The AAN Migraine Report

Migraines can be extremely difficult to treat and their physiologic etiology remains unknown.  Many patients suffer from migraines quite often (10 times or more a month).  Here’s the latest direction, evidence based, for choosing migraine medications.

In the April 24^th issue of Neurology, two new reviews were released by the American Academy of Neurology (AAN) regarding the treatment of episodic migraines.  The first reviewed the evidence for prescription strength medications and the second reviewed the use of non-steroidal anti-inflammatory meds as well as complementary medications.  

There were seven medications that were considered effective (meaning they had to have at least 2 trials that were randomized and considered high quality, and found to have a statistically significant improvement in symptoms).  These meds included:

Depakote  (AED)
Depacon  (AED)
Topamax (AED)
Metoprolol (B-blocker)
Propranolol (B-Blocker)
Timolol (B-blocker)
Frovatriptan (triptan)

These medications include three anti-epileptic meds (AEDs), three beta blockers and one triptan.  Interestingly, Gabapentin and verapamil used to be considered first line agents but they have been downgraded as studies have not proven their effectiveness.

For the second review, only one treatment option was found to warrant approval.  This is Petasites, also known as butterbur.  It is a plant in the daisy family. 

There are many other treatment options, but currently only these 8 items have the evidence to support their recommendation for first line use.  Of course, other options can and should be looked at when these items do not work or are not appropriate for one reason or another, including Botox^®, ibuprofen, naproxen, and verapamil, just to name a few.