Prevention has an important role in the treatment of migraines, researchers say

BMJ 2010; 340 doi: (Published 19 February 2010) Cite this as: BMJ 2010;340:c1013
  1. Barbara Kermode-Scott
  1. 1Calgary, Alberta

Prophylaxis should be considered for patients whose migraines affect their quality of life despite appropriate symptomatic treatment, or who are at risk of headache through overuse of drugs, says a Canadian systematic review of studies investigating migraine prevention. (CMAJ 2010 doi:10.1503/cmaj.081657).

The review, by researchers from the University of Calgary, looked at prospective, double blind, randomised, controlled trials of drugs commonly used in clinical practice in North America and Europe to prevent migraines. These included antiepileptics, antidepressants, antihypertensives and vitamins, minerals, and herbal agents.

The antidepressant amitriptyline and the antiepileptic topiramate were shown to be “very effective”—most people experience clinically significant improvement.

Four trials evaluated amitriptyline as prophylaxis for migraine, and all reported a beneficial effect. One trial of 100 patients found an odds ratio of 2.41 (95% confidence interval 1.07 to …

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