New guidelines on preventing migraine headaches
American Headache Society Meeting, Boston June 27th 2008
Dr Stephen Silberstein, Thomas Jeffereson University, Philadelphia, presented the latest review of migraine prevention. He is part of a team, working in conjunction with the American Association of Neurology, to produce practice guidelines for neurologists and other physicians who treat migraine.
There are some new additions since the last guidance in 2000. Most notable is the inclusion of topiramate as a group 1, recommended, prevention. The full list of recommended prevention is:
- Topiramate
- Divalproate sodium
- Sodium valproate
- Amitryptiline
- Metoprolol
- Propranolol
- Timolol
- Petasites
If you are experiencing more than one migraine per week and have reached the point of requiring a preventative treatment, these should be tried first. The actual choice will depend on who you are and your medical history. Women planning a pregnancy are adised to avoid valproate or topiramate, people with asthma should avoid propranolol, timolol and metoprolol etc.
It is not clear when the updated guidelines will be published, but they usually appear at AAN homepage