Migraine treatment

According to latest NICE guidelines, it’s now worth trying combination treatment (triptan + NSAID or paracetamol) as first-line, as found to be effective.
For prophylaxis, as per NICE:

  • First-line: Propranolol or topiramate
  • Second-line: Gabapentin (up to 1200 mg/day) or acupuncture (10 sessions over 5 – 8 weeks)

CMAJ paper has slightly different advice:

  • First-line: Propranolol, amitriptyline, or nadolol (sometimes more effective than propranolol)
  • Second-line: Topiramate, gabapentin, venlafaxine, lisinopril, or candesartan
  • Third-line: Pizotifen (quite marked sedation/weight gain SEs)

Alternative medicine prophylactics with some evidence from RCTs:

  • Acupuncture (see above)
  • Magnesium citrate 600 mg od (the only prophylactic with Cat A evidence of safety in pregnancy)
  • Riboflavin 400 mg od
  • Coenzyme Q10 300 mg od

Note that feverfew, although commonly recommended, does not appear effective.

Menstrual-related migraine: consider zolmitriptan 2.5 mg bd or tds, or frovatriptan 2.5 mg bd, prophylactically on days when migraine is expected (but note high cost).

(Pulse on-line learning module)

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About Dr Sarah

I'm a GP with a husband and two young children.
This entry was posted in Alternative medicine, Migraine, Neurology. Bookmark the permalink.

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