:: Preventive drugs ::
Following treatment of an acute migraine, it is important to consider preventive measures. Factors that prompt consideration of such measures include: 1) more than two migraines per month with disabilities lasting three or more days per month; 2) failure of acute treatments; 3) contraindications to acute treatments; 4) adverse reactions from acute treatments; 5) use of acute treatments more than twice a week; or 6) presence of uncommon symptoms such as hemiplegia, prolonged, aura, or migraine infarction.
The main goal of preventive therapy is to reduce the frequency, severity, and durations of migraines, and to increase the effectiveness of abortive therapy. Another reason is to avoid medication overuse headache (MOH), otherwise known as rebound headache, which is an extremely common problem among migraneurs. This occurs in part due to overuse of pain medications. MOH results in the development of chronic daily headache due to “transformed” migraine.
Preventive medication has to be taken on a daily basis, usually for a few weeks, before the effectiveness can be determined. Supervision by a neurologist is advisable. A large number of medications with varying modes of action can be used. Selection of a suitable medication for any particular patient is a matter of trial and error, since the effectiveness of individual medications varies widely from one patient to the next. Often preventive medications do not have to be taken indefinitely. Sometimes as little as six months of preventive therapy is enough to “break the headache cycle” and then they can be discontinued.
The most effective prescription medications include several drug classes:
- beta blockers such as propranolol and atenolol. A meta-analysis by the Cochrane Collaboration of nine randomized controlled trials or crossover studies, which together included 668 patients, found that propranolol had an “overall relative risk of response to treatment (here called the ‘responder ratio’)” was 1.94.[48]
- anticonvulsants such as valproic acid and topiramate. A meta-analysis by the Cochrane Collaboration of ten randomized controlled trials or crossover studies, which together included 1341 patients, found anticonvulsants had an “2.4 times more likely to experience a 50% or greater reduction in frequency with anticonvulsants than with placebo” and a number needed to treat of 3.8.[49] However, concerns have been raised about the marketing of gabapentin.[50]
- antidepressants include tricyclic antidepressants (TCAs) such as amitriptyline and the newer selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine. A meta-analysis by the Cochrane Collaboration found selective serotonin reuptake inhibitors are no more effective than placebo.[51] Another meta-analysis found benefit from SSRIs among patients with migraine or tension headache; however, the effect of SSRIs on only migraines was not separately reported.[52] A randomized controlled trial found that amitriptyline was better than placebo and similar to propranolol.[53]
Other drugs:
- Sansert was withdrawn from the US market by Novartis, but is available in Canadian pharmacies. Although highly effective, it has rare but serious side effects, including retroperitoneal fibrosis.
- Namenda, memantine HCI tablets, which is used in the treatment of Alzheimer’s Disease, is beginning to be used off label for the treatment of migraines. It has not yet been approved by the FDA for the treatment of migraines.
- ASA or Asprin can be taken daily in low doses such as 80 to 81 mg, the blood thinners in ASA has been shown to help some migrainures, especially those who have an aura.
Physical therapy
Many physicians believe that exercise for 15-20 minutes per day is helpful for reducing the frequency of migraines.[54]
Massage therapy and physical therapy are often very effective forms of treatment to reduce the frequency and intensity of migraines. However, it is important to be treated by a well-trained therapist who understands the pathophysiology of migraines. Deep massage can ‘trigger’ a migraine attack in a person who is not used to such treatments. It is advisable to start sessions as short in duration and then work up to longer treatments.
Frequent migraines can leave the sufferer with a stiff neck which can cause stress headaches that can then exacerbate the migraines. Claims have been made that Myofascial Release can relieve this tension and in doing so reduce or eliminate the stress headache element.
Source: http://en.wikipedia.org/wiki/Migraine
More information: www.trustedprescriptionsonline.com
