AAN issues new guidelines for migraine headaches

As many as 80% of patients who are candidates for preventive treatments for migraine headaches could be helped by these treatments, the author of new guidelines issued by the American Academy of Neurology (AAN) told Formulary.

However, the study’s author, Stephen D. Silberstein, MD, FACP, FAHS, Jefferson Headache Center at Thomas Jefferson University in Philadelphia, said that most of the patients who could benefit from the treatments recommended by the guidelines aren’t taking them.

The reasons, he said, include:

Not enough people know that their headaches would be diagnosed as migraines.

Patients are not aware of the treatments that are available.

Patients have taken the wrong dosing previously and either the treatment worked too slowly or they suffered side effects.

The guidelines on migraine treatments were announced at the AAN’s annual meeting in New Orleans and were published in the April 24 print issue of Neurology.

Researchers reviewed all available evidence on migraine prevention, according to a news release. They found that the following prescription drugs are effective for migraine prevention:

Seizure drugs divalproex sodium, sodium valproate, and topiramate.

Beta-blockers metoprolol, propranolol, and timolol.

The most effective over-the-counter (OTC) treatment is the herbal preparation Petasites, also known as butterbur. Other OTC treatments that were found to be likely effective are the nonsteroidal anti-inflammatory drugs fenoprofen, ibuprofen, ketoprofen, naproxen and naproxen sodium, subcutaneous histamine as well as the complementary treatments magnesium, MIG-99 (feverfew), and riboflavin.

Patients using the OTC and complementary treatments should still see their physicians for follow-ups, Dr Silberstein said.

“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,” Dr Silberstein said in the news release.