Migraine secondary prevention: Difference between revisions
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Selecting pharmacological treatment | Selecting pharmacological treatment | ||
First-line agents | ===First-line agents=== | ||
We recommend [[amitriptyline]], [[venlafaxine]], one of the beta blockers [[propranolol]] or [[metoprolol]], [[topiramate]], or one of the [[calcitonin gene-related peptide]] (CGRP) antagonists as initial treatments for the majority of patients with episodic migraine (≤14 headache days per month) who meet the criteria for preventive therapy (see 'Indications' above). | |||
As to the American Headache Society's 2024 position statement, we list CGRP antagonists [[erenumab]], [[fremanezumab]], [[galcanezumab]], [[eptinezumab]], [[rimegepant]], and [[atogepant]] as first-line alternatives.<ref name="PMID:38466028">{{cite journal |vauthors=Charles AC I |title=Calcitonin gene-related peptide-targeting therapies are a first-line option for the prevention of migraine: An American Headache Society position statement update year=2024 |pmid=38466028 | doi: 10.1111/head.14692. Epub 2024 Mar 11 |url=}}</ref>. Numerous clinical trials, meta-analyses, and postapproval open-label cohort studies have demonstrated the effectiveness, safety, and tolerability of these medications.<ref name="PMID: 36063264">{{cite journal |vauthors=Murray AM I |title=Real-World Patient Experience of CGRP-Targeting Therapy for Migraine: a Narrative Review |pmid=38466028 | doi: 10.1007/s11916-022-01077-z. Epub 2022 Sep 5.|url=}}</ref><ref name="PMID: 36855951">{{cite journal |vauthors=Haghdoost F I |title=Evaluating the efficacy of CGRP mAbs and gepants for the preventive treatment of migraine: A systematic review and network meta-analysis of phase 3 randomised controlled trials |PMID: 36855951 | doi: 10.1177/03331024231159366.|url=}}</ref> | As to the American Headache Society's 2024 position statement, we list CGRP antagonists [[erenumab]], [[fremanezumab]], [[galcanezumab]], [[eptinezumab]], [[rimegepant]], and [[atogepant]] as first-line alternatives.<ref name="PMID:38466028">{{cite journal |vauthors=Charles AC I |title=Calcitonin gene-related peptide-targeting therapies are a first-line option for the prevention of migraine: An American Headache Society position statement update year=2024 |pmid=38466028 | doi: 10.1111/head.14692. Epub 2024 Mar 11 |url=}}</ref>. Numerous clinical trials, meta-analyses, and postapproval open-label cohort studies have demonstrated the effectiveness, safety, and tolerability of these medications.<ref name="PMID: 36063264">{{cite journal |vauthors=Murray AM I |title=Real-World Patient Experience of CGRP-Targeting Therapy for Migraine: a Narrative Review |pmid=38466028 | doi: 10.1007/s11916-022-01077-z. Epub 2022 Sep 5.|url=}}</ref><ref name="PMID: 36855951">{{cite journal |vauthors=Haghdoost F I |title=Evaluating the efficacy of CGRP mAbs and gepants for the preventive treatment of migraine: A systematic review and network meta-analysis of phase 3 randomised controlled trials |PMID: 36855951 | doi: 10.1177/03331024231159366.|url=}}</ref> | ||
Second-line medications | ===Second-line medications=== | ||
In patients who do not respond well to two or more first-line medications, or who do not respond well enough to them after at least eight weeks at a therapeutic dose, we recommend using second-line medications to prevent episodic migraine. Among these are additional antihypertensives including [[gabapentin]], [[venlafaxine]], [[candesartan]], [[lisinopril]], [[verapamil]], and [[valproate]]. | |||
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The sections that follow describe our method for selecting migraine preventative therapy.
Selecting pharmacological treatment
First-line agents
We recommend amitriptyline, venlafaxine, one of the beta blockers propranolol or metoprolol, topiramate, or one of the calcitonin gene-related peptide (CGRP) antagonists as initial treatments for the majority of patients with episodic migraine (≤14 headache days per month) who meet the criteria for preventive therapy (see 'Indications' above).
As to the American Headache Society's 2024 position statement, we list CGRP antagonists erenumab, fremanezumab, galcanezumab, eptinezumab, rimegepant, and atogepant as first-line alternatives.[1]. Numerous clinical trials, meta-analyses, and postapproval open-label cohort studies have demonstrated the effectiveness, safety, and tolerability of these medications.[2][3]
Second-line medications
In patients who do not respond well to two or more first-line medications, or who do not respond well enough to them after at least eight weeks at a therapeutic dose, we recommend using second-line medications to prevent episodic migraine. Among these are additional antihypertensives including gabapentin, venlafaxine, candesartan, lisinopril, verapamil, and valproate.
References
- ↑ Charles AC I. "Calcitonin gene-related peptide-targeting therapies are a first-line option for the prevention of migraine: An American Headache Society position statement update year=2024". PMID 38466028 Check
|pmid=value (help). Text " doi: 10.1111/head.14692. Epub 2024 Mar 11 " ignored (help) - ↑ Murray AM I. "Real-World Patient Experience of CGRP-Targeting Therapy for Migraine: a Narrative Review". PMID 38466028 Check
|pmid=value (help). Text " doi: 10.1007/s11916-022-01077-z. Epub 2022 Sep 5." ignored (help) - ↑ Haghdoost F I. "Evaluating the efficacy of CGRP mAbs and gepants for the preventive treatment of migraine: A systematic review and network meta-analysis of phase 3 randomised controlled trials". Text " doi: 10.1177/03331024231159366." ignored (help); Text "PMID: 36855951 " ignored (help); Vancouver style error: name (help)