Fast Five Quiz: Chronic Migraine Prevention

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


February 04, 2022

Calcitonin gene-related peptide inhibitors, such as erenumab, fremanezumab, galcanezumab, and eptinezumab have been approved by the FDA for migraine prophylaxis. These agents may diminish migraine frequency, headache days, and acute medication usage; additionally, their reduced dosing administration (once monthly for all except eptinezumab, which is administered every 3 months; fremanezumab also has a quarterly dosing option) may help to improve adherence compared with other prophylactic agents.

Antiepileptics are effective, but adverse events lead to discontinuation in a majority of patients within 6-12 months. With topiramate, dysesthesia and cognitive slowness may occur; with divalproex sodium, adverse events may include weight gain, hair loss, and polycystic ovary disease.

In controlled clinical trials, the NSAID naproxen sodium demonstrated better efficacy than placebo and similar efficacy to propranolol. However, this agent should be reserved for short-term use, such as for menstrual migraine.

A combination of beta-blocker therapy and behavioral management may improve outcomes in patients with frequent migraine attacks.

Learn more about preventing chronic migraine.


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