Drugs Used in Prevention of Migraine

There are several drugs that can be used for prophylaxis of migraine headache. Some of the drugs which have efficacy as a preventive agent for migraine but have considerable side effects and are not commonly used. Many of the drugs with efficacy as preventive agent in migraine are not approved by the FDA and some are approved by FDA for prophylaxis of migraine (local rules should always be sought before prescribing a drug for prophylaxis of migraine). Some drugs are not available in some countries and availability is an important factor.

FDA has approved propranolol, timolol, sodium valproate, and topiramate for prophylactic treatment of migraine. Methysergide is also approved by FDA for prophylaxis of migraine, but not available in the United States. There are also many more drugs which shows efficacy in prevention of migraine but not approved by FDA for prophylaxis of migraine.

The following drugs can stabilize migraine and can be used for prophylaxis of migraine, dosage and side effects given in bracket:

  • Propranolol a beta blocker (40–120 mg twice a day. Side effects are tiredness, weakness, aggravation of symptoms in asthma and contraindicated in asthma).
  • Sodium valproate an anti-convulsant (400–600 mg twice a day. Side effects are weight gain, drowsiness, liver abnormalities, alopecia, tremor etc. Should not be used during pregnancy as it can cause fetal abnormalities).
  • Topiramate an anti-convulsant (25–200 mg per day. Side effects are weight loss, cognitive problems, numbness, glaucoma).
  • Methysergide (1-4 mg once a day. Side effects are drowsiness, alopecia; leg cramps, retroperitoneal fibrosis and one moth gap should be given every 6 months to prevent this).
  • Amitriptyline a tricyclic antidepressant (10-75 mg at bed time. Side effect is drowsiness).
  • Pizotifen (0.5-2 mg once a day. Side effects are drowsiness and weight gain).

There are other drugs which are also in use for prophylaxis of migraine such as tricyclic antidepressants (Nortriptyline, Dothiepin), gabapentin, Flunarizine etc. These drugs have similar side effects profile as their parent groups and are equally effective in prophylaxis of migraine.