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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This paper describes current non-antibody pharmacologic approaches to the prevention of migraine in adults. Preventive therapy should be considered for patients with migraine who routinely have more than 6 headache days per month or in other special circumstances. Choices for preventive therapy are based on patient preferences about side effects and evidence of efficacy. The evidence level and commonly used doses for selected categories of migraine preventive medication are reviewed, including antiepileptic drugs, antihypertensive drugs, and antidepressants. Propranolol, timolol, topiramate, and divalproex sodium are approved for migraine prevention by the US FDA. OnabotulinumtoxinA is approved for prevention of chronic migraine. Several off-label drugs, especially lisinopril, candesartan, and amitriptyline also have good evidence of benefit. The spectrum of response to preventive therapy varies; in general, complete cessation of headaches is uncommon, although there are "super-responders" to every therapy, as illustrated by patient reports of dramatic responses to treatment. Preventive treatment should be started at a low dose and doses increased slowly until therapeutic benefit is achieved or side effects preclude continued use.
Headache 2018 11
PMID:Pharmacologic Prevention of Migraine: A Narrative Review of the State of the Art in 2018. 3013 71

Migraine is the most common cause of headache during pregnancy. Pregnancy increases risk for many causes of headache, including pathologic vascular processes. Headache associated with neurologic signs or symptoms or that is progressive and refractory to treatment; acute in onset; and severe, postural, or different from typical headaches should be evaluated. Work-up should include cerebral and cerebrovascular imaging and monitoring for hypertension. Acetaminophen is first-line symptomatic treatment during pregnancy, and evidence supports triptans rather than butalbital combination analgesics as second-line treatment. Propranolol is preferred preventive treatment, and amitriptyline and verapamil may be considered. Treatment of migraine during lactation is less restrictive than during pregnancy.
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PMID:Headache in Pregnancy and the Puerperium. 3047 Feb 74


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