Treatment
Table 1. Classification of Migraine Preventive Therapies (available in the United States) (continued)
Level A: Established efficacy
• Petasites (butterbur) (50-75 mg bid)
Level B: Probably effective
• Magnesium • MIG-99 (feverfew) • Riboflavin
Level C: Possibly effective
Herbal preparations, vitamins, minerals, & other
• Co-Q10 100 mg tid
• Estradiol 1.5 mg (gel patch)
• Omega-3 fatty acids (3 g bid)
• Soy isoflavones (60 mg), dong quai (100 mg), and black cohosh (50 mg) (each component standardized to its primary alkaloid)
Not effective • Lamotrigine
Probably not effective Possibly not effective
• Clomipramine • Montelukast
• Acebutolol • Clonazepam • Nabumetone • Oxcarbazepine • Telmisartan (80 mg)
a
FDA approved. Please see specific product labeling for complete prescribing information including precautions and warnings.
Risks Associated with OTC/Complementary Treatments for Migraine Prevention
Medication Use
ÎPatients may not know how to take OTC/complementary treatments for migraine prevention. Instructions and dosing limitations will help ensure patients do not escalate their treatment, which may lead to medication overuse headache.
ÎPatients may also need instruction on how to specifically dose these treatments for use as migraine preventives.
Evaluation
ÎPatients may not be aware of improvement or deterioration in their headache condition if they are not tracking their attacks or being followed in a medical care setting. Patients should be encouraged to keep daily and monthly headache diaries in order to follow:
• improvements and deterioration in headache patterns • presence of adverse events and • relationship of headache to notable triggers (e.g., estrogen fluctuations with menstruation).
Patient Education
ÎPatients using OTC/complementary treatments for migraine prevention will need specific instructions on how to manage a chronic illness such as migraine.
Level U: Inadequate or conflicting data
