Fast Five Quiz: Chronic Migraine Prevention

Stephanie J. Nahas, MD, MSEd; Helmi L. Lutsep, MD


February 04, 2022

As with abortive medications, the choice of a preventive medication for patients with chronic migraine must include consideration of comorbid conditions and the side-effect profile. Beta-blockers are among the first-line agents for migraine prophylaxis, and two are approved by the US Food and Drug Administration (FDA) for migraine prevention (propranolol and timolol). However, beta-blockers should not be used as a first-line agent for patients over 60 years who smoke. Other first-line agents include tricyclic antidepressants (not FDA-approved) and two anticonvulsants, divalproex sodium and topiramate (both FDA-approved). The only therapy FDA-approved specifically for prevention of chronic migraine is onabotulinumtoxinA.

Learn more about the management of chronic migraine.


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