NEW ORLEANS—An estimated 12% of the worldwide population experiences migraines. Of these people, about 38% are candidates for preventative treatment, yet less than a third of these migraineurs actually use preventive drugs, according to new guidelines. The new guidelines, codeveloped by the American Academy of Neurology (AAN) and the American Headache Society (AHS), were announced at the 64th Annual Meeting of the AAN and will be published in the April 24, 2012, print issue of Neurology.
“Studies show that migraine is underrecognized and undertreated,” said guideline author Stephen D. Silberstein, MD, of Jefferson Headache Center at Thomas Jefferson University in Philadelphia. According to Dr. Silberstein, candidates for migraine prevention include the following people:
• Patients with frequent attacks, which are a risk factor for developing chronic migraine;
• Patients who overuse acute medication, which leads to medication overuse headache;
• Patients for whom acute medications do not work or are not tolerable, or for whom headaches keep coming back.
The new guidelines are the result of systematic literature reviews that examined the available evidence for episodic migraine prevention. “The guidelines consider how good the evidence is for a drug, not whether the drug works,” Dr. Silberstein clarified. Some of the highlights of the new AAN/AHS guidelines include upgraded recommendations for topiramate, based on a review of the large controlled trial data for the drug, and downgraded recommendations for gabapentin and verapamil, based on new analyses that use rigid criteria, including the number of dropouts in clinical trials. In addition to these major changes, the guidelines conclude that the seizure drugs divalproex sodium and sodium valproate (in addition to topiramate), along with the beta-blockers metoprolol, propranolol, and timolol, are effective for migraine prevention and should be offered to patients with migraine to reduce the frequency and severity of attacks. The seizure drug lamotrigine was found to be ineffective in preventing migraine.
The guidelines also reviewed over-the-counter treatments and complementary treatments. They conclude that the herbal preparation Petasites, also known as butterbur, is effective in preventing migraine. Other treatments that were found to be probably effective are the nonsteroidal anti-inflammatory drugs fenoprofen, ibuprofen, ketoprofen, naproxen, and naproxen sodium; subcutaneous histamine; and complementary treatments such as magnesium, MIG-99 (feverfew), and riboflavin.
To view a webcast related to this news article, please click here.
Silberstein SD, Holland S, Freitag F, et al. 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. 2012;78(17):1337-1345.
Holland S, Silberstein SD, Freitag F, et al. Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012;78(17):1346-1353.