MIGRAINE-PROPHYLAXIS DRUGS

SUMMARY

1. Beta-blockers: Propranolol and timolol are FDA-approved for migraine, but alsoatenolol, metoprolol.

2. Tricyclic antidepressants: amitriptyline; side effects = oversedation, dry mouth, palpitations, orthostasis, blurry vision, weight gain, constipation, and short-term memory impairment or confusion especially in the elderly, or those with baseline cognitive impairment.

3. Tetracyclic antidepressants, AKA noradrenergic and specific serotonergic antidepressants (NaSSA) (e.g., mirtazapine), and mixed serotonin-norepinephrine reuptake inhibitors (SNRIs) (e.g., venlafaxine, duloxetine).

4. Anticonvulsants (valproate, topiramate).
5. Calcium channel blockers (verapamil, nimodipine) may develop tolerance.
6. ACE inhibitors and ARBs (lisinopril and candesartan).
7. NSAIDs.
8. Botulinum toxin injection (Botox®) was approved by the FDA in 2010 for refractory chronic migraine

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].