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{| style="border: 2px solid #696969;" align="center"
{| style="border: 2px solid #696969;" align="center"
|+ <SMALL>''Classification, Dosage, and Side-Effects of Migraine Preventive Therapies.''<ref name="Silberstein-2012">{{Cite journal  | last1 = Silberstein | first1 = SD. | last2 = Holland | first2 = S. | last3 = Freitag | first3 = F. | last4 = Dodick | first4 = DW. | last5 = Argoff | first5 = C. | last6 = Ashman | first6 = E. | title = 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. | journal = Neurology | volume = 78 | issue = 17 | pages = 1337-45 | month = Apr | year = 2012 | doi = 10.1212/WNL.0b013e3182535d20 | PMID = 22529202 }}</ref><ref name="Goadsby-2010">{{Cite journal  | last1 = Goadsby | first1 = PJ. | last2 = Sprenger | first2 = T. | title = Current practice and future directions in the prevention and acute management of migraine. | journal = Lancet Neurol | volume = 9 | issue = 3 | pages = 285-98 | month = Mar | year = 2010 | doi = 10.1016/S1474-4422(10)70005-3 | PMID = 20170842 }}</ref></SMALL>
|+ <SMALL>''Classification, Dosage, and Side-Effects of Migraine Preventive Therapies.''<ref name="Silberstein-2012">{{Cite journal  | last1 = Silberstein | first1 = SD. | last2 = Holland | first2 = S. | last3 = Freitag | first3 = F. | last4 = Dodick | first4 = DW. | last5 = Argoff | first5 = C. | last6 = Ashman | first6 = E. | title = 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. | journal = Neurology | volume = 78 | issue = 17 | pages = 1337-45 | month = Apr | year = 2012 | doi = 10.1212/WNL.0b013e3182535d20 | PMID = 22529202 }}</ref><ref name="Goadsby-2010">{{Cite journal  | last1 = Goadsby | first1 = PJ. | last2 = Sprenger | first2 = T. | title = Current practice and future directions in the prevention and acute management of migraine. | journal = Lancet Neurol | volume = 9 | issue = 3 | pages = 285-98 | month = Mar | year = 2010 | doi = 10.1016/S1474-4422(10)70005-3 | PMID = 20170842 }}</ref></SMALL>
| style="background: #A5B2D6; border: 0px solid #696969; padding: 0 5px; width: 20px" | 123
| style="background: #A5B2D6; border: 0px solid #696969; padding: 0 5px; width: 10%" | '''Evidence'''
| style="background: #A5B2D6; border: 0px solid #696969; padding: 0 5px; width: 100px" | '''Migraine Prophylactics'''
| style="background: #A5B2D6; border: 0px solid #696969; padding: 0 5px; width: 15%" | '''Agent'''
 
| style="background: #A5B2D6; border: 0px solid #696969; padding: 0 5px; width: 15%" | '''Dosage'''
| style="background: #A5B2D6; border: 0px solid #696969; padding: 0 5px; width: 100px" | '''Dosage'''
| style="background: #A5B2D6; border: 0px solid #696969; padding: 0 5px; width: 60%" | '''Potential Side-Effects'''
 
| style="background: #A5B2D6; border: 0px solid #696969; padding: 0 5px; width: 400px" | '''Potential Side-Effects'''
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left rowspan=10 valign=top | '''Level A''' <BR> <SMALL> Medications with established efficacy (>2 Class I trials) </SMALL>
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=center rowspan="10" |'''Level A''' <BR> <SMALL> Medications with <BR> established efficacy <BR> (>2 Class I trials) </SMALL>
 
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left colspan="3" | '''Antiepileptic Drugs'''
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left colspan=3 | '''Antiepileptic drugs'''
 
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Divalproex sodium]]'''''
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Divalproex sodium]]'''''
 
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''250 mg twice daily'''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''400–600 mg twice daily'''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | Drowsiness, weight gain, tremor, hair loss, fetal abnormalities, hematological or liver abnormalities
 
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left colspan=2 | '''Drowsiness, weight gain, tremor, hair loss, fetal abnormalities, hematological or liver abnormalities'''
 
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Sodium valproate]]'''''
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Sodium valproate]]'''''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''400–600 mg twice daily'''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''400–600 mg twice daily'''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | Drowsiness, weight gain, tremor, hair loss, fetal abnormalities, hematological or liver abnormalities
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Topiramate]]'''''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''50–200 mg daily'''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | Paresthesia, cognitive dysfunction, weight loss, care with a family history of glaucoma, nephrolithiasis
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left colspan="3" | '''Beta Blockers'''
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Metoprolol]]'''''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''25–100 mg twice daily'''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | Reduced energy, tiredness, postural symptoms; contraindicated in asthma
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Propranolol]]'''''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''40–120 mg twice daily'''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | Paresthesias, sleepiness, gastrointestinal intolerance
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Timolol]]'''''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''10 mg twice daily'''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | Reduced energy, tiredness, postural symptoms; contraindicated in asthma
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left colspan="3" | '''Triptans''' <SMALL> (short-term prophylaxis of menstrually-related migraine) </SMALL>
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Frovatriptan]]'''''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''2.5 mg twice daily'''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | Coronary artery vasospasm, transient myocardial ischemia, myocardial infarction, arrhythmia
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=center rowspan="9" | '''Level B''' <BR> <SMALL> Medications are <BR> probably effective <BR> (1 Class I or <BR> 2 Class II studies) </SMALL>
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left colspan="3" | '''Antidepressants/SSRI/SSNRI/TCA'''
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Amitriptyline]]'''''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''25–75 mg every night'''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | Nausea, vomiting, drowsiness, hypersomnolence, dry mouth, concentration difficulties
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Venlafaxine]]'''''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''75–150 mg daily'''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | Nausea, vomiting, drowsiness
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left colspan="3" | '''Beta Blockers'''
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Atenolol]]'''''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''50 mg daily'''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | Reduced energy, tiredness, postural symptoms; contraindicated in asthma
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Nadolol]]'''''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''80–240 mg daily'''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | Reduced energy, tiredness, postural symptoms; contraindicated in asthma
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left colspan="3" | '''Triptans''' <SMALL> (short-term prophylaxis of menstrually-related migraine) </SMALL>
|-
|-
 
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Naratriptan]]'''''
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Divalproex sodium]]'''''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''1 mg twice daily'''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''250 mg twice daily'''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | Dizziness, chest pain, malaise
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''Drowsiness, weight gain, tremor, hair loss, fetal abnormalities, hematological or liver abnormalities'''
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Zolmitriptan]]'''''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''2.5 mg twice daily'''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | Asthenia, headache, dizziness, nausea
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=center rowspan="14" |'''Level C''' <BR> <SMALL> Medications are <BR> possibly effective <BR> (1 Class II study)</SMALL>
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left colspan="3" | '''ACE Inhibitors'''
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Lisinopril]]'''''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''20 mg daily'''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | Cough, dizziness
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left colspan="3" | '''Angiotensin Receptor Blockers'''
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Candesartan]]'''''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''16 mg daily'''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | Birth defects and fetal death
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left colspan="3" | '''Alpha Agonists'''
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Guanfacine]]'''''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''1 mg daily'''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | Dizziness, drowsiness, headache, constipation, diarrhea, loss of appetite, fatigue, nasal congestion
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left colspan="3" | '''Antiepileptic Drugs'''
|-
|-
 
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Carbamazepine]]'''''
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Tobramycin]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''5—20 mg'''''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''200 mg daily'''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | Drowsiness, motor coordination impairment, upset stomach
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Amikacin]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''5—50 mg'''''
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left colspan="3" | '''Beta Blockers'''
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Polymyxin B]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''5 mg'''''
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Nebivolol]]'''''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''5 mg daily'''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | Fatigue, clinical depression, bradycardia, impotence
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Colistin]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''10 mg'''''
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left colspan="3" | '''Antihistamines'''
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Quinupristin dalfopristin|Quinupristin/Dalfopristin]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''2—5 mg'''''
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Cyproheptadine]]'''''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''4 mg twice daily'''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | Increased appetite, weight gain, abdominal discomfort, diarrhea, nausea, vomiting, xerostomia, depression, somnolence
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Teicoplanin]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''5—40 mg'''''
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left colspan="3" | '''Calcium Channel Blockers'''
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Amphotericin B]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''0.1—0.5 mg/day'''''
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Nicardipine]]'''''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''20 mg twice daily'''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | Headache, upset stomach, dizziness, fatigue, numbness, palpitations, constipation, heartburn
|-
|-
|}
|}

Latest revision as of 04:08, 21 February 2014

Classification, Dosage, and Side-Effects of Migraine Preventive Therapies.[1][2]
Evidence Agent Dosage Potential Side-Effects
Level A
Medications with
established efficacy
(>2 Class I trials) 		Antiepileptic Drugs
▸ Divalproex sodium 250 mg twice daily Drowsiness, weight gain, tremor, hair loss, fetal abnormalities, hematological or liver abnormalities
▸ Sodium valproate 400–600 mg twice daily Drowsiness, weight gain, tremor, hair loss, fetal abnormalities, hematological or liver abnormalities
▸ Topiramate 50–200 mg daily Paresthesia, cognitive dysfunction, weight loss, care with a family history of glaucoma, nephrolithiasis
Beta Blockers
▸ Metoprolol 25–100 mg twice daily Reduced energy, tiredness, postural symptoms; contraindicated in asthma
▸ Propranolol 40–120 mg twice daily Paresthesias, sleepiness, gastrointestinal intolerance
▸ Timolol 10 mg twice daily Reduced energy, tiredness, postural symptoms; contraindicated in asthma
Triptans (short-term prophylaxis of menstrually-related migraine)
▸ Frovatriptan 2.5 mg twice daily Coronary artery vasospasm, transient myocardial ischemia, myocardial infarction, arrhythmia
Level B
Medications are
probably effective
(1 Class I or
2 Class II studies) 		Antidepressants/SSRI/SSNRI/TCA
▸ Amitriptyline 25–75 mg every night Nausea, vomiting, drowsiness, hypersomnolence, dry mouth, concentration difficulties
▸ Venlafaxine 75–150 mg daily Nausea, vomiting, drowsiness
Beta Blockers
▸ Atenolol 50 mg daily Reduced energy, tiredness, postural symptoms; contraindicated in asthma
▸ Nadolol 80–240 mg daily Reduced energy, tiredness, postural symptoms; contraindicated in asthma
Triptans (short-term prophylaxis of menstrually-related migraine)
▸ Naratriptan 1 mg twice daily Dizziness, chest pain, malaise
▸ Zolmitriptan 2.5 mg twice daily Asthenia, headache, dizziness, nausea
Level C
Medications are
possibly effective
(1 Class II study) 		ACE Inhibitors
▸ Lisinopril 20 mg daily Cough, dizziness
Angiotensin Receptor Blockers
▸ Candesartan 16 mg daily Birth defects and fetal death
Alpha Agonists
▸ Guanfacine 1 mg daily Dizziness, drowsiness, headache, constipation, diarrhea, loss of appetite, fatigue, nasal congestion
Antiepileptic Drugs
▸ Carbamazepine 200 mg daily Drowsiness, motor coordination impairment, upset stomach
Beta Blockers
▸ Nebivolol 5 mg daily Fatigue, clinical depression, bradycardia, impotence
Antihistamines
▸ Cyproheptadine 4 mg twice daily Increased appetite, weight gain, abdominal discomfort, diarrhea, nausea, vomiting, xerostomia, depression, somnolence
Calcium Channel Blockers
▸ Nicardipine 20 mg twice daily Headache, upset stomach, dizziness, fatigue, numbness, palpitations, constipation, heartburn




References

  1. ↑ Silberstein, SD.; Holland, S.; Freitag, F.; Dodick, DW.; Argoff, C.; Ashman, E. (2012). "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". Neurology. 78 (17): 1337–45. doi:10.1212/WNL.0b013e3182535d20. PMID 22529202. Unknown parameter |month= ignored (help)
  2. ↑ Goadsby, PJ.; Sprenger, T. (2010). "Current practice and future directions in the prevention and acute management of migraine". Lancet Neurol. 9 (3): 285–98. doi:10.1016/S1474-4422(10)70005-3. PMID 20170842. Unknown parameter |month= ignored (help)
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