Which medication should be avoided when your patient has an acute migraine? Which drugs should you prescribe for menstrual-associated migraine prevention? Take the quiz and learn more.
According to 2016 guidelines by the American Academy of Neurology, about 1.2 million Americans present to the emergency department each year for acute migraine. Recommended therapy for these patients include intravenous metoclopramide, intravenous prochlorperazine, and subcutaneous sumatriptan. However, evidence suggests that subcutaneous and intravenous octreotide may be ineffective and is associated with increased local reactions and diarrhea. The AAN advises avoidance of octreotide in these patients.
According to 2012 guidelines by the AAN (reaffirmed in 2015), the following drugs have Level A evidence and should be offered for the prevention of episodic migraine in adults: divalproex sodium, sodium valproate, topiramate, metoprolol, propranolol, timolol, and frovatriptan for short-term menstrual-associated migraine prevention. Lamotrigine is established as ineffective and should not be considered for migraine prevention (Level A negative). Clomipramine is probably ineffective and should not be considered for migraine prevention (Level B negative). The following drugs have Level C negative evidence and should probably not be considered for migraine prevention: acebutolol, clonazepam, nabumetone, oxcarbazepine, and telmisartan.
According to 2016 guidelines from the AAN, Botox (OnabotulinumtoxinA, or OnaBoNT-A), strong Level A evidence supports the use of Botox in treating chronic migraine, and the drug should be offered to increase the number of headache-free days in these patients. Strong, Level A evidence suggests that Botox is not effective in episodic migraine, and should not be offered as a treatment. Moderate, Level B evidence suggests that botulinum toxin is probably ineffective in treating chronic tension-type headache.
