Treatment
Table 1. Classification of Migraine Preventive Therapies (available in the United States)
Level A: Established efficacy
• Divalproex sodiuma (Depakote®
• Sodium valproate • Topiramatea (Topamax®
(50–200 mg/d) ) Antidepressants TCA / SSRI / SNRI
• Amitriptyline • Venlafaxine
Beta-blockers
• Metoprolol (200 mg/d)
• Timolola (Blocadren®
(80 mg/d) ) NSAIDs
• Fenoprofen • Ibuprofen • Ketoprofen • Naproxen • Naproxen sodium
• Naratriptan (1 mg bid)
• Zolmitriptan (2.5 bid/tid)
Others
Histamines • Histamine subcut ACE inhibitors/ARB
• Candesartan • Lisinopril
Alpha-agonists • Clonidine • Guanfacine
Antihistamines • Cyproheptadine (4 mg/d)
Antithrombotics • Acenocoumarol • Coumadin • Picotamide
Ca++ Blockers • Nicardipine • Nifedipine • Nimodipine • Verapamil
Other • Acetazolamide • Cyclandelate • Hyperbaric oxygen
• Flurbiprofen • Mefenamic acid
Triptans (For short-term prophylaxis of menstrually related migraine) Frovatriptan
• Aspirin • Indomethacin
• Propranolola (Inderal®
)
• Atenolol • Nadolol
• Nebivolol • Pindolol
• Bisoprolol
• Fluoxetine (20 mg/d)
• Fluvoxamine • Protriptyline
Level B: Probably effective
Antiepileptic drugs (AEDs) )
Level C: Possibly effective
• Carbamazepine
Level U: Inadequate or conflicting data
• Gabapentin (4-week titration phase to 2,400 mg/d)
