Prophylactic Therapy of Migraine
Prophylactic therapy for migraine involves using drugs to prevent attacks and reduce migraine headaches’ intensity, frequency, and duration. Migraine is one of the leading causes of disability worldwide, leading to significant healthcare expenses and lost productivity.
Despite the importance of prevention for migraine, only half of those affected by migraine take daily preventive medications to manage their attacks. If not adequately managed, migraine attacks may progress into chronic migraine and become a more complex disorder with greater difficulty managing them (Loder and Biondi 2005).
Prophylactic medication should be chosen based on the patient’s severity of migraine attacks, their frequency and response to acute treatment, as well as preferences, comorbidities, and co-morbidities. Furthermore, taking into account experience with other anti-migraine therapies when selecting a preventive medication is recommended.
Beta-blockers are commonly prescribed for migraine prophylaxis, as they help to prevent attacks by blocking the effects of epinephrine, a hormone produced when you become stressed or excited. Furthermore, these drugs relax blood vessels and slow your heart rate, making it easier for blood to circulate throughout your body.
Nonsteroidal anti-inflammatory drugs, or NSAIDs, have been demonstrated to be effective in migraine prophylaxis. They work by decreasing acetylcholine release from presynaptic nerve endings and inhibiting pain mediators like substance P and glutamate.
Angiotensin-converting enzyme inhibitors, or ACEIs, have been demonstrated to be successful in preventing migraine attacks for many patients. Studies have demonstrated they decrease vasoreactivity, alter sympathetic tone, reduce oxidative stress and destroy proinflammatory factors like substance P, enkephalin and bradykinin; furthermore they modulate the endogenous opioid system which has been found to be helpful when managing pain after migraine attacks.
Other drugs being studied for migraine prophylaxis include triptans, calcitonin gene related peptide antagonists, lasmiditan, dihydroergotamine and methylphenidate. Studies conducted on these compounds have yielded results ranging from moderate to excellent efficacy levels.
Botulinum toxin A is a neuromodulator that blocks the release of acetylcholine and other chemicals from presynaptic neurons. Studies have shown it to be an effective and safe way to prevent migraine in women who experience pure menstrual migraine, or when their headaches are triggered by specific triggers. Unfortunately, data are scarce and this procedure hasn’t yet been proven beneficial for all those suffering from migraine.
Prophylactic medications such as amitriptyline and divalproex can also be used for prophylaxis of migraines; studies have demonstrated that they provide relief in up to 50% of patients. These drugs work for both episodic and chronic migraines, and may be combined with abortive therapies when necessary.
Prophylaxis for migraine is essential, not only to reduce headache days and their intensity, but it can also improve patient quality of life. It may prevent the progression of more complex, treatment-resistant migraine disorders as well as cut down on healthcare costs and lost productivity.