Traditional migraine symptoms are well known---one-sided head pain, light sensitivity and, possibly, visual or hearing changes (called auras). Migraines occur repeatedly and can last for hours to days. Triggers include hormone levels associated with the menstrual cycle; foods (often specific to the patient) such as salt, sugar and caffeine; and environmental changes like excessive light, stress or sleep changes. Because migraines can occur suddenly and often, preventive treatments are warranted for some patients.
Beta Blockers
Beta blockers like propranolol or timolol, although used most often for blood pressure treatment, is a first-choice option to control migraine pain; propranolol is approved by the Food and Drug Administration (FDA) as a migraine prevention treatment. One primary method of action for beta blockers is to block dilation of blood vessels; blood vessel changes are considered one possible cause of one-sided migraine pain. However, prostaglandin and serotonin effects are possible methods as well. Doses of propranolol ranging from 80 mg to 240 mg in three or four divided doses each day can be tapered to provide headache prevention with the fewest side effects. Common side effects are related to beta blocker cardiac effects and include low blood pressure and dizziness as well as sleep trouble or tiredness; stomach upset is also common.
Anticonvulsants
Anticonvulsants are antiseizure medications that are often used off label (without FDA approval) to control frequent migraines, especially those occurring more than 2 times a week. Because older anticonvulsants like phenobarbital are associated with numerous side effects, newer drugs like valproic acid (formulated as Depakote medications), gabapentin and topiramate are being studied for migraines in the 21st century. As of April 2010, Depakote formulations have the most research data to support effective migraine reduction, by approximately 50 percent or more with continued use of at least 3 months (according to Dr. Alan M. Rapaport of the New England Center for Headache). Conversely, gabapentin, topiramate and other 21st-century anticonvulsant treatments need additional research before safe use outweighs risks. Some side effects of any anticonsulvants studied for migraine prevention are nausea, tremor, hair loss and excessive sleepiness.
Antidepressants
Antidepressant options are myriad, as are their uses. There are antidepressant medicines that affect every nervous system chemical, such as norepinephrine, serotonin and dopamine. Although the role of these chemicals in migraines is unclear even in 2010, definite benefit from antidepressants has been seen for migraine prevention. In 2009, S. Tarlaci reviewed antidepressant options for migraine prevention and noted that newer agents venlafaxine and escitalopram appear most effective at decreasing migraine numbers, severity and duration. Venlafaxine (Effexor) was more effective but is associated with greater side effects, like blurry vision and anxiety. Escitalopram (Celexa), conversely, may cause no side effects or only mild ones like dizziness or dry mouth.
References
- MayoClinic.com: Migraine Causes
- Mulleners WM, Chronicle EP. Anticonvulsants in migraine Prophylaxis: A Cochrane Review. Cephalalgia. June 2008, pp 585-597
- Neurology Reviews: Are Anticonvulsants Appropriate for Migraine Prevention? May 2000
- Tarlaci S. Escitalopram and venlafaxine for the prophylaxis of migraine headache without mood disorders. Clin Neuropharmacol. September-October 2009, pp 254-258
- S. Evers.Treatment of migraine with prophylactic drugs. Expert Opin Pharmacother. October 2008, pp 2565-2573
