Sandbox/m02

Classification, Dosage, and Side-Effects of Migraine Preventive Therapies.

Evidence	Agent	Dosage	Potential Side-Effects
Level A Medications with established efficacy (>2 Class I trials)	Antiepileptic Drugs
	▸ Divalproex sodium	250 mg twice daily	Drowsiness, weight gain, tremor, hair loss, fetal abnormalities, hematological or liver abnormalities
	▸ Sodium valproate	400–600 mg twice daily	Drowsiness, weight gain, tremor, hair loss, fetal abnormalities, hematological or liver abnormalities
	▸ Topiramate	50–200 mg daily	Paresthesia, cognitive dysfunction, weight loss, care with a family history of glaucoma, nephrolithiasis
	Beta Blockers
	▸ Metoprolol	25–100 mg twice daily	Reduced energy, tiredness, postural symptoms; contraindicated in asthma
	▸ Propranolol	40–120 mg twice daily	Paresthesias, sleepiness, gastrointestinal intolerance
	▸ Timolol	10 mg twice daily	Reduced energy, tiredness, postural symptoms; contraindicated in asthma
	Triptans (short-term prophylaxis of menstrually-related migraine)
	▸ Frovatriptan	2.5 mg twice daily	Coronary artery vasospasm, transient myocardial ischemia, myocardial infarction, arrhythmia
Level B Medications are probably effective (1 Class I or 2 Class II studies)	Antidepressants/SSRI/SSNRI/TCA
	▸ Amitriptyline	25–75 mg every night	Nausea, vomiting, drowsiness, hypersomnolence, dry mouth, concentration difficulties
	▸ Venlafaxine	75–150 mg daily	Nausea, vomiting, drowsiness
	Beta Blockers
	▸ Atenolol	50 mg daily	Reduced energy, tiredness, postural symptoms; contraindicated in asthma
	▸ Nadolol	80–240 mg daily	Reduced energy, tiredness, postural symptoms; contraindicated in asthma
	Triptans (short-term prophylaxis of menstrually-related migraine)
	▸ Naratriptan	1 mg twice daily	Dizziness, chest pain, malaise
	▸ Zolmitriptan	2.5 mg twice daily	Asthenia, headache, dizziness, nausea
Level C Medications are possibly effective (1 Class II study)	ACE Inhibitors
	▸ Lisinopril	20 mg daily	Cough, dizziness
	Angiotensin Receptor Blockers
	▸ Candesartan	16 mg daily	Birth defects and fetal death
	Alpha Agonists
	▸ Guanfacine	1 mg daily	Dizziness, drowsiness, headache, constipation, diarrhea, loss of appetite, fatigue, nasal congestion
	Antiepileptic Drugs
	▸ Carbamazepine	200 mg daily	Drowsiness, motor coordination impairment, upset stomach
	Beta Blockers
	▸ Nebivolol	5 mg daily	Fatigue, clinical depression, bradycardia, impotence
	Antihistamines
	▸ Cyproheptadine	4 mg twice daily	Increased appetite, weight gain, abdominal discomfort, diarrhea, nausea, vomiting, xerostomia, depression, somnolence
	Calcium Channel Blockers
	▸ Nicardipine	20 mg twice daily	Headache, upset stomach, dizziness, fatigue, numbness, palpitations, constipation, heartburn