy of Neurology’s 64th Annual Meeting in New Orleans and published in the April 24, 2012, print issue of Neurology®, the medical journal of the American Academy of Neurology.

“Studies show that migraine is underrecognized and undertreated,” said guideline author Stephen D. Silberstein, MD, FACP, FAHS, of Jefferson Headache Center at Thomas Jefferson University in Philadelphia and a Fellow of the American Academy of Neurology.

“About 38 percent of people who suffer from migraine could benefit from preventive treatments, but only less than a third of these people currently use them.”

Unlike acute treatments, which are used to relieve the pain and associated symptoms of a migraine attack when it occurs, preventive treatments usually are taken every day to prevent attacks from occurring as often and to lessen their severity and duration when they do occur.

“Some studies show that migraine attacks can be reduced by more than half with preventive treatments,” Silberstein said.

The guidelines, which reviewed all available evidence on migraine prevention, found that among prescription drugs, the seizure drugs divalproex sodium, sodium valproate and topiramate, along with the beta-blockers metoprolol, propranolol and timolol, are effective for migraine prevention and should be offered to people with migraine to reduce the frequency and severity of attacks. The seizure drug lamotrigine was found to be ineffective in preventing migraine.

The guidelines also reviewed over-the-counter treatments and complementary treatments. The guideline found that the herbal preparation Petasites, also known as butterbur, is effective in preventing migraine. Other treatments that were found to be probably effective are the nonsteroidal anti-inflammatory drugs fenoprofen, ibuprofen, ketoprofen, naproxen and naproxen sodium, subcutaneous histamine and complementary treatments magnesium, MIG-99 (feverfew) and riboflavin.

Silberstein noted that while people do not need a prescription from a physician for these over-the-counter and complementary treatments, they should still see their doctor regularly for follow-up.

“Migraines can get better or worse over time, and people should discuss these changes in the pattern of attacks with their doctors and see whether they need to adjust their dose or even stop their medication or switch to a different medication,” said Silberstein.

“In addition, people need to keep in mind that all drugs, including over-the-counter drugs and complementary treatments, can have side effects or interact with other medications, which should be monitored.”

-more-Learn more about the guideline’s recommendations at http://www.aan.com/guidelines.

The American Academy of Neurology, an association of more than 25,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as stroke, Alzheimer’s disease, epilepsy, Parkinson’s disease and multiple sclerosis.

The American Headache Society® (AHS) is a professional society of health care providers dedicated to the study and treatment of headache and face pain. The Society’s objectives are to promote the exchange of information and ideas concerning the causes and treatments of headache and related painful disorders. Educating physicians, health professionals and the public and encouraging scientific research are the primary functions of this organization. AHS activities include an annual scientific meeting,

a comprehensive headache symposium, regional symposia for neurologists and family practice physicians, publication of the journal Headache and sponsorship of the AHS Committee for Headache Education (ACHE). http://www.americanheadachesociety.org

For more information about the American Academy of Neurology, visit http://www.aan.com or find us on Facebook, Twitter, Google+ and YouTube.

__________________________________________________________________________________________

SPECIAL ARTICLE

Evidence-based guideline update: Pharmacologic

treatment for episodic migraine prevention

in adults

Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society

ABSTRACT

Objective: To provide updated evidence-based recommendations for the preventive treatment of migraine headache. The clinical question addressed was: What pharmacologic therapies are proven effective for migraine prevention?

Methods: The authors analyzed published studies from June 1999 to May 2009 using a struc- tured review process to classify the evidence relative to the efficacy of various medications avail- able in the United States for migraine prevention.

Results and Recommendations: The author panel reviewed 284 abstracts, which ultimately yielded 29 Class I or Class II articles that are reviewed herein. Divalproex sodium, sodium val- proate, topiramate, metoprolol, propranolol, and timolol are effective for migraine prevention and should be offered to patients with migraine to reduce migraine attack frequency and severity (Level A). Frovatriptan is effective for prevention of menstrual migraine (Level A). Lamotrigine is ineffective for migraine prevention (Level A). Neurology® 2012;78:1337–1345

7 thoughts on “New Migraine Prevention Guidelines

  1. I’m on a regimen of Propananol,magnesium,and when needed,Imitrex! I’ve had migraines that have lasted weeks,and have cause me nausia,led into vomiting,and dry heaves! I’ve gone to ER’s because I can’t even keep water down,and was hooked up to an IV,cause I was severly dehydrated,,,,I’ve suffered from migraines since ’82,after my second born child!

  2. What is the mechanism of action of beta-blocker in migraine treatment??…..let me know, plz. Hopefully, this is one of the best source of information of Migraine treatment!

  3. So much great information on this post. I’ve suffered from migraines since I was 8 – I remember the first like it was yesterday. I’ve found that the best treatment has been diet modification. I also think it bears suggesting to everyone who suffers from chronic migraines that they get some scans done – I learned only recently that my septum was severely deviated and my sinus cavities had suffered chronic sinusitis. I had surgery to correct and so far I’ve had only 1 migraine in 30 days – that’s practically a miracle for me!

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