Migraine headaches are a common and disruptive disorder – one that often leads people to hole up in a dark room until the migraine passes. But despite the prevalence and impairment caused by migraines, many patients are not currently on preventative therapy.
A recent article from Cleveland Clinic researchers details current guidelines for preventing migraines, including how to approach preventive treatment, who needs such treatment and a range of therapy and medication methods.
Authors Emad N. Estemalik, MD, and Stewart Tepper, MD, of the Neurological Center for Pain at the Cleveland Clinic, looked at information provided by a variety of organizations, including the 2000 US Headache Consortium, the Migraine Prevalence and Prevention Study and 2012 Canadian Headache Society guidelines.
According to the authors, 18 percent of women and 6 percent of men experience migraine headaches. However, they reported that only 3 to 13 percent are on some sort of preventive therapy, and another 38 percent need a preventive agent.
Drs. Estemalik and Tepper noted that migraines are no minor problem, writing, “Annual health care utilization may exceed one billion dollars for migraine patients while loss of productivity for employers may reach billions of dollars.”
The review suggested that prevention should be started in patients who have at least six headache days a month, at least three of which involve severe impairment or bed rest. Preventive therapy should also be considered in those with two migraine days involving severe impairment per month.
Doctors are advised to follow several steps, including starting with a low dose, allowing each medication a trial time of at least two months, avoiding medications that may interfere with other prescriptions, involving the patient and their preferences in the process and following up to reevaluate the treatment.
“The challenge among physicians is not only when to start a daily preventive agent but which preventive agent to choose,” the authors wrote.
The authors reported that a variety of medications can be used to treat migraines, including anti-epileptic drugs, beta and calcium channel blockers, antidepressants, supplements, herbs and vitamins. The review detailed the effectiveness of various medications as shown in studies of different types.
The authors noted that medicinal treatment is not the only option for preventive therapy, but that other approaches like cognitive behavioral therapy, relaxation techniques and biofeedback can be helpful.
“When deciding on preventive treatment, a care provider should keep in mind the frequency, severity, and disability of migraines,” the authors concluded. “The selection of a drug should be based upon level of evidence for efficacy, adverse effect profile, and patient comorbidities in order to treat multiple disorders at the time to improve adherence.”
The authors also recommended patients keep headache diaries to help them and their doctors track progress and success of treatment in detail.
The study was published in the journal Neuropsychiatric Disease and Treatment on May 16.
Dr. Tepper receives research grants from various pharmaceutical companies, and he has served as a consultant, speaker and advisory board member for several pharmaceutical companies.